摘要
目的采用历史队列研究方法,通过分析本中心糖尿病肾病腹膜透析患者生存质量的数据,探讨该人群的生存质量的变化及相关影响因素。方法对2005年1月～2012年3月期间宁夏医科大学总医院腹膜透析中心进行规律腹膜透析治疗的患者共238例,其中糖尿病肾病患者118例,非糖尿病肾病患者120例作为对照组,对患者的一般资料、血液、尿液的生化、并发症情况、残余肾功能、透析充分性评估进行检测和记录,并定期评估患者的生活质量。结果①与非糖尿病肾病组患者相比,糖尿病肾病患者的透析龄明显短[(30.34±27.03)比(38.52±22.14),P<0.01],进入透析时的血清肌酐较低[(631.06±215.22)比(785.25±278.12)],故eGFR水平较高[(11.26±3.67)比(8.88±4.01),P<0.05];尿蛋白浓度明显高于N-DN组[(1.16±0.85)比(0.84±0.67),P=0.001]而血清白蛋白的水平较低(28.09±4.61)比(32.41±5.17),P<0.05);②在基线水平及透析后的1～3年:与非糖尿病肾病组相比,糖尿病肾病组的总体生活质量SF-36及绝大部分维度均低于非糖尿病肾病组,此差异在透析后2～3年更为显著(P<0.01);③2组患者中,由本人操作者生活质量最高,家属操作者次之,保姆操作者生活质量最低(P<0.05);④Charlson并发症指数与SF-36呈显著负相关,并发症越多,生存质量越低下(r=-0.752,P=0.000);尿蛋白浓度与生活质量呈明显负相关,尿蛋白浓度越高,生活质量越低(r=-0.532,P=0.000)。⑤透析后1～3年,非糖尿病肾病组患者在透析的1～2年生活质量呈持续上升趋势,第3年开始下降,而糖尿病肾病组患者的生活质量在透析后1年明显改善并达到平台,第3年开始明显下降。结论①糖尿病肾病腹膜透析患者的生活质量在开始透析时及透析后1～3年均明显低于非糖尿病肾病患者;②在腹膜透析后糖尿病与非糖尿病患者的生活质量变化趋势有所不同;③透析由他人操作者、透析时并发症多者及尿蛋白浓度高者均使糖尿病肾病患者的生活质量下降。
Objective Using historical cohort study method, we aimed to evaluate the quality of life （QOL） in peritoneal dialysis （PD） patients, to compare the difference of QOL between diabetes nephropathy on PD patients （DN） and non-diabetes nephropathy on PD patients （N-DN）, and to analyze the factors affecting QOL in DN patients. Methods A total of 238 patients （118 DN and 120 N-DN patients） on maintenance PD treated in our center from January 2005 to March 2012 were included. Their baseline characteristics, general information, results of biochemistry tests, complications, residual renal function and urinary protein were evaluated. QOL （by SF-36 and the 8 scales） and endpoints events were followed up. Results （1） Comparing to N-DN patients, DN patients had shorter dialysis age （30.34 ＋ 27.03 vs. 38.52 4- 22.14, P 〈 0.01）, higher eGFR （11.26 ＋ 3.67 vs. 8.88 ＋ 4.01, P 〈 0.01）, higher urinary protein concentration （1.16 ＋ 0.85 vs. 0.84 ＋ 0.67, P =0.001）, and lower serum albumin level （28.09 ＋ 4.61 vs. 32.41 ＋ 5.17, P 〈 0.05）; （2） During the first one to three years of PD, SF-36 and most QOL scales were much lower in DN patients than in N-DN patients, and the differences became more significant in the two to three years of PD; （3） PD operator influenced patient＇s QOL in both groups; QOL was higher in patients whose PD were operated by themselves, was lower in those by family members, and was lowest in those by housemaids （P 〈 0.01）; （4） QOL was negatively correlated with Charlson complication index （r =-0.752, P =0.00） and quantity of urinary protein （r=-0.532, P =0.00）; （5） In DN patients, QOL was improved in the first dialysis year, reached to a platform, and then declined in the following two years; while in N-DN patients, QOL improved continuously in the first two years of PD, and declined from the third year. Conclusions （1） QOL was lower in DN than in N-DN patients; （3） he trend of QOL change was different between DN and N-DN patients; （2） In DN patients, QOL was lower in those with PD operation by others, more complications and higher amount of proteinuria.
出处
《中国血液净化》
2013年第4期184-188,共5页
Chinese Journal of Blood Purification
关键词
腹膜透析
糖尿病肾病
生活质量
Peritoneal dialysis
Diabetes nephropathy
Quality of life
