维持性腹膜透析患者睡眠质量的影响因素研究

Risk factors of sleep quality in peritoneal dialysis patients

摘要:

目的 探究维持性腹膜透析（PD）患者睡眠障碍的影响因素。方法 选取2017 年6 月—2019 年 3 月就诊于安徽医科大学第一附属医院肾脏内科腹膜透析中心且透析龄>3 个月的175 例维持性PD 患者。收 集患者基本资料、腹透评估资料及各检查指标（包括血常规、血清白蛋白、肾功能、血电解质、血脂、全段 甲状旁腺激素、高敏C 反应蛋白、25- 羟维生素D 等），对每位患者进行贝克抑郁量表积分、SAS 焦虑量表 积分及匹森堡睡眠指数（PSQI）评分。根据患者PSQI 分为睡眠较好组（PSQI ≤ 5 分）和睡眠障碍组（PSQI>5 分）。 分析睡眠与各因素的相关性。结果 睡眠障碍组抑郁、焦虑、睡眠总分、iPTH 及hs-CRP 较睡眠较好组高 （P <0.05），血红蛋白、BMI、总Kt/V 较睡眠较好组低（P <0.05）。经Spearman 相关分析显示，PD 患者PSQI 与血红蛋白、总Kt/V 呈负相关（r s =-0.332 和-1.890，P <0.05），与iPTH、BDI- Ⅱ及SAS 呈正相关（r s =0.363、 0.450 和0.354，P <0.05）。经线性回归分析，BDI- Ⅱ、iPTH 是PSQI 的影响因素（P <0.05）。轻度贫血组 PSQI 较正常组高（P <0.05），中度贫血组PSQI 较轻度贫血组高（P <0.05），中度贫血组与重度贫血组PSQI 比较， 差异无统计学意义（P >0.05）。结论 PD 患者睡眠障碍患病率较高，与血红蛋白水平、透析充分性、甲状旁 腺功能及抑郁水平有关。

Abstract:

Objective To explore the risk factors of sleep disturbances in patients under peritoneal dialysis. Methods Totally 175 peritoneal dialysis patients form our peritoneal dialysis center were included. Demographic, clinical and laboratory characteristics, beck depression scale score-II (BDI-II), self-rating anxiety scale score (SAS) and the pittsburgh sleep index (PSQI) of each patients were collected. According to patients’ PSQI, they were divided into two groups named “normal group” (PSQI ≤ 5 points) and “poor sleep group (PSQI > 5 points). Results Depression, anxiety, total sleep score, iPTH and hs-CRP in sleep disorder group were higher than those in better sleep group (P < 0.05), while hemoglobin, BMI and total kt/V in poor sleep group were lower than those in normal group (P < 0.05). iPTH, hs-CRP, the scales of BDI-II and SAS was significantly higher than normal group (r s = 0.363, 0.450 and 0.354, P < 0.05), and PSQI was negatively correlated with hemoglobin level and total Kt/V (r s = -0.332 and -1.89, P < 0.05). Moreover, the BDI-II score and iPTH were independent risk factors of PSQI (P < 0.05). According to patients’ hemoglobin, they were divided into three anemia groups, the difference between the two groups was statistically significant; the PSQI of mild anemia group was higher than that of normal group (P < 0.05); and that of moderate anemia group was higher than that of mild anemia group (P < 0.05); there was no significant difference in PSQI between moderate anemia group and severe anemia group (P > 0.05). Conclusions Sleep disturbances are common among peritoneal dialysis patients, which may be related to anemia, dialysis adequacy, iPTH and depression.