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頁籤選單縮合
題名 | Sleep Disorders and Hypertriglyceridemia in Peritoneal Dialysis Patients=腹膜透析病患之睡眠障礙與高三酸甘油脂血症 |
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作者 | 許媺琇; 黃政文; 洪冠予; 李宇宙; 吳明修; 吳寬墩; 蔡敦仁; | 書刊名 | 臺灣腎臟醫學會雜誌 |
卷期 | 16:3 2002.09[民91.09] |
頁次 | 頁114-118+140 |
分類號 | 415.816 |
關鍵詞 | 高三酸甘油脂血症; 殘餘腎功能; 腿部不寧症候群; 睡眠障礙; Anemia; Intravenous ascorbic acid; Hemodialysis; HD; Iron overload; Erythropoietin hyporesponsiveness; |
語文 | 英文(English) |
中文摘要 | 透析病患中睡眠障礙是常見問題,但是對於它真正發生的原因仍未廣泛研究。本文藉著睡眠評量的方式,評估腹膜透析病患睡眠品質與其他代謝因子及腿部不寧症候群(Restless leg syndrome)的相關性。本研究顯示有高達62%(N=21)的透析患者報當嚴腿部不寧的經驗;檢視匹茲保睡眠品質量表(PSQI)發現,以8分為分割點最能預測患者的主觀睡眠品質:34位病患中有52%有睡眠障礙,以PSQI大於8者為睡眠障礙組,PSQI小於等於8者為無睡眠障礙組。PSQI大於8的透析病患其血液中三酸甘油脂偏高的現象(p=0.003)。此相關性是以前的研究所未發現。PSQI大於8的透析病患之殘餘腎功能,包括腎肌酸酐清除率(renal creatinine clearance;p=0.01),腎尿素氮清除率(renal urea clearance,p=0.02)及24小時尿量(p=0.007)均較PSQI小於等於8者低。另外平均腎尿素氮清除率(renal urea clearance Kt/V)及每週殘餘腎肌酸酐清除率(weekly renal creatinine clearance)在PSQI大於8的透椷病患為0.144±0.06 & 6.51±2.88L/week/1.73m²相對於PSQI小於等於8的透析病患其數值0.41±0.09 & 15.16±3.56L/week/1.73m²,兩者在統計上有明顯意義(p=0.007;p=0.01)。但是在PSQI大於8的透析病患中,當腹膜透椷量也包括的時候,總尿素氮清除率(total urea clearance,Kt/V)和總每週肌酸酐清除率(weekly total creatinine clearance)則與睡眠評估出現無明顯相關性(p=0.81,p=0.06)。比較PSQI大於8的的透析病患,發現PSQI大於8的透析病患其血鈣較高(p=0.007);至於其他代謝因子及地理性的變數均與透析病患的睡眠障礙無相嗎性,總結本文發現腹膜透析病患之殘餘腎功能與睡眠品質有相關性,腿部不寧症候群的發生與殘餘腎功能的關係究係為何,值得進一步探討。 |
英文摘要 | Sleep problems are very common in dialysis patients but data about the causal factor is limited. A questionnaire was distributed to peritoneal dialysis patients to determine the relationship between sleep quality and metabolic factors and restless leg syndrome. Pittsburg Sleep Quality Index (PSQI) was used in this study and we found that cutting point of PSQI >8 could reflect the subjective sleep complaints of peritoneal dialysis patients. Of the 34 patients who completed the survey, 52% had sleep complaints. Peritoneal patients with PSQI greater than 8 were considered as having sleep disorders and patients with PSQI less than or equal to 8 were considered as without sleep disorders. Patinets with PSQI greater than 8 were more likely to have hypertriglyceridemia (mean 259.39±35.8 vs 116.8 Background: Recent studies have demonstrated that inadequate iron mobilization and defective rion utilization may cause recombinant erythropoieitin (rhEPO) hyporesponsiveness in hemodialysis (HD) patients with iron overload. Intravenous ascorbic acid (IVAA) has also been proven effective in HD patients selected based on iron overload and rhEPO resistance. However, the efficacy of lower dose IVAA in HD patients with hyperferritinemia is uncertain. This study focuses on such patients to analyze the effect of low dose IVAA in improving anemia and erythropoiesis. Materials and Methods: Forty-two chronic stable HD patients were enrooled in the study. In phase I, patients were treated with rhEPO 2000 U twice weekly for 12 weeks. Patients whose hematocrit values failed to reach the target level (above 30%) int the last four weeks were defined as poor responders. Sixteen poor responders then were enrolled in the phase Ⅱ study and received low dose IVAA (100 mg thrice weekly) for 8 weeks. Results: The demographic characteristics of the 21 good responders and 16 poor responders showed no differences in age, sex H/D duration, serum albumin, serum aluminum, serum iPTH and KT/V. This study in the phase Ⅰ period demonstrated that the good responders of rhEPO therapy tend to have lower ferritin levels and higher TSAT levels compared to the poor responders. As for phase Ⅱ, mean HCT level was significantly increased at the 8(superscript th) week (27.7±1.7 vs 19.5±2/2%, P<0.05). TSAT also was raised at the 4(superscript th) and 8(superscript th) weeks compared to the start of phase Ⅱ (32.3±5.2, 31.9±4.9 vs 27.0±7.8, P<0.05). Finally, mean ferritin was significantly lower at the 8th week of phase Ⅱ compared to its initial value (650.7±165.1 vs 823.4±171.5, P<0.05). Conclusion: Low dose IVAA therapy provides and acceptable adjuvant therapy for facilitating iron release from the reticuloendothelial system and also increases iron utilization in HD patients with iron overload. 10.06 mg/dL, p=0.003) and this association didi not appear to have been reported before. Besides, those with PSQI greater than 8 had lower residual renal function as measured by renal creatinine clearance (0.55±0.28 vs 1.5±0.35 ml/min; p=0.01), renal urea clearance (0.37±0.15 vs 1.27±0.3 ml/min; p=0.02) and 24hr urine output (146.18±0.28 vs 485.63±104.5 cc/day; p=0.007), resepectively. Mean residual renal urea clearance Kt/V and weekly creatinine clearance in those with PQSI greater than 8 were 0.144±0.06 & 6.51±2.88 L/week/1.73m² for those PQSI less or equal to 8 with statistical significance (p=0.007; p=0.01). While the amounts of peritoneal dialysis were included in those with PSQI greater than 8, total urea clearance Kt/V and total weekly creatinine clearance did not correlate with sleep disorder scores (p=0.81, p=0.06, respectively). In addition, calcium levels were higher in patients who had poor sleep quality than the better sleeper (mean calcium 2.47±0.034 vs 2.36±0.021 mmol/L; p=0.007). No other metabolic or demographic variables were associated with sleep disorders. In our study, residual renal function is associated with sleep quality among peritoneal dialysis patients. |
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