维持性血液透析患者睡眠质量的影响因素及与氧化应激水平、生活质量和疲乏状况的关系研究

摘要 目的：分析调查维持性血液透析（MHD）患者睡眠质量的影响因素，并分析其与生活质量、氧化应激水平和疲乏状况的关系。方法：研究对象选取自2019年8月~2021年5月在首都医科大学附属北京朝阳医院血液透析室长期规律行MHD治疗的终末期肾脏病患者150例，收集患者的临床资料，采用匹兹堡睡眠指数（PSQI）量表评定睡眠质量。采用修订版Pieper疲劳量表（RPFS）评估所有患者的疲乏程度。采用肾脏病生活质量量表（KDQOL-SF）评估患者生活质量。分析MHD患者睡眠质量的影响因素，并分析其与氧化应激水平、生活质量和疲乏状况的关系。结果：150例MHD患者中有114例PSQI评分>5分，本血液透析室MHD患者睡眠障碍发生率为76.00% (114/150)。根据是否发生睡眠障碍将患者分为睡眠障碍组（n=114）和无睡眠障碍组（n=36）。单因素分析结果显示睡眠障碍组、无睡眠障碍在年龄、透析时间、血红蛋白（Hb）、血清甲状旁腺激素（iPTH）、透析治疗效率标准（Kt/V）、血钙方面组间对比有差异（P<0.05）。透析时间、年龄、Hb、iPTH、Kt/V均是MHD患者睡眠质量的影响因素（P<0.05）。睡眠障碍组的一般健康状况、肾病相关、总分均低于无睡眠障碍组（P<0.05）。睡眠障碍组的疲乏评分高于无睡眠障碍组（P<0.05）。睡眠障碍组的丙二醛（MDA）高于无睡眠障碍组，超氧物歧化酶（SOD）、人谷胱甘肽-过氧化物酶（GSH-Px）低于无睡眠障碍组（P<0.05）。结论：透析时间、年龄、Hb、iPTH、Kt/V均是MHD患者睡眠质量的影响因素，且睡眠质量变差会加重MHD患者疲乏程度，加重氧化应激反应，降低患者的生活质量。

Study on the Influencing Factors of Sleep Quality and its Relationship with Oxidative Stress, Quality of Life and Fatigue in Maintenance Hemodialysis Patients

ABSTRACT Objective: To analyze and investigate the influencing factors of sleep quality in maintenance hemodialysis (MHD) patients, and to analyze its relationship with quality of life, oxidative stress and fatigue. Methods: The study subjects were 150 patients with end-stage renal disease who underwent long-term regular MHD treatment in the Hemodialysis Room of Beijing Chaoyang Hospital Affiliated to Capital Medical University from August 2019 to may 2021 The clinical data of patients were collected, and the sleep quality was evaluated by Pittsburgh sleep index (PSQI). The fatigue degree of all patients was evaluated by the revised Pieper Fatigue Scale (RPFS). Renal disease quality of life scale (KDQOL-SF) was used to evaluate the quality of life of patients. The influencing factors of sleep quality in MHD patients and its relationship with quality of life and fatigue were analyzed. Results: The average PSQI score of 150 MHD patients, of which 114 patients had PSQI score > 5 scores. The incidence of sleep disorder in MHD patients in our hemodialysis center was 76.00% (114/150). The patients were divided into sleep disorder group (n=114) and non-sleep disorder group (n=36) according to whether there was sleep disorder. Univariate analysis showed that there were significant differences in age, dialysis time, hemoglobin (Hb), serum parathyroid hormone (iPTH), dialysis treatment efficiency standard (Kt/V) and blood calcium between sleep disorder group and non-sleep disorder group (P<0.05). Dialysis time, age, Hb, iPTH and Kt/V were the influencing factors of sleep quality in MHD patients (P<0.05). The general health status, nephropathy related and total scores of the sleep disorder group were lower than those of the non-sleep disorder group (P<0.05). The fatigue score of sleep disorder group was higher than that of non-sleep disorder group(P<0.05). Malondialdehyde (MDA) in sleep disorder group was higher than that in non sleep disorder group, and Superoxide dismutase (SOD), human glutathione peroxidase (GSH-Px) were lower than those in non sleep disorder group (P<0.05). Conclusion: Dialysis time, age, Hb, iPTH and Kt/V are the influencing factors of sleep quality in MHD patients, and the deterioration of sleep quality will aggravate the degree of fatigue aggravate oxidative stress response, reduce the quality of life of MHD patients.