中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (04): 184-188.doi: 10.3969/j.issn.1671-4091.2013.04.00

• 临床研究 • 上一篇    下一篇

糖尿病肾病腹膜透析患者生存质量的队列研究及相关因素分析

田娜,马小琴,张红霞,陈孟华   

  1. 宁夏医科大学总医院肾脏内科
  • 收稿日期:2012-07-23 修回日期:2013-01-04 出版日期:2013-04-12 发布日期:2013-07-01
  • 通讯作者: 陈孟华nxchenmh@163.com E-mail:nxchenmh@163.com

Cohort study of quality of life and its influence factors in diabetes nephropathy patients on peritoneal dialysis

  • Received:2012-07-23 Revised:2013-01-04 Online:2013-04-12 Published:2013-07-01

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摘要： [摘要] 目的：采用历史前瞻队列研究方法，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及相关影响因素。方法：对2005年1月-2012年3月期间我院腹透中心收治的慢性肾衰竭、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、KT/V及腹膜炎次数进行检测和记录，并定期评估患者的生活质量。结果：（1）与非糖尿病组患者相比，糖尿病患者的透析龄明显短（30.34±27.03 vs 38.52±22.14，Ｐ＜0.01），进入透析时的血清肌酐较低（631.06±215.22 vs 785.25±278.12），故eGFR水平较高（11.26±3.67 vs 8.88±4.01，Ｐ＜0.05），而血清白蛋白的水平较低（28.09±4.61 vs 32.41±5.17，Ｐ＜0.05）；（2）在透析后的1-3年：与非糖尿病组相比，糖尿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组，此差异在透析后2-3年更为显著（Ｐ＜0.01）；（3）透析后1-3年，两组患者生活质量变化趋势的比较：非糖尿病组患者在透析的1年后生活质量呈上升趋势，2年后下降，而糖尿病组患者的生活质量呈持续下降趋势；（4）不同透析操作者对生活质量的影响：分析透析后1年的数据，两组患者中，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）；（5）Charlson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）；腹膜炎与生活质量呈负相关，发生次数越多，生活质量越低（r=-0.481，P =0.002）；尿蛋白定量与生活质量呈明显负相关，尿蛋白量越多，生活质量越低（r=-0.532， P =0.000）。结论：（1）糖尿病肾病腹膜透析患者的生活质量明显低于非糖尿病患者；（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）操作者的不同、并发症的多少、腹膜炎的次数及尿蛋白定量均对糖尿病肾病患者的生活质量产生重要影响。

关键词: 腹膜透析, 糖尿病肾病, 生存质量

Abstract: [Abstract] Objective: Using historical prospective cohort study method, to evaluate the quality of life(QOL) of peritoneal dialysis (PD) patients, and compare the difference of in QOL between diabetes and non-diabetes patients, as well as analysis the factors impacting on QOL of diabetes peritoneal dialysis patients. Methods: 238 patients on maintenance peritoneal dialysis in our center were included from January 2005 to March 2012. General information、chemical test、complication、residual renal function and peritonitis of 118 diabetes and 120 non-diabetes patients were evaluated . QOL and endpoints events were also followed-up. Results: (1) In contracting with non-diabetes patients, the diabetes patients had shorter dialysis age（30.34±27.03 vs 38.52±22.14，Ｐ＜0.01）、higher eGFR （11.26±3.67 vs 8.88±4.01，Ｐ＜0.01）and lower serum albumin level（28.09±4.61 vs 32.41±5.17，Ｐ＜0.05）; (2) During one to three years of dialysis, SF-36 and the most QOL scales were much lower in diabetes patients than in non-diabetes patients. And the difference was more significant in two to three years after dialysis; (3) Qol of non-diabetes patients was improved in the first dialysis year and declinded in the following two years, while that of diabetes patients consisted declining in three years; (4) Different PD operators had influence on QOL of patients. In two groups, QOL of patients who operated by themselves were highest while by family members were lower and by housemaids were lowest（Ｐ＜0.01）; (5) Charlson complication index（r=-0.752，P =0.000）、peritonitis （r=-0.481，P =0.002）and the quantity of urine protein（r=-0.532， P =0.000） were all negtively related with QOL. Conclusion: (1) QOL of diabetes patients were much lower than that of non-diabetes patients;(2)There were differences of QOL changing trend between diabetes patients and non- diabetes patients;(3) QOL of diabetes patients were influenced by many factors such as operators、complications、peritonitis and urine protein.

Key words: Peritoneal Dialysis, diabetes nephropathy, quality of life