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  • 沈颖婧,储传敏,徐成钢.维持性血液透析患者合并不宁腿综合征的危险因素分析[J].第二军医大学学报,2018,39(3):245-251    [点击复制]
  • SHEN Ying-jing,CHU Chuan-min,XU Cheng-gang.Risk factors of restless leg syndrome in maintenance hemodialysis patients[J].Acad J Sec Mil Med Univ,2018,39(3):245-251   [点击复制]
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维持性血液透析患者合并不宁腿综合征的危险因素分析
沈颖婧1△,储传敏2△,徐成钢1*
0
(1. 海军军医大学(第二军医大学)东方肝胆外科医院肾内科, 上海 200438;
2. 海军军医大学(第二军医大学)东方肝胆外科医院泌尿外科, 上海 200438
共同第一作者
*通信作者)
摘要:
目的 探讨维持性血液透析患者合并不宁腿综合征(RLS)的相关危险因素。方法 回顾性分析2016年7月至2017年9月于海军军医大学(第二军医大学)东方肝胆外科医院诊治的74例维持性血液透析患者的临床资料,对比分析合并RLS与未合并RLS患者的性别、年龄、糖尿病史以及各项生化指标的差异。以性别、年龄、糖尿病史及各项生化指标为协变量,以是否合并RLS为因变量行单因素logistic回归分析;依据2003国际不宁腿综合征委员会(IRLSSG)评分标准将合并RLS患者分为症状轻微、中等、严重、十分严重4组,未合并RLS患者为对照组,对单因素logistic回归分析差异有统计学意义的变量进行两两比较,并将差异有统计学意义的变量纳入模型行多因素logistic回归分析。对主要相关因素绘制受试者工作特征(ROC)曲线,计算曲线下面积并确定最佳临界值及对应的灵敏度和特异度。结果 共纳入维持性血液透析患者74例,其中男46例,女28例;年龄为21~87岁,平均年龄(56.70±14.52)岁;未合并RLS者55例,合并RLS者19例。合并RLS维持性血液透析患者的血钙水平高于未合并RLS者[(2.56±0.38)mmol/L vs(2.26±0.29)mmol/L,t=2.61,P=0.02)]。多因素logistic回归分析结果显示,血甲状旁腺激素(PTH)>515.39 pg/mL是维持性血液透析患者合并RLS的独立危险因素(OR=1.00,95%CI:1.00~1.01,P=0.03)。PTH临界值为515.39 pg/mL时,诊断血液透析患者合并RLS的ROC曲线下面积为0.759,其95%CI为0.610~0.907,该点的灵敏度为0.47、特异度为0.98。结论 RLS是维持性血液透析患者的常见并发症,慢性肾脏病-矿物质及骨代谢紊乱可能与维持性血液透析患者RLS的发生有关。
关键词:  血液透析  下肢不宁综合征  甲状旁腺激素  慢性肾脏病  骨矿物质  骨代谢
DOI:10.16781/j.0258-879x.2018.03.0245
投稿时间:2017-11-21修订日期:2018-02-06
基金项目:
Risk factors of restless leg syndrome in maintenance hemodialysis patients
SHEN Ying-jing1△,CHU Chuan-min2△,XU Cheng-gang1*
(1. Department of Nephrology, Eastern Hepatobiliary Surgery Hospital, Navy Medical University(Second Military Medical University), Shanghai 200438, China;
2. Department of Urology, Eastern Hepatobiliary Surgery Hospital, Navy Medical University(Second Military Medical University), Shanghai 200438, China
Co-first authors.
*Corresponding author)
Abstract:
Objective To investigate the risk factors of restless leg syndrome (RLS) in maintenance hemodialysis patients. Methods The clinical data of 74 maintenance hemodialysis patients in Eastern Hepatobiliary Surgery Hospital of Navy Medical University (Second Military Medical University) from July 2016 to September 2017 were retrospectively analyzed. The gender, age, diabetes mellitus and other biochemical indicators of the patients with or without RLS were compared. The univariate logistic regression analysis was performed with the gender, age, diabetes mellitus and other biochemical indicators as covariates, and the RLS as dependent variable. According to the 2003 International Restless Leg Syndrome Study Group (IRLSSG) criteria, the patients with RLS were divided into mild, moderate, severe and very severe groups, with the patients without RLS as controls; the variables that were significantly different between the groups as analyzed by univariate logistic regression analysis were compared by t-test and multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve for the main relevant factors was plotted, and the area under the curve was calculated to determine the best critical value and the corresponding sensitivity and specificity. Results A total of 74 maintenance hemodialysis patients were enrolled in this study, including 46 males and 28 females; the patients aged from 21 to 87 years, with an average age of (56.70±14.52) years; 55 patients without RLS, and 19 with RLS. The serum calcium in patients with RLS was significantly higher than that without RLS ([2.56±0.38] mmol/L vs[2.26±0.29] mmol/L, t=2.61, P=0.02). Multivariate logistic regression analysis showed that serum parathyroid hormone (PTH)>515.39 pg/mL was an independent risk factor for RLS in maintenance hemodialysis patients (OR=1.00, 95% CI 1.00-1.01, P=0.03). With the cut-off value being 515.39 pg/mL, area under ROC curve performed by PTH for RLS was 0.759, with the 95% CI being 0.610-0.907, and the sensitivity and specificity being 0.47 and 0.98, respectively. Conclusion RLS is a common complication in maintenance hemodialysis patients. Chronic kidney disease-mineral and bone metabolism disorder may be related to the occurrence of RLS in maintenance hemodialysis patients.
Key words:  hemodialysis  restless leg syndrome  parathyroid hormone  chronic kidney disease  mineral of bone  bone metabolism