腹膜透析和血液透析患者胃肠道症状的调查分析  

A survey of gastrointestinal symptoms in peritoneal dialysis patients and hemodialysis patients

作　　者：陈瑾[1] 毛敏[1] 张涛[1] 李贵森[1] 陈秀玲[1] 高辉[1] 张渊[1] 王莉[1] 

机构地区：[1]电子科技大学附属医院四川省人民医院肾内科,成都610072

出　　处：《临床肾脏病杂志》2017年第6期340-344,共5页Journal Of Clinical Nephrology

基　　金：十二五"国家科技支撑计划项目(No.2011BAI10B08)

摘　　要：目的探讨腹膜透析和血液透析患者胃肠道症状的发生情况。方法选择2015年7~8月在我院肾内科进行腹膜透析和血液透析的患者为研究对象,其中腹膜透析患者(腹膜透析组)89例,血液透析患者(血液透析组)102例,采用胃肠道症状分级评分量表(gastrointestinal symptom rating scale,GSRS)和GerdQ自评量表进行问卷调查评估患者胃肠道症状的发生情况及严重程度。了解患者的年龄、性别、透析时间、糖尿病史、吸烟史及激素或非甾体类药物用药史,记录体质量指数(body mass index,BMI)、血红蛋白(hemoglobin,Hb)、校正钙(corrected calcium,cC a)、血磷、全段甲状旁腺素(intact parathyroidhormone,iP TH)、血白蛋白(serum albumin,Alb)、血肌酐(SCr)、尿素氮(BUN)、尿素清除指数(Kt/V)等指标。采用t检验,χ~2检验进行组间比较,并对Kt/V达标患者的胃肠道症状与各项指标进行逐步多元回归分析。结果 2组患者的年龄、性别、透析时间、吸烟史、服用激素或非甾体类药物史、糖尿病肾脏疾病比例差异无统计学意义,但是血液透析组患者具有更高的Alb、BUN水平及Kt/V值达标率。腹膜透析组胃肠道症状分级评分>1分的发生率为83.1%,血液透析组为82.4%。腹膜透析组胃肠道症状分级评分明显高于血液透析组[(4.7±4.3)分比(3.8±3.3)分;P=0.004]。腹膜透析组烧心(P=0.029)、反酸(P=0.001)和恶心呕吐(P=0.004)发生率明显高于血液透析组。GerdQ自评量表评分结果显示,腹膜透析组有胃食管反流症状的患者16例(占18.0%),血液透析组8例(占7.0%),2组比较差异有统计学意义(P=0.048)。逐步多元回归分析提示,腹膜透析和血液透析患者胃肠道评分与BMI呈正相关(B=0.28,P=0.005)、与Hb水平呈负相关(B=-0.057,P=0.002)。结论多数透析患者具有消化道症状,腹膜透析患者更易出现胃食管反流现象,BMI及Hb水平与胃肠道症状具有相关性。Objective To investigate the gastrointestinal symptoms in peritoneal dialysis（ PD）patients and hemodialysis（ HD） patients. Methods Eighty-nine PD patients（ PD group） and 102 HD patients（ HD group） in Department of Nephrology between July to August in 2015 were recruited in this study. The incidence and severity of gastrointestinal symptoms were assessed by the（ gastrointestinal symptom rating scale,GSRS） and Gastroesophageal Reflux Disease Questionnaire（ Gerd Q）. Patients ＇age,gender,duration of dialysis,history of diabetes,smoking,taking glucocorticoid and nonsteroidal anti-inflammatory drugs were recorded. Body mass index（ BMI）,blood hemoglobin（ Hb）,corrected calcium（ c Ca）,phosphorus,intact parathyroid hormone（ i PTH）,serum albumin（ Alb）,serum creatinine（ SCr）,blood urea nitrogen（ BUN） and Kt/V were collected. Using T test and Chi-square test,the data were compared between two groups,and the main influencing factors of gastrointestinal symp-toms were screened out by stepwise multiple regression analysis. Results There was no statistically significant difference in age,gender,duration of dialysis,history of diabetes,smoking,taking glucocorticoid and nonsteroidal anti-inflammatory drugs between PD and HD groups. But the levels of serum albumin,BUN and achieving the goal of Kt/V were higher in HD group than in PD group. The prevalence of troublesome gastrointestinal symptoms（ GSRS 1） was 83. 1 % for PD,and 82. 4 % for HD. The mean GSRS scores in PD group were higher than in HD group（ 4. 7 ± 4. 3 vs. 3. 8 ± 3. 3,P =0. 004）. The occurrence rate of heart burn（ P = 0. 029）,reflux（ P = 0. 001）,nausea and vomiting（ P = 0. 004） was higher in PD group than in HD group. Sixteen patients（18%） in PD group had determined gastroesophageal reflux by Gerd Q,which was significantly higher than in HD group（ 8 patients,7 %）. Stepwise multiple regression analysis revealed BMI was positively correlated to GSRS scores in dialysis patients（ B = 0. 28

关 键 词：透析 胃肠道症状 胃食管反流 

分 类 号：R692.5[医药卫生—泌尿科学]