301例透析患者不安腿综合征相关因素研究

摘要

目的:对透析患者进行调研,旨在发现与尿毒症不安腿综合征(uremic restless legs syndrome,u-RLS)发病有关的因素.方法:用流行病学现场调查方法,收集301例透析患者的一般情况、实验室检验及检查结果、临床不适主诉.根据年龄、性别、透析龄、透析方式(腹膜透析、血液透析)进行比配,设计病例对照研究(共225例),分为不安腿阳性组(76例)及阴性组(149例),比较两组间差异,并通过多因素分析方法分析各因素与u-RLS之间的相关性.在匹配的患者中,根据有无糖尿病,分为糖尿病亚组(44例)及非糖尿病亚组(181例),分别分析两组中不安腿与各个因素之间的关系.结果:在比配的225例病例及非糖尿病亚组中,均提示:失眠、肢体麻木、血肌酐、血β2微球蛋白(β2-MG)、血清钙,血清甲状旁腺激素水平(parathyroidmone,PTH)、血清铁蛋白、血清维生素B12浓度与u-RLS差异有统计学意义(P＜0.05),Logistic回归分析提示PTH、血肌酐、血清铁蛋白、血β2-MG、血清维生素B12浓度是u-RLS发病的独立因素(P＜0.05).在糖尿病亚组中,失眠、肢体麻木、血清维生素B12浓度、血清铁蛋白与u-RLS差异有统计学意义(P＜0.05),血清维生素B12浓度、血清铁蛋白是u-RLS发病的独立因素(P＜0.05).结论:尿毒症不安腿综合征与失眠、肢体麻木的共病可能性大;小分子毒素(血肌酐)、中大分子毒素(PTH、β2-MG)水平与尿毒症不安腿综合征的发生呈正相关;血清铁蛋白水平、血清维生素B12浓度与尿毒症不安腿综合征的发生呈负相关.%Objective:To find the factors associated with the onset of the restless legs syndrome in patients with uremia.Methods:Hemodialysis patients and peritoneal dialysis patients were collected with the method of epidemiological field survey.The total number of cases was 301.It was the general condition,laboratory inspection,inspection results,and chief complaints of clinical discomfort that mainly had been collected.Patients were compared and matched on the basis of ages,sexes,dialysis ages and dialysis methods (peritoneal dialysis and hemodialysis),which provided information for the design of case-control study.They were then divided into the positive group (RLS group) and the negative group (NRLS group) of restless legs,which contained 76 cases of RLS group and 149 cases of NRLS group.Apart from the comparison between two groups,the correlation between various factors and the uremic with restless legs syndrome was analyzed by means of multivariate methods.According to whether there was diabetes mellitus among matched patients,patients were divided into the diabetes group (44 cases) and non-diabetes group (181 cases).Differences between two groups were compared.Results:Both 225 compared and matched case and the non-diabetes group provide the information that the inter-group differences among insomnia,limb numbness,serum creatinine,serum β2-microglobulin,serum calcium,the lever of serum parathyroid hormone (PTH),serum ferritin and the concentration of serum vitamin B12 exert statistical significance on the research (P ＜ 0.05).Logistic regression analysis has shown that PTH,serum creatinine,serum ferritin,serum β2-microglobulin and the concentration of serum vitamin B12 are independent factors of the uremia restless legs syndrome,In diabetes group,the inter-group differences among insomnia,limb numbness,the concentration of serum vitamin B12 and serum ferritin are of statistical significance (P ＜0.05).The concentration of serum vitamin B12 and serum ferritin are the independent factors of the uremia restless legs syndrome.Conclusion:There exists high possibility of comorbidity of uremia restless legs syndrome and insomnia and limb numbness;The level of micromolecule urotoxins (serum creatinine),and macro-and mid-molecule urotoxins (PTH and serum β2-microglobulin) between uremia restless legs syndrome represents the positive correlation;The level of the concentration of serum vitamin B12 and serum ferritin between uremia restless legs syndrome represents the negative correlation.