中医药干预对肾移植术后患者生存质量的影响
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摘要
目的探讨中医药干预治疗对肾移植术后患者的生存质量的影响。
方法采用回顾性调查的方法,对肾移植术后患者进行生存质量评估。我们向2008年11月至2009年4月期间在广州中医药大学第一附属医院、广东省第二人民医院、广州军区总医院门诊和住院的肾移植患者发放KDQOL-SF~(TM)量表和一般情况表(包括一般人口学特征及肾病临床资料),进行问卷调查。接受问卷调查的肾移植术后患者被分为两组,在服用免疫抑制西药的基础上加用虫草制剂、雷公藤多甙等辅助治疗,并且服用时间超过2月的患者,或者出现术后并发症服用中药辅助治疗的患者纳入中西医结合组;常规服用免疫抑制西药的患者归入西医组。
结果共收集符合纳入标准的肾移植术后病例200例,其中中西医结合组120例,西医组80例。统计分析显示两组在年龄、性别、文化程度、职业、婚姻、家庭经济情况、医疗费用支付方式、原发病与共患病、移植前肾脏替代治疗方式、透析时间、移植时间、服用免疫抑制剂的种类、免疫抑制剂的副作用各方面具有可比性,但中西医结合组发生急性排斥反应的次数明显低于西医组。中西医结合组在SF-36评分的8个维度,KDTA评分的11个方面中除工作状态(WS)、认知功能(SF)、医护鼓励(DSE)、患者满意度(PS)外均高于西医组。排除急性排斥反应发生次数对生存质量评估造成的影响,中西医结合组的生存质量总体评分高于西医组。
结论1.中西医结合治疗能够减少肾移植术后患者发生急性排斥反应的次数。
2.中西医结合组的肾移植术后患者生存质量高于西医组。体现在SF-36评分的8个维度:PF(体能)、RP(体力所致工作和生活受限)、Pain(疼痛)、GH(总体健康状况)、EWB(情感状况)、RE(情感问题对工作生活的影响)、SF(社会功能)、Energy(精力状况),和KDTA评分的7个方面中:SPL(症状与不适)、EKD(肾病对日常生活的影响)、BKD(肾病给生活带来的负担)、QSI(社交质量)、SexF(性功能)、Sleep(睡眠)、SOS(社会支持)。
Objective To investigate the effect of Chinese Medicine on the quality of life(QOL) after kidney transplantation.
Methods By adopting the means of retrospective investigation,we had an evaluation on the patients' Quality of Life after kidney transplantation. We ask these patients,who were recruited at the First Affiliated Hospital of Guangzhou TCM University,the Second Provincial People's Hospital of Guangdong,and the Military Region General Hospital from November 2008 to April 2009,to fill out KDQOL-SF~(TM) and the general form which included demographic characteristics and clinical characteristics.Patients were divided into two groups.The first group is integrated Chinese medicine and western medicine (integrated CM and WM) group,which used Chinese Medicine preparations such as Tripterygium wilfordii,Cordyceps as adjuvant therapy at least two months or take Chinese medicine to treat the complications,the second group is the western medicine(WM) group,which took immunosuppressive drug only with western medicine.
Results 200 cases about kidney transplantation recipients,who accorded with the inclusive criteria were collected.The integrated CM and WM group has 120 recipients and the WM group has 80 recipients.Statistical analysis showed that the two groups are comparable in age,sex,education level, profession,marriage,economic level,health insurance,primary renal disease, comorbid medical condition,renal replacement therapy before kidney transplantation,the duration of dialysis,the duration of kidney transplantation,kinds of immunosuppressive,side effect of immunosuppressive, but the times of acute rejection in integrated CM and WM group were less than that in the WM group.Integrated CM and WM group had higher scores in all scales of SF-36 compare to the WM group.Advantages were also observed in 11 categories of KDTA,except WS(Work status),CF(Cognitive function),PS(Patient satisfaction),DSE(Dialysis staff encouragement).Excluding the times of acute rejection effect on the quality of life,the scores of KDQOL-SF~(TM) in integrated CM and WM group were higher than the WM group.
Conclusion 1.Combined treatment of CM and WM can reduce the times of acute rejection after kidney transplantation.
2.Compared to the recipients treated with WM,the recipients treated with CM and WM showed a better quality of life in kidney.All scales of SF-36(PF, RP,Pain,GH,EWB,RE,SF,Energy) had improved.Improvement was also observed in 7 categories of the KDTA(SPL,EKD,BKD,QSI,SexF,Sleep,SOS),but WS, CF,DSE,PS had no significant changes.
