维持性血液透析患者血清甲状旁腺激素水平 与心功能及生存质量的相关性研究

Correlations of serum parathyroid hormone level with cardiac function and quality of life in patients with maintenance hemodialysis

摘要:

目的 探讨维持性血液透析（MHD）患者血清甲状旁腺激素（PTH）水平与心功能及生存质 量的相关性。方法 选取2015 年9 月—2017 年9 月在海南省三亚市人民医院行MHD 治疗≥ 3 个月的109 例MHD 患者，按照PTH 水平将其分为PTH<500 pg/ml（A 组41 例）、500 ～ 800 pg/ml（B 组32 例）及> 800 pg/ml（C 组36 例）。采用彩色多普勒超声诊断仪检测患者心功能指标，肾脏病生存质量KDQOL-SFTM 量表调查患者生存质量。分析PTH 与患者心功能指标及生存质量的相关性。结果 3 组心功能指标比较，差 异有统计学意义（P <0.05）；B、C 组LVD、LVDD、LVPWT、IVST、LVM 及LVMI 高于A 组，LVEF 低于A 组，且C 组LVD、LVDD、LVPWT、IVST、LVM 及LVMI 高于B 组，LVEF 低于C 组（P <0.05）。3 组SF- 36、肾病和透析相关生存质量及总体健康评估评分，经方差分析，差异有统计学意义（P <0.05），B、C 组SF- 36、肾病和透析相关生存质量及总体健康评估评分低于A 组，且C 组低于B 组（P <0.05）。B、C 组SF-36 各维 度评分低于A 组，C 组低于B 组；B、C 组肾病和透析相关生存质量维度中的症状与不适、肾病对生活的影响、 社交质量、睡眠及患者满意度评分低于A 组，C 组症状与不适、肾病对生活的影响、社交质量、患者满意度评 分低于B 组（P <0.05）。MHD 患者血清PTH 水平与心功能指标中LVD、LVDD、LVPWT、IVST、LVM 及 LVMI 呈正相关（P <0.05），与LVEF、生存质量中SF-36、肾病和透析相关生存质量及总体健康评估呈负相关 （P <0.05），其中PTH 与躯体健康、躯体角色功能、躯体疼痛、总体健康、精力、症状与不适、肾病对生活的影响、 社交质量、性功能、睡眠及患者满意度呈负相关（P <0.05）。结论 MHD 患者存在不同程度的PTH 水平升高， 其与患者心功能、生存质量有相关性。早期检测有助于评估患者病情，从而指导临床采取针对性干预措施。

Abstract:

Objective To explore the correlations of serum parathyroid hormone (PTH) level with cardiac function and quality of life in patients with maintenance hemodialysis (MHD). Methods From September 2015 to September 2017, 109 cases of MHD patients were treated in Sanya People's Hospital for more than 3 months. The patients were divided into group A (PTH level <500 pg/ml, n = 41), group B (PTH level 500-800 pg/ml, n = 32), group C (PTH level >800 pg/ml, n = 36) according to PTH level. The cardiac function indexes were detected by color Doppler ultrasonic diagnostic instrument. The quality of life was investigated by the Kidney Disease Quality of Life Short-Form (KDQOL-SFTM) Scale. The correlations of PTH with cardiac function indexes and quality of life were analyzed. Results The indexes of cardiac function of the three groups were significantly different (P < 0.05). LVD, LVDD, LVPWT, IVST, LVM and LVMI in the groups B and C were greater than those in the group A, while LVEF in the groups B and C was lower than that in the group A; LVD, LVDD, LVPWT, IVST, LVM and LVMI of the group C were larger than those of the group B, and LVEF was lower than that of the group B (P < 0.05). The scores of SF-36, kidney and dialysis related quality of life and overall health assessment of the three groups were statistically different (P < 0.05). SF-36, kidney disease and dialysis related quality of life and overall health assessment score in the groups B and C were lower than those of the group A, and they were lower in the group C than that in the group B (P < 0.05); the score of each dimension of SF-36 in the groups B and C was lower than that in the group A, and that was lower in the group C than in the group B. The scores of KDQOL-SFTM Scale in symptoms and discomfort, the impact of kidney disease on life, social quality, sleep and patient satisfaction in the groups B and C were lower than those in the group A; the scores of symptoms and discomfort, the influence of kidney disease on life, social quality and patient satisfaction in the group C were lower than those in the group B (P < 0.05). The serum PTH of the MHD patients was positively correlated with LVD, LVDD, LVPWT, IVST, LVM and LVMI in cardiac function indexes (P < 0.05), but negatively correlated with LVEF, SF-36, renal disease and dialysis related quality of life and overall health assessment scores (P < 0.05). PTH was negatively correlated with physical health, physical role function, somatic pain, general health, energy, symptoms and discomfort, the influence of kidney disease on life, social quality, sexual function, sleep and patient satisfaction (P < 0.05). Conclusions The serum PTH in MHD patients increases in various degrees, which is associated with cardiac function and the quality of life. Early detection of PTH helps to assess the condition of the patients and provide guidance for targeted interventions.