肌少症对维持性血液透析患者生活质量影响的研究

发布时间：2018-09-10 16:22

【摘要】：[目的]研究肌少症对维持性血液透析(Maintenance Hemodialysis,MHD)患者生活质量的影响。[方法]选取2015年6月至2016年12月在昆明医科大学第一附属医院及云南肾脏病医院规律血液透析3个月以上且病情稳定的60例非住院MHD患者作为研究对象,为每个研究对象建立临床个案表(包括患者性别、身高、年龄、透析龄、原发病、相关实验室资料)并编号。生物电阻抗法(Bioelectrical Impedance Analysis,BIA)测定患者肌肉质量(Skeletal Muscle Mass,SMM),并计算骨骼肌质量指数(Skeletal Muscle Index,SMI),SMI=SMM/身高2,握力计测定患者握力并评估肌肉力量,日常步速评估法(UsualGaitspeed,UGS)评估患者肌肉功能。依照欧洲老年肌少症工作组(European Working Group on Sarcopenia in Older People,EWGSOP)制订的诊断标准,根据 SMI、握力及 UGS结果将入组患者分为无肌少症组、肌少症前期组、肌少症期组以及重度肌少症期组四组,比较四组患者的基本资料,探讨MHD患者肌少症的危险因素,用SF-36量表测评肌少症对MHD患者生活质量的影响。[结果]1.一般资料:入组的60例MHD患者中,男性31例(51.7%),女29例(48.3%),平均年龄48.48±14.36岁,平均透析龄60(26～78)月,原发病:慢性肾炎33例(55.0%),高血压肾病10例(16.7%),糖尿病肾病6例(10.0%),多囊肾2例(3.3%),梗阻性肾病2例(3.3%),间质性肾炎2例(3.3%),不详 5 例(8.3%)。2.肌少症的分布情况:按照EWGSOP制订的诊断标准,60例入组MHD患者中,无肌少症者34例(56.7%),肌少症前期者13例(21.7%),肌少症期者9例(15.0%),重度肌少症期者4例(6.7%)。3.四组MHD患者一般资料及实验室资料比较:无肌少症、肌少症前期、肌少症期、重度肌少症期四组各项指标比较后发现:年龄、性别、握力、BMI、ALB、25羟维生素D3、hs-CRP、总胆固醇差异有统计学意义(P0.05),而透析时间、原发病、SMI、步速、KT/V、PA、TP、血钙、血磷、PTH、IL-6、TNF-α、HDL-c、LDL-c、TG无统计学意义(p0.05)。4.根据年龄≤60岁,年龄60岁将患者分为成人组和老年人组2组,结果成人组肌少症的发生率为38.8%(19/49),低于老年人组63.6%(7/11),差异有统计学意义(X2=11.894,P=0.008)。5.将患者按性别分为2组,表现为肌少症发生率男性74.19%(23/31)高于女性 10.34%(3/29),差异有统计学意义(X2=30.209,P=0.000)。6.肌少症危险因素的logistic回归分析:以是否发生肌少症作为因变量,将有意义的因素年龄、性别、握力、BMI、ALB、25羟维生素D3、hs-CRP、总胆固醇等8个变量作为自变量进行logistic回归分析,结果显示:控制相关混杂因素后,高hs-CRP水平是MHD患者肌少症的独立危险因素,差异有统计学意义(OR=8.379,95%CI=1.184～59.315,P0.05)。7.肌少症对MHD患者生活质量的影响:肌少症前期、肌少症期、重度肌少症期三组生活质量在体能(PF)、躯体疼痛(BP)、精力状况(Energy)、生理健康(PH)、总分方面差异有统计学意义(P0.05);进一步组间两两比较后发现,生活质量在体能(PF)、体力所致工作和生活受限(RP)、躯体疼痛(BP)、总体健康(GH)、精力状况(Energy)、情感状况(EWB)、心理健康(MH)、生理健康(PH)、总分方面差异有统计学意义(P0.05);肌少症程度与体能(PF)、躯体疼痛(BP)、总体健康(GH)、精力状况(Energy)、生理健康(PH)、心理健康(MH)、总分呈负相关,差异有统计学意义(P0.05)。[结论]1.MHD患者肌少症发生率为43.3%,老年MHD患者肌少症发生率高于成人,男性MHD患者肌少症发生率高于女性。2.hs-CRP水平越高,即微炎症状态越重,MHD患者越容易发生肌少症。3.肌少症影响MHD患者的生活质量,主要以体能(PF)、体力所致工作和生活受限(RP)、躯体疼痛(BP)、精力状况(Energy)、总体健康(GH)、生理健康(PH)方面为主。
[Abstract]:[Objective] To study the effect of myoliasis on the quality of life in maintenance hemodialysis (MHD) patients. A clinical case list (including patient's sex, height, age, dialysis age, primary disease, laboratory data) was established and numbered. Skeletal Muscle Mass (SMM) was measured by Bioelectrical Impedance Analysis (BIA), and skeletal muscle mass index (SMI) was calculated. M / Height 2, Grip Dynamometer measures grip strength and assesses muscle strength, and Usual Gait Speed (UGS) measures muscle function. [Results] 1. General data: Among 60 MHD patients, 31 were male (51.7%) and 29 were female (48.7%). The average age was 48.48 (+ 14.36) years, with an average dialysis age of 60 (26-78) months. Primary diseases: 33 cases of chronic nephritis (55.0%), 10 cases of hypertensive nephropathy (16.7%), 6 cases of diabetic nephropathy (10.0%), 2 cases of polycystic kidney (3.3%), 2 cases of obstructive nephropathy (3.3%), 2 cases of interstitial nephritis (3.3%) and 5 cases (8.3%) of myoporosis were unknown. Standards: Among the 60 MHD patients, 34 (56.7%) were free of myasthenia, 13 (21.7%) were pre-myasthenia, 9 (15.0%) were oligomyasthenia, and 4 (6.7%) were severe myasthenia. Age, sex, grip strength, BMI, ALB, 25-hydroxyvitamin D3, hs-CRP, total cholesterol were significantly different (P 0.05), but dialysis time, primary disease, SMI, walking speed, KT/V, PA, TP, serum calcium, phosphorus, PTH, IL-6, TNF-a, HDL-c, LDL-c, TG were not statistically significant (P 0.05). 4. According to age < 60 years old, patients were divided into two groups: adult group and elderly group. The incidence of myasthenia was 38.8% (19/49) in adults, which was lower than 63.6% (7/11) in the elderly group. The difference was statistically significant (X2 = 11.894, P = 0.008). 5. Patients were divided into two groups according to gender. The incidence of myasthenia was 74.19% (23/31) in males and 10.34% (3/29) in females. The difference was statistically significant (X2 = 30.209, P = 0.000). IC Regression Analysis: Using age, sex, grip strength, BMI, ALB, 25-hydroxyvitamin D3, hs-CRP and total cholesterol as independent variables, logistic regression analysis showed that high hs-CRP level was an independent risk factor for myasthenia in MHD patients after controlling for related confounding factors. The difference was statistically significant (OR = 8.379, 95% CI = 1.184-59.315, P 0.05). 7. The effect of myolithiasis on the quality of life of MHD patients: pre-myolithiasis, myolithiasis, severe myolithiasis in physical fitness (PF), body pain (BP), energy status (PH), the total score was statistically significant (P 0.05); The quality of life in physical fitness (PF), physical limitation of work and life (RP), body pain (BP), general health (GH), energy, emotional status (EWB), mental health (MH), physical health (PH), total score were significantly different (P 0.05); the degree of myasthenia and physical fitness (PF), body pain (BP), general health (GH); [Conclusion] 1. The incidence of myolipomyopathy in MHD patients was 43.3%. The incidence of myolipomyopathy in elderly MHD patients was higher than that in adults. The incidence of myolipomyopathy in male MHD patients was higher than that in female. Myolipomyopathy affects the quality of life of MHD patients, mainly physical fitness (PF), physical limitation of work and life (RP), body pain (BP), energy status (energy), general health (GH), physical health (PH).
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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