【摘要】：[目的]研究肌少癥對(duì)維持性血液透析(Maintenance Hemodialysis,MHD)患者生活質(zhì)量的影響。[方法]選取2015年6月至2016年12月在昆明醫(yī)科大學(xué)第一附屬醫(yī)院及云南腎臟病醫(yī)院規(guī)律血液透析3個(gè)月以上且病情穩(wěn)定的60例非住院MHD患者作為研究對(duì)象,為每個(gè)研究對(duì)象建立臨床個(gè)案表(包括患者性別、身高、年齡、透析齡、原發(fā)病、相關(guān)實(shí)驗(yàn)室資料)并編號(hào)。生物電阻抗法(Bioelectrical Impedance Analysis,BIA)測(cè)定患者肌肉質(zhì)量(Skeletal Muscle Mass,SMM),并計(jì)算骨骼肌質(zhì)量指數(shù)(Skeletal Muscle Index,SMI),SMI=SMM/身高2,握力計(jì)測(cè)定患者握力并評(píng)估肌肉力量,日常步速評(píng)估法(UsualGaitspeed,UGS)評(píng)估患者肌肉功能。依照歐洲老年肌少癥工作組(European Working Group on Sarcopenia in Older People,EWGSOP)制訂的診斷標(biāo)準(zhǔn),根據(jù) SMI、握力及 UGS結(jié)果將入組患者分為無(wú)肌少癥組、肌少癥前期組、肌少癥期組以及重度肌少癥期組四組,比較四組患者的基本資料,探討MHD患者肌少癥的危險(xiǎn)因素,用SF-36量表測(cè)評(píng)肌少癥對(duì)MHD患者生活質(zhì)量的影響。[結(jié)果]1.一般資料:入組的60例MHD患者中,男性31例(51.7%),女29例(48.3%),平均年齡48.48±14.36歲,平均透析齡60(26～78)月,原發(fā)病:慢性腎炎33例(55.0%),高血壓腎病10例(16.7%),糖尿病腎病6例(10.0%),多囊腎2例(3.3%),梗阻性腎病2例(3.3%),間質(zhì)性腎炎2例(3.3%),不詳 5 例(8.3%)。2.肌少癥的分布情況:按照EWGSOP制訂的診斷標(biāo)準(zhǔn),60例入組MHD患者中,無(wú)肌少癥者34例(56.7%),肌少癥前期者13例(21.7%),肌少癥期者9例(15.0%),重度肌少癥期者4例(6.7%)。3.四組MHD患者一般資料及實(shí)驗(yàn)室資料比較:無(wú)肌少癥、肌少癥前期、肌少癥期、重度肌少癥期四組各項(xiàng)指標(biāo)比較后發(fā)現(xiàn):年齡、性別、握力、BMI、ALB、25羥維生素D3、hs-CRP、總膽固醇差異有統(tǒng)計(jì)學(xué)意義(P0.05),而透析時(shí)間、原發(fā)病、SMI、步速、KT/V、PA、TP、血鈣、血磷、PTH、IL-6、TNF-α、HDL-c、LDL-c、TG無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。4.根據(jù)年齡≤60歲,年齡60歲將患者分為成人組和老年人組2組,結(jié)果成人組肌少癥的發(fā)生率為38.8%(19/49),低于老年人組63.6%(7/11),差異有統(tǒng)計(jì)學(xué)意義(X2=11.894,P=0.008)。5.將患者按性別分為2組,表現(xiàn)為肌少癥發(fā)生率男性74.19%(23/31)高于女性 10.34%(3/29),差異有統(tǒng)計(jì)學(xué)意義(X2=30.209,P=0.000)。6.肌少癥危險(xiǎn)因素的logistic回歸分析:以是否發(fā)生肌少癥作為因變量,將有意義的因素年齡、性別、握力、BMI、ALB、25羥維生素D3、hs-CRP、總膽固醇等8個(gè)變量作為自變量進(jìn)行l(wèi)ogistic回歸分析,結(jié)果顯示:控制相關(guān)混雜因素后,高h(yuǎn)s-CRP水平是MHD患者肌少癥的獨(dú)立危險(xiǎn)因素,差異有統(tǒng)計(jì)學(xué)意義(OR=8.379,95%CI=1.184～59.315,P0.05)。7.肌少癥對(duì)MHD患者生活質(zhì)量的影響:肌少癥前期、肌少癥期、重度肌少癥期三組生活質(zhì)量在體能(PF)、軀體疼痛(BP)、精力狀況(Energy)、生理健康(PH)、總分方面差異有統(tǒng)計(jì)學(xué)意義(P0.05);進(jìn)一步組間兩兩比較后發(fā)現(xiàn),生活質(zhì)量在體能(PF)、體力所致工作和生活受限(RP)、軀體疼痛(BP)、總體健康(GH)、精力狀況(Energy)、情感狀況(EWB)、心理健康(MH)、生理健康(PH)、總分方面差異有統(tǒng)計(jì)學(xué)意義(P0.05);肌少癥程度與體能(PF)、軀體疼痛(BP)、總體健康(GH)、精力狀況(Energy)、生理健康(PH)、心理健康(MH)、總分呈負(fù)相關(guān),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。[結(jié)論]1.MHD患者肌少癥發(fā)生率為43.3%,老年MHD患者肌少癥發(fā)生率高于成人,男性MHD患者肌少癥發(fā)生率高于女性。2.hs-CRP水平越高,即微炎癥狀態(tài)越重,MHD患者越容易發(fā)生肌少癥。3.肌少癥影響MHD患者的生活質(zhì)量,主要以體能(PF)、體力所致工作和生活受限(RP)、軀體疼痛(BP)、精力狀況(Energy)、總體健康(GH)、生理健康(PH)方面為主。
[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).
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692.5

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