透析充分性、微炎症、营养状态对血液透析患者生存质量及长期生存率的影响

目的:探讨透析充分性、微炎症、营养状态对血液透析患者生存质量及长期生存率的影响。方法:随机选择我院血液透析中心维持透析每周3次,治疗6月以上的患者89例,观察并评估其入组时、入组后第3、6、12、18、24月的生存质量(KDTA、SF-36)、营养状况(MQSGA、MAMC)、微炎症(hCRP、IL-6)及透析充分性(iPTH、Kt/V、β2-MG),并分析透析充分性、营养状况、微炎症与生存质量、生存率的相关性。结果:89例患者有9例死亡,死亡率为10.1%;iPHT、MQSGA与KDTA、SF-36呈负相关(P0.05),Kt/V与KDTA、SF-36呈正相关(P0.05),β2-MG、胆固醇与KDTA、SF-36无明显相关(P0.05);hCRP、IL-6分别与KDTA、SF-36呈负相关(P0.05);HGS与KDTA呈正相关(P0.05),与SF-36无明显相关(P0.05),ALB、MAMC与KDTA、SF-36呈正相关(P0.05);Kt/V、MQSGA、IL-6、iPTH均与KDAT及SF-36存回归关系(P0.05);Cox回归模型发现Kt/V、ALB及开始透析年龄是导致血透患者死亡的危险因素(P0.05)。结论:透析充分性、微炎症及营养状况均影响透析患者的生存质量及长期生存率;iPTH、Kt/V、MQSGA、IL-6是其生存质量的独立影响因素,Kt/V、ALB及开始透析年龄是血透患者的死亡独立危险因素。

The Effect of Dialysis Adequacy, Microinflammation and Nutritional Status on the Quality of Life and Survival Rate in Maintenance Hemodialysis Patients

Objective:To study the effect of dialysis adequacy, microinflammation and nutritional status on the quality of life (Qol) and survival rate in maintenance hemodialysis patients.Methods:This was a prospective study on 89 cases of long-term hemodialysis patients. The Qol(KDTA, SF-36), survival rate, nutritional status(MQSGA, MAMC), microinflammation (hCRP, IL-6) and dialysis adequacy (iPTH, Kt/V,beta2-MG) were evaluated at beginning, the 3th, 6th , 12th, 18th and 24th month, and then calculated the means and analyzed the correlation of dialysis adequacy, microinflammation and nutritional status with Qol and survival rate.Results:9 cases out of 89 died, mortality was 10.1 %; There was negative correlation between iPTH and KDTA, SF-36, while the correlation of Kt/V with KDTA and SF-36 was positive; There was no correlation of beta2-MG with KDTA and SF-36; there were negative correlation of hCRP and IL-6 with KDTA and SF-36; There were negative correlation of MQSGA with KDTA and SF-36, and HGS had positive correlation with KDTA respectively, while no correltion with SF-36; ALB and MAMC had positive correlation with KDTA and SF-36, while there was no correlation of cholesterol with KDTA and SF-36; Kt/V, MQSGA, IL-6, iPTH had regressive association to KDTA and SF-36; The Cox regression analysis revealed that Kt/V, ALB and beginning dialysis age were significant determinants of mortality in long-term hemodialysis patients.Conclusion:The dialysis adequacy, microinflammation and nutritional status had effect on KDTA and SF-36; Kt/V, MQSGA, IL-6, iPTH were the independent factors of KDTA and SF-36; Kt/V, ALB and beginning dialysis age were the death risk factors of hemodialysis patients.