方法采用回顾性调查的方法,对肾移植术后患者进行生存质量评估。我们向2008年11月至2009年4月期间在广州中医药大学第一附属医院、广东省第二人民医院、广州军区总医院门诊和住院的肾移植患者发放KDQOL-SF~(TM)量表和一般情况表(包括一般人口学特征及肾病临床资料),进行问卷调查。接受问卷调查的肾移植术后患者被分为两组,在服用免疫抑制西药的基础上加用虫草制剂、雷公藤多甙等辅助治疗,并且服用时间超过2月的患者,或者出现术后并发症服用中药辅助治疗的患者纳入中西医结合组;常规服用免疫抑制西药的患者归入西医组。
结果共收集符合纳入标准的肾移植术后病例200例,其中中西医结合组120例,西医组80例。统计分析显示两组在年龄、性别、文化程度、职业、婚姻、家庭经济情况、医疗费用支付方式、原发病与共患病、移植前肾脏替代治疗方式、透析时间、移植时间、服用免疫抑制剂的种类、免疫抑制剂的副作用各方面具有可比性,但中西医结合组发生急性排斥反应的次数明显低于西医组。中西医结合组在SF-36评分的8个维度,KDTA评分的11个方面中除工作状态(WS)、认知功能(SF)、医护鼓励(DSE)、患者满意度(PS)外均高于西医组。排除急性排斥反应发生次数对生存质量评估造成的影响,中西医结合组的生存质量总体评分高于西医组。
结论1.中西医结合治疗能够减少肾移植术后患者发生急性排斥反应的次数。
2.中西医结合组的肾移植术后患者生存质量高于西医组。体现在SF-36评分的8个维度:PF(体能)、RP(体力所致工作和生活受限)、Pain(疼痛)、GH(总体健康状况)、EWB(情感状况)、RE(情感问题对工作生活的影响)、SF(社会功能)、Energy(精力状况),和KDTA评分的7个方面中:SPL(症状与不适)、EKD(肾病对日常生活的影响)、BKD(肾病给生活带来的负担)、QSI(社交质量)、SexF(性功能)、Sleep(睡眠)、SOS(社会支持)。
Objective To investigate the effect of Chinese Medicine on the quality of life(QOL) after kidney transplantation.
Methods By adopting the means of retrospective investigation,we had an evaluation on the patients' Quality of Life after kidney transplantation. We ask these patients,who were recruited at the First Affiliated Hospital of Guangzhou TCM University,the Second Provincial People's Hospital of Guangdong,and the Military Region General Hospital from November 2008 to April 2009,to fill out KDQOL-SF~(TM) and the general form which included demographic characteristics and clinical characteristics.Patients were divided into two groups.The first group is integrated Chinese medicine and western medicine (integrated CM and WM) group,which used Chinese Medicine preparations such as Tripterygium wilfordii,Cordyceps as adjuvant therapy at least two months or take Chinese medicine to treat the complications,the second group is the western medicine(WM) group,which took immunosuppressive drug only with western medicine.
Results 200 cases about kidney transplantation recipients,who accorded with the inclusive criteria were collected.The integrated CM and WM group has 120 recipients and the WM group has 80 recipients.Statistical analysis showed that the two groups are comparable in age,sex,education level, profession,marriage,economic level,health insurance,primary renal disease, comorbid medical condition,renal replacement therapy before kidney transplantation,the duration of dialysis,the duration of kidney transplantation,kinds of immunosuppressive,side effect of immunosuppressive, but the times of acute rejection in integrated CM and WM group were less than that in the WM group.Integrated CM and WM group had higher scores in all scales of SF-36 compare to the WM group.Advantages were also observed in 11 categories of KDTA,except WS(Work status),CF(Cognitive function),PS(Patient satisfaction),DSE(Dialysis staff encouragement).Excluding the times of acute rejection effect on the quality of life,the scores of KDQOL-SF~(TM) in integrated CM and WM group were higher than the WM group.
Conclusion 1.Combined treatment of CM and WM can reduce the times of acute rejection after kidney transplantation.
2.Compared to the recipients treated with WM,the recipients treated with CM and WM showed a better quality of life in kidney.All scales of SF-36(PF, RP,Pain,GH,EWB,RE,SF,Energy) had improved.Improvement was also observed in 7 categories of the KDTA(SPL,EKD,BKD,QSI,SexF,Sleep,SOS),but WS, CF,DSE,PS had no significant changes.
引文
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[2]Lapaucis A,Muirhead N,Keown P,Wong C:A disease-specific questionnaire for assessing quality of life in patients on hemodialysis[J].Nephron,1992;60:302-306
[3]Dew MA,Simmons RG:The advantage of multiple measures of quality of life[J].Scan JUrlo Nephrol,1990;24:523-S30
[4]Bakewell AB,Higgins RM,Edmunds ME.Does ethnicity influence perceived quality of life of patients on dialysis and following renal transplant?[J].Nephrol Dial Transplant,2001 Jul;16(7):1395-401.
[5]黄璟,吴培根,郑智华等.影响肾移植患者生存质量的因素调查[J].中华器官移植杂志,2005:26(5):272-274
[6]Klapheke MM.The role of the psychiatrist in organ transplantation[J].Bulletin of the Menninger Clinic,1999;63:13-15
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