中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (10): 719-723.doi: 10.3969/j.issn.1671-4091.2022.10.004

• 临床研究 • 上一篇    下一篇

腹膜透析患者营养状态的动态变化与瘙痒及睡眠障碍的关系

王晓培   吕 晶   梁嫦娜   李 昭   路万虹   

  1. 710061 西安，西安交通大学第一附属医院肾脏病医院肾内科
  • 收稿日期:2022-04-19 修回日期:2022-07-14 出版日期:2022-10-12 发布日期:2022-10-12
  • 通讯作者: 吕晶 E-mail:drlvjing@163.com
  • 基金资助:
    陕西省自然科学基础研究计划项目(2022JM-598)；陕西省重点研发计划(2019KW-040)

The relationship between the dynamic changes of nutritional status and the symptoms of pruritus and sleep disturbance in peritoneal dialysis patients 

WANG Xiao-pei, LV Jing, LIANG Chang-na, LI Zhao, LU Wan-hong   

  1. Department of Nephrology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
  • Received:2022-04-19 Revised:2022-07-14 Online:2022-10-12 Published:2022-10-12
  • Contact: 710061 西安，1西安交通大学第一附属医院肾脏病医院肾内科 E-mail:drlvjing@163.com

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摘要： 目的  探讨腹膜透析(peritoneal dialysis,PD)患者营养状况变化与睡眠障碍及瘙痒的关系。 方法  使用匹兹堡睡眠质量指数(pittsburgh sleep quality index，PSQI)问卷及中文版四项目瘙痒问卷(four-item itch questionnaire,FIIQ)对西安交通大学第一附属医院肾脏内科腹膜透析中心规律随访超过3个月的PD患者进行睡眠质量及瘙痒评分，收集患者临床资料、透析充分性，透析前白蛋白(ALB0)和研究时白蛋白(ALB1)及其他生化指标。根据白蛋白水平变化，将所有患者分为A组：白蛋白正常组(ALB0，ALB1均≥35g/L)，B组：白蛋白升高组(ALB0＜35g/L，ALB1≥35g/L)，C组：持续低白蛋白组(ALB0，ALB1均＜35g/L),D组：白蛋白降低组(ALB0≥35g/L，ALB1＜35g/L),分析血清白蛋白变化对睡眠及瘙痒的影响。 结果  ①共调查166人，其中A组63人，B组47人，C组38人，D组18人。4组年龄(F =8.490，  P ＜0.001)，透析龄(F =2.266，P =0.043)，C反应蛋白(F =4.051，P =0.025)，糖尿病比例(χ2=28.160，  P ＜0.001)比较差异有统计学意义。②PSQI睡眠评分D组高于A组(H =9.037，P =0.022)及B组(H =6.806，P =0.033)，C组高于A组(H =3.269，P =0.049)及B组(H=3.503，P =0.045)，与D组比较无统计学差异(H =23.458，P =0.459)。FIIQ瘙痒评分D组高于A组(P =0.001)，B组(P =0.003),C组(P =0.006)。睡眠障碍发生率，D组为55.6%,高于其他3组(与其他3组比较，均P ＜0.05)；瘙痒发生率D组为64.7%，高于其他3组(与其他3组两两比较，均P ＜0.05)。③Logistics回归示：透析后白蛋白降低是瘙痒(OR=3.886，95% CI：1.132～13.333,P =0.031)、睡眠障碍(OR =4.682,95% CI：1.466～14.958，P =0.009)的独立危险因素。 结论  ①糖尿病、老年、透析龄长、微炎症状态的PD患者，更容易出现营养不良及营养状态恶化。②PD患者营养恶化使睡眠障碍及瘙痒风险增加。

关键词: 腹膜透析, 营养状态, 瘙痒, 睡眠障碍

Abstract: Objective  To investigate the influence of serum albumin changes on sleep quality and uremic pruritus in peritoneal dialysis (PD) patients.   Methods   Pittsburgh Sleep Quality Index (PSQI) and Four-Item Itch Questionnaire (FIIQ) were used to assess sleep quality and pruritus in the 166 PD patients regularly followed up in our PD center. Their clinical data and laboratory results were recruited. According to the changes of serum albumin level before PD (ALB0) and after PD (ALB1), the PD patients were divided into four groups: group A, normal albumin group (both ALB0 and ALB1 ≥35g/L); group B, elevated albumin group (ALB0＜35g/L, and ALB1≥35g/L); group C, persistent low protein group (both ALB0 and ALB1＜35g/L); group D, decreased albumin group (ALB0≥35g/L, and ALB1＜35g/L). Sleep disturbance, itching and other clinical parameters were compared among the groups.   Results   ①There were 63 patients in group A, 47 in group B, 38 in group C, and 18 in group D. Age (F=8.490, P＜0.001), dialysis duration (F=2.266, P=0.043), CRP (F=4.051, P=0.025) and the incidence of diabetes (χ²=28.160, P＜0.001) were significantly different among the four groups. ②The mean PSQI sleep score in group D was higher than that in group A (H=9.037, P=0.022) and group B (H=6.806, P=0.033); the mean PSQI sleep score in group C was higher than that in group A (H=3.269, P=0.049) and group B (H=3.503, P=0.045); the mean PSQI sleep score had no difference between group D and group C (H=23.458, P=0.459). The pruritus score in group D was significantly higher than that in groups A, B and C (P=0.001, 0.003 and 0.006 respectively). The incidence of sleep disorder in group D was 55.6%, significantly higher than that in groups A, B and C (P ＜0.05). The incidence of pruritus in group D was 64.7%, also significantly higher than that in groups A, B and C (P＜0.05). ③Logistic regression showed that decreased serum albumin after PD was an independent risk factor for pruritus (OR=3.886, 95% CI :1.132～13.333, P=0.031) and sleep disorder (OR=4.682, 95% CI 1.466～14.958, P=0.009).  Conclusion  ①PD patients with diabetes, older age, longer dialysis duration and micro-inflammatory state are prone to suffer from malnutrition or to negatively affect the nutritional status. ②Deterioration of nutritional status leads to the risk of sleep disorders and pruritus in PD patients.

Key words: Peritoneal dialysis, Nutritional status, Pruritus, Sleep disorder

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