合肥市维持性血液透析患者不宁腿综合征流行病学调查

发布时间：2018-01-12 09:25

本文关键词：合肥市维持性血液透析患者不宁腿综合征流行病学调查　出处：《安徽医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的调查合肥市维持性血液透析患者不宁腿综合征(restless legs syndrome,RLS)患病率及RLS相关危险因素;评估RLS对维持性血液透析患者生活质量、睡眠质量、抑郁及焦虑的影响。方法调查2013.12.1至2014.03.31在安徽医科大学第二附属医院、合肥市第一人民医院、安徽省第二人民医院、合肥市第五人民医院、武警安徽省总队医院血液净化中心行血液透析的透析龄3个月或以上的成年患者;排除不愿意参与该调查、不能够提供知情同意、不能进行正常交流、急性感染期、合并其他器官严重功能衰竭、帕金森病、痴呆症、妊娠、昏迷、肿瘤患者。对符合条件的所有患者行面对面问卷调查,调查内容包括一般人口学特点如性别、年龄,临床资料如慢性肾衰竭原发病、透析龄、透析方式、RLS家族史,RLS诊断问卷、Zung抑郁自评量表(Self-Rating Depression Scale,SDS)、Zung焦虑自评量表(Self-Rating Anxiety Scale,SAS)、匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)调查表、肾脏病和生活质量问卷(kidney disease and quality of life,KDQOLTM-36),同时收集患者调查期间血液透析前临床实验室检查数据。根据患者是否诊断为RLS将患者分为RLS+组和RLS-组,比较两组患者之间一般人口学特征、临床特点、实验室检查指标等有无差异;以是否诊断为RLS为结果变量,上述人口学特征、临床特点、实验室检查指标为自变量,建立logistic多因素回归模型,寻找血液透析患者合并RLS相关危险因素;比较RLS+组患者和RLS-组患者生活质量、睡眠质量、抑郁评分、焦虑评分的差异,了解RLS对血液透析患者的影响。结果1.符合条件人数269人,男性188人,女性81人,平均年龄51.8±14.3岁,中位透析龄33(12.5,69.0)月;2.诊断RLS 39人,RLS患病率为14.50%;根据单因素分析,RLS+组患者血红蛋白浓度明显低于RLS-组(98.67±13.50 VS 106.34±17.75g/l,P=0.011),碱性磷酸酶浓度明显高于RLS-组(131.0(98.0,226.0)VS 94.0(69.8,157.5)u/l,P=0.001),两组患者在性别、年龄、透析类型、透析龄、血钙、磷、肌酐、尿素氮、铁蛋白、转铁蛋白饱和度、全段甲状旁腺激素、是否合并糖尿病、是否合并高血压等方面差异均无统计学意义;根据Logistic回归分析,高血红蛋白浓度为RLS患病保护因素(OR:0.975,95%CI(0.956-0.995),P=0.015),高碱性磷酸酶浓度为RLS患病危险因素(OR:1.003,95%CI(1.001-1.005),P=0.018);3.睡眠质量方面,RLS+患者PSQI总分(11.86±4.72 VS 7.90±4.39,P0.001)、主观睡眠质量(1.89±0.81VS 1.12±0.86,P0.001)、睡眠潜伏期(2.00±1.03VS 1.49±1.07,P0.007,)、睡眠持续时间(1.59±1.17 VS 0.90±1.01 P0.001)、习惯睡眠效率(1.89±1.29 VS 1.14±1.26,P=0.001)、睡眠干扰(2.50±0.51 VS 2.06±0.51,P0.001)、日间功能(1.62±0.95 VS 1.17±1.09,P=0.019)方面评分均明显高于RLS-组患者;生活质量方面,RLS+组在总体健康评分(32.64±16.71 VS 40.78±19.58,P=0.019)、社会情感评分(38.89±44.90 VS 58.99±44.62,P=0.013)、精力体力评分(37.78±26.09 VS 49.35±27.25,P=0.019)、症状影响评分(69.51±19.74VS82.17±15.06,P0.001)方面明显低于RLS-组患者;RLS+患者抑郁自评分(45.28±10.35 VS 40.07±10.10,P=0.005)、焦虑自评分(37.61±8.75 VS 34.28±6.10,P=0.034)均明显高于RLS-组患者。结论合肥市维持性血液透析患者RLS患病率为14.5%,高血红蛋白浓度为RLS保护因素,高碱性磷酸酶浓度为RLS危险因素;不宁腿综合征对血液透析患者睡眠质量多个方面及生活质量多个方面影响严重,且导致患者抑郁及焦虑程度重于非不宁腿综合征患者。
[Abstract]:Objective to investigate Hefei hemodialysis patients with restless legs syndrome (restless legs syndrome, RLS RLS) prevalence and related risk factors; evaluation of RLS to maintain the quality of life in patients with hemodialysis affect sleep quality, depression and anxiety. Methods 2013.12.1 to 2014.03.31 in the Second Affiliated Hospital of Medical University Of Anhui, the first people's Hospital of Hefei City, Second People's Hospital of Anhui Province, the Fifth People's Hospital of Hefei City, the Armed Police Corps in Anhui province hospital blood purification center for hemodialysis at the age of 3 months or more adult patients; exclude the willingness to participate in the investigation, not to be able to provide informed consent, not the normal communication, acute infection period, combined with the other organ function seriously failure, Parkinson's disease, Alzheimer's disease, pregnancy, coma, cancer patients. All patients underwent investigation to meet the conditions of the face-to-face questionnaire, the survey includes general people Demographic characteristics such as gender, age, clinical data such as chronic renal failure of primary disease, dialysis, dialysis, RLS family history, RLS diagnostic questionnaire, Zung self rating Depression Scale (Self-Rating Depression Scale, SDS), Zung self rating Anxiety Scale (Self-Rating Anxiety Scale, SAS), Pittsburgh (sleep quality index Pittsburgh Sleep Quality