从中西医结合角度探讨终末期肾病患者身体功能及其影响因素

Exploring the physical function and influencing factors of end-stage renal disease patients from the perspective of integrated traditional Chinese and Western medicine

关键词:  终末期肾病  身体功能  中医体质  中西医结合  影响因素  横断面调查

Key words:  end-stage renal disease  physical functionality  traditional Chinese medicine constitutions  integration of traditional Chinese and Western medicine  factors influencing resilience  cross-sectional study

摘要:

[目的] 旨在从中西医结合角度探讨终末期肾病（ESRD）患者身体功能及其影响因素，并明确中医体质与其影响因素的相关性，为优化健康管理路径提供依据。[方法] 采用横断面研究设计，选取2024年肾内科门诊的188 例维持性血液透析（HD）患者及242例维持性腹膜透析（PD）患者，应用Karnofsky功能状态评分（KPS）量表、匹兹堡睡眠质量指数（PSQI）量表评估患者身体功能及睡眠质量，采用国际不安腿综合征诊断标准及《中医体质分类与判定自评量表》进行不安腿综合征（RLS）及体质判定，同时收集实验室数据。根据KPS评分划分为Low组（0~70 分）与High组（80~100 分），比较组间差异并应用二元Logistic回归分析探讨ESRD患者身体功能的影响因素。采用Spearman分析KPS的影响因素与中医体质的相关性。[结果] 研究中ESRD患者身体功能低下的总发生率17.44 %，HD患者KPS水平优于PD患者（P<0.05）。年龄、血白蛋白、重度RLS是低KPS的独立影响因素（P<0.05）。年龄与阳虚、阴虚、气虚、血瘀质呈正相关（P<0.05），与湿热、平和质呈负相关（P<0.05）；血白蛋白与体质无显著相关性（P>0.05）；RLS重度与阳虚、阴虚及血淤质呈正相关（P<0.05）。[结论] HD患者身体功能优于PD患者，ESRD患者身体功能受年龄、血白蛋白、重度RLS的多重影响，中医体质与影响因素显著相关，提示体质可能参与了身体功能的调控，建议引入“因质制宜”的理念，制定针对性护理干预策略。

Abstract:

[Objective] The study aims to explore the physical function of patients with end-stage renal disease（ESRD）and its influencing factors from the perspective of integrated traditional Chinese and Western medicine，clarify the correlation between traditional Chinese medicine（TCM）constitution and its influencing factors，and provide a basis for optimizing health management pathways. [Methods] A cross-sectional study design was adopted to select 188 maintenance hemodialysis（HD） patients and 242 maintenance peritoneal dialysis（PD）patients from the nephrology outpatient department in 2024. Karnofsky functional status score （KPS）and Pittsburgh sleep quality index（PSQI）were used to evaluate the patients’physical function and sleep quality. International diagnostic criteria for restless leg syndrome（RLS） and the Self Evaluation Scale for Traditional Chinese Medicine Constitution Classification and Determination were used for RLS and constitution determination，and laboratory data were collected. According to the KPS score，patients were divided into Low group（0 to 70 points）and High group（80 to 100 points），and the differences between the groups were compared. Binary logistic regression analysis was applied to explore the influencing factors of physical function in ESRD patients. Spearman analysis was used to investigate the correlation between the influencing factors of KPS and traditional Chinese medicine constitution. [Results] The total incidence of physical dysfunction in ESRD patients in our center is 17.44 %，and the KPS level in HD patients is better than that in PD patients（P<0.05）. Age，serum albumin，and severe RLS are independent influencing factors for low KPS（P<0.05）. Age is positively correlated with yang deficiency，yin deficiency，qi deficiency，and blood stasis（P<0.05），and negatively correlated with damp heat and calmness（P<0.05）. There was no significant correlation between serum albumin and physical constitution（P>0.05）. Severe RLS was positively correlated with yang deficiency，yin deficiency，and blood stasis （P<0.05）. [Conclusion] HD patients have better physical function than PD patients. ESRD patients’physical function is influenced by multiple factors such as age，blood albumin，and severe RLS. TCM constitution is significantly correlated with influencing factors， suggesting that constitution may be involved in regulating physical function. It is recommended to introduce the concept of“tailored to quality”and develop targeted nursing intervention strategies.