维持性血液透析患者合并不宁腿综合征的危险因素分析

目的 探讨维持性血液透析患者合并不宁腿综合征的相关危险因素。方法 回顾性分析2016年7月至2017年9月于海军军医大学（第二军医大学）东方肝胆外科医院诊治的74例维持性血液透析患者的临床资料，按照国际不宁腿综合征研究小组诊断标准进行流行病学调查。对比分析性别、年龄、是否合并糖尿病及各项生化指标与合并不宁腿综合征事件之间的关系。对合并RLS组与不合并RLS组两组间差异进行比较分析，计量资料的比较采用配对t检验，计数资料的比较采用卡方检验。按RLS评分将研究对象分为无症状、轻微、中等、严重、十分严重5组，用配对t检验分别进行两两组间比较。以性别、年龄、是否合并糖尿病及各项生化指标为协变量，以是否合并RLS为因变量，先进行单因素Logistic回归分析，然后对有统计学意义的因素再纳入模型做多因素Logistic回归分析。进一步对主要相关因素检测作图绘制ROC曲线，计算曲线下面积，找出最佳临界点及对应的灵敏度和特异度。采用SPSS 24.0软件进行数据分析。以P＜0.05为有统计学差异。结果 本研究共纳入维持性血液透析患者74例，其中男46例，女28例；年龄为21～87岁，平均年龄(56.70±14.52)岁。合并不宁腿综合征的维持性血液透析患者的血钙（2.56±0.38） mmol/L、血磷(2.22±0.61) mmol/L、血甲状旁腺激素(746.49±799.04) pg/mL均高于不合并不宁腿综合征的患者[（2.26±0.29） mmol/L、（1.84±0.72mmol/L）、（183.10±135.70） pg/mL，P均<0.05）]。Logistic多因素回归分析结果显示，甲状旁腺激素（OR=1.00，95% CI：1.00～1.01，P=0.03）是维持性血液透析患者合并不宁腿综合征的独立危险因素。PTH预测血液透析患者是否合并RLS诊断的ROC评价曲线的曲线下面积为0.759，其95%可信区间为（0.610-0.907），临界点为515，该点的灵敏度为0.47，特异度为0.98。结论 不宁腿综合征是维持性血液透析患者的常见合并症。慢性肾脏病-矿物质及骨代谢紊乱与不宁腿综合征的发生可能有密切关系。

Risk factors of restless leg syndrome in maintenance hemodialysis patients

Objective To investigate the risk factors of restless leg syndrome (RLS) in maintenance hemodialysis patients. Methods The clinical data of 74 maintenance hemodialysis patients in Eastern Hepatobiliary Surgery Hospital of Navy Medical University (Second Military Medical University) from July 2016 to September 2017 were retrospectively analyzed. The gender, age, diabetes mellitus and other biochemical indicators of the patients with or without RLS were compared. The univariate logistic regression analysis was performed with the gender, age, diabetes mellitus and other biochemical indicators as covariates, and the RLS as dependent variable. According to the 2003 International Restless Leg Syndrome Study Group (IRLSSG) criteria, the patients with RLS were divided into mild, moderate, severe and very severe groups, with the patients without RLS as controls; the variables that were significantly different between the groups as analyzed by univariate logistic regression analysis were compared by t-test and multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve for the main relevant factors was plotted, and the area under the curve was calculated to determine the best critical value and the corresponding sensitivity and specificity. Results A total of 74 maintenance hemodialysis patients were enrolled in this study, including 46 males and 28 females; the patients aged from 21 to 87 years, with an average age of (56.70±14.52) years; 55 patients without RLS, and 19 with RLS. The serum calcium in patients with RLS was significantly higher than that without RLS ([2.56±0.38] mmol/L vs[2.26±0.29] mmol/L, t=2.61, P=0.02). Multivariate logistic regression analysis showed that serum parathyroid hormone (PTH)>515.39 pg/mL was an independent risk factor for RLS in maintenance hemodialysis patients (OR=1.00, 95% CI 1.00-1.01, P=0.03). With the cut-off value being 515.39 pg/mL, area under ROC curve performed by PTH for RLS was 0.759, with the 95% CI being 0.610-0.907, and the sensitivity and specificity being 0.47 and 0.98, respectively. Conclusion RLS is a common complication in maintenance hemodialysis patients. Chronic kidney disease-mineral and bone metabolism disorder may be related to the occurrence of RLS in maintenance hemodialysis patients.