Index, PSQI) questionnaire, kidney disease and quality of life questionnaire (kidney disease and quality of life, KDQOLTM-36), were collected during the investigation before hemodialysis clinical laboratory data. According to whether patients diagnosed as RLS were divided into RLS+ group and RLS- group. The clinical features of general demographic characteristics, comparison there is no difference between the two groups of patients, laboratory indicators; as to whether RLS was diagnosed as outcome variables, the demographic characteristics, clinical features, laboratory examination indexes as the independent variables, multiple factors to establish logistic To find the relative risk model of hemodialysis patients with RLS factors; comparison of patients in group RLS+ and group RLS- patients' quality of life, sleep quality, depression score, anxiety score differences, understand the effect of RLS on hemodialysis patients. Results 1. of the eligible population 269 people, 188 male, 81 female, the average age of 51.8. At the age of 14.3, median age 33 months of dialysis (12.5,69.0); 2. diagnosis of RLS 39, the prevalence rate of RLS was 14.50%; according to univariate analysis, patients in group RLS+ hemoglobin concentration was significantly lower than in group RLS- (98.67 + 13.50 VS 106.34 + 17.75g/l, P=0.011), the concentration of alkaline phosphatase was significantly higher than that of group RLS- (131 (98.0226.0) VS 94 (69.8157.5) u/l, P=0.001), the two groups in gender, age, dialysis, dialysis, serum calcium, phosphorus, creatinine, urea nitrogen, ferritin, transferrin saturation, parathyroid hormone, diabetes mellitus, hypertension etc. There were no significant differences; according to Logistic regression analysis, the high hemoglobin concentration is RLS in protective factor (OR:0.975,95%CI (0.956-0.995), P=0.015), high concentration of alkaline phosphatase was RLS risk factors (OR:1.003,95%CI (1.001-1.005), P=0.018); 3. patients with RLS+ sleep quality, the total score of PSQI (11.86 + 4.72 VS 7.90 + 4.39. P0.001), subjective sleep quality (1.89 + 1.12 + 0.86 0.81VS, P0.001), sleep latency (2 + 1.49 + 1.07 1.03VS, P0.007), sleep duration (1.59 + 1.17 VS 0.90 + 1.01 P0.001), habitual sleep efficiency (1.89 + 1.29 VS 1.14 + 1.26, P=0.001 (2.50), sleep disturbance 2.06 + 0.51 VS + 0.51, P0.001), daytime function (1.62 + 0.95 VS 1.17 + 1.09, P=0.019) score were significantly higher than that in RLS- group; RLS+ group in terms of quality of life, general health score (32.64 + 16.71 VS 40.78 + 19.58, P=0.019), social emotional score (38.89 58.99 + 44.90 VS + 44.62, P=0.013), physical energy score (37.78 + 26.09 VS 49.35 + 27.25, P=0.019), the symptoms affect the score (69.51 + 19.74VS82.17 + 15.06, P0.001) was significantly lower than group RLS- patients; depression in patients with RLS+ score (45.28 + 10.35 VS 40.07 + 10.10, P=0.005), self rating Anxiety Scale (37.61 + 8.75 VS 34.28 + 6.10, P=0.034) were significantly higher than those in group RLS- patients. Conclusion Hefei hemodialysis patients RLS prevalence rate was 14.5%, the high hemoglobin concentration is RLS protective factors, high concentration of alkaline phosphatase were risk factors for RLS; restless legs syndrome effects on many aspects of quality the quality of life of sleep in hemodialysis patients is serious, and the cause of depression and anxiety in patients with restless legs syndrome.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.5;R741

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