The Study Of The Association Between Quality Of Life And Hemoglobin Variability And TCM Syndrome Types In Maintenance Hemodialysis Patients

Objective To evaluate the quality of life of(MHD)patients with maintenance hemodialysis,to explore the relationship between quality of life and hemoglobin variability and TCM syndrome type of MHD patients,and to analyze the factors affecting the quality of life of MHD patients,so as to provide theoretical basis for clinical improvement of patients' quality of life and TCM clinical syndrome differentiation and treatment.Method1.According to the input and discharge criteria,patients who underwent maintenance hemodialysis and regular follow-up in the Blood purification Center of Wuhan Integrated traditional Chinese and Western Medicine Hospital from December 2014 to December 2018 were selected,and their general conditions and clinical biochemical indexes were collected.2.The patients with MHD included in this study were scored by the chronic Kidney Disease scale(KDQOL-SFTM1.3),and the patients with MHD were divided into deficiency syndrome(spleen-kidney qi deficiency syndrome,spleen-kidney yang deficiency syndrome,liver-kidney yin deficiency syndrome,qi-yin deficiency syndrome,yang-yang deficiency syndrome)and standard positive syndrome(dampness-turbid syndrome,damp-heat syndrome,blood stasis syndrome,heat-toxin syndrome,wind-movement syndrome),while professional TCM doctors classified the MHD patients into two syndrome types: spleen-kidney qi deficiency syndrome,spleen-kidney yang deficiency syndrome,liver-kidney yin deficiency syndrome,qi-yin deficiency syndrome and yang-yang deficiency syndrome.3.To observe the distribution of TCM syndrome types in patients with MHD,and to compare the differences of quality of life score and hemoglobin variability among patients with different syndrome types.4.The differences of TCM syndrome types and quality of life scores of patients with different hemoglobin variability were compared.5.The general condition of patients,the correlation between laboratory index and quality of life score were analyzed,and the factors affecting the difference of quality of life score were analyzed at the same time.Result1.A total of 227 MHD patients were included and completed the study,including 118males(51.98%)and 109females(48.02%),with a male-to-female ratio of about 1;the average age was 55.70 ±10.51years;the average duration of dialysis was 71.43 ±53.61months;the scores of KDTA and SF-36 were 61.25 ±14.89 and 52.24±18.77 respectively.2.In terms of the distribution of TCM syndrome types,patients with yin deficiency of liver and kidney accounted for the most(30%),patients with yang deficiency of spleen and kidney accounted for the least(13.7%),dampness syndrome accounted for the most(48.5%),and wind syndrome accounted for the least(1.8%).Damp-turbid syndrome was the most distributed in spleen-kidney yang deficiency syndrome(71.0%),and it was more than liver-kidney yin deficiency syndrome and yin-yang deficiency syndrome(P<0.05).Blood stasis syndrome was less distributed in spleen-kidney yang deficiency syndrome(9.7%),and less than liver-kidney yin deficiency syndrome,qi-yin deficiency syndrome and yin-yang deficiency syndrome(P<0.05).3.The HB of patients with damp-heat syndrome was higher than that of patients with heat-toxin syndrome,the score of quality of life of patients with deficiency of both yin and yang syndrome was lower than that of patients with spleen-kidney qi deficiency syndrome and liver-kidney yin deficiency syndrome,and the score of patients with blood stasis syndrome was lower than that of patients with dampness-heat syndrome.4.In different hemoglobin variability groups,the scores of patients with low CV in SF-36,PF,RP,BP,VT,RE,MH,MCS,KDTA,SPL,EKD,WS,CF and Sleep were higher than those in high CV group,but there was no significant difference in Hb-CV% among patients with different syndrome types.5.In the scores of KDTA and SF-36,the scores of male,working,married patients with internal fistula were higher than those of female,unemployed,unmarried and non-internal fistula patients(P<0.05.The older the patients were,the lower the quality of life was,the higher the average annual income of the family was,the higher the quality of life was,and the quality of life of BMI was the best in the standard range.In the KDTA domain score,the primary disease was primary glomerulonephritis,and the higher the degree of education,the better the score.In the SF-36 domain score,there was no difference in the quality of life score between the patients with different primary disease and the degree of education(P>0.05).6.Pearson correlation analysis showed that the score of KDTA domain was positively correlated with SF and ALB,and negatively correlated with SBP,Hb-CV%,Scr,blood glucose,hs-CRP and TC(0.154,-0.216,-0.274,-0.134,-0.230,-0.154,P<0.05).In the SF-36 domain score,it was positively correlated with SF and ALB(0.160,0.246),and negatively correlated with Hb-CV%,Scr,blood glucose,hs-CRP and TC(0.214,-0.193,-0.149,-0.174,-0.204).2.The results of multiple linear regression analysis showed that age,BMI,ALB,Scr,Hb,Hb-CV% and LDL were related to the quality of life of the patients.The results of Logistic regression analysis showed that ALB and HB-CV% were independent protective factors for high quality of life,age,hypertensive nephropathy,per capita annual income(relative to more than 50 000 yuan)were less than10 000 yuan,and Scr were independent risk factors for high quality of life(P<0 05).Conclusion1.This study found that the quality of life of MHD patients in Wuhan first Hospital is generally low,and the disease has a heavy burden on patients and has a greater impact on their lives.2.Age,type of primary disease,work,education,family per capita annual income,diastolic blood pressure,Hb,Hb-CV%,ALB and Scr have influence on patients' quality of life.Age,family per capita annual income,hypertensive nephropathy and Scr are independent risk factors affecting quality of life,while Hb-CV%and ALB are independent protective factors.The frequency and intensity of clinical monitoring of patients' hemoglobin should be strengthened.And pay attention to the nutritional status of patients in real time.3.Among the TCM syndrome types of MHD patients,the deficiency syndrome of liver and kidney is mainly yin deficiency syndrome,and the standard syndrome is damp-turbid syndrome;in terms of quality of life,the score of yin-yang deficiency syndrome and wind syndrome in standard syndrome is lower,so we should pay more attention to the patients of this syndrome type,and adopt appropriate combination of traditional Chinese and western medicine therapy to improve the quality of life of patients.