Department of Nephrology, Toranomon Hospital, Tokyo, Japan.
Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
Nephrol Dial Transplant. 2017 Jul 1;32(7):1176-1183. doi: 10.1093/ndt/gfx186.
Currently, there are few strategies for improving the quality of life (QOL) in patients with autosomal dominant polycystic kidney disease (ADPKD) and massive kidneys. Renal transcatheter arterial embolization (TAE) reduces kidney volume, but its impact on QOL in ADPKD patients on hemodialysis is unknown. This study investigated the influence of renal TAE on QOL in ADPKD patients with massive kidneys receiving hemodialysis.
This prospective observational study enrolled 188 ADPKD patients on hemodialysis (92 men and 96 women; mean age 56.7 ± 9.1 years) who underwent renal TAE at Toranomon Hospital between August 2010 and July 2014. The 36-item Short Form Health Survey (SF-36) and our original 15-item questionnaire were used to evaluate QOL.
Using a linear mixed model, the least squares mean values of the SF-36 physical component summary (PCS), mental component summary (MCS) and role/social component summary (RCS) before renal TAE were calculated as 38.21 [95% confidence interval (CI) 36.50-39.91], 48.45 (47.05-49.86) and 43.04 (40.70-45.37), respectively. These values improved to 42.0 (40.22-43.77; P < 0.001 versus before TAE), 51.25 (49.78-52.71; P = 0.001) and 49.67 (47.22-52.12; P < 0.001), respectively, 1 year after renal TAE. Scores for abdominal fullness, poor appetite and heartburn showed marked improvement after renal TAE, while scores for fever, bodily pain and sleep disorder also improved slightly, but significantly. Scores for constipation and use of analgesics/sleeping medications/laxatives did not improve significantly. All of the SF-36 scores and the scores for specific symptoms (except bodily pain, snoring and constipation) were significantly correlated with the sequential decrease of the height-adjusted total kidney volume.
In ADPKD patients on hemodialysis, renal TAE was effective in improving abdominal fullness, appetite, heartburn and SF-36 scores (MCS and RCS scores), but not for sleep disturbance, constipation and physical strength (PCS score).
目前，对于改善常染色体显性多囊肾病（ADPKD）伴巨大肾脏患者的生活质量（QOL），尚无有效的策略。肾动脉栓塞术（TAE）可减少肾脏体积，但它对正在接受血液透析的 ADPKD 患者的 QOL 影响尚不清楚。本研究旨在探讨肾动脉栓塞术对正在接受血液透析的巨大肾脏 ADPKD 患者 QOL 的影响。
本前瞻性观察性研究纳入了 2010 年 8 月至 2014 年 7 月期间在我院接受肾动脉栓塞术的 188 例 ADPKD 血液透析患者（男 92 例，女 96 例；平均年龄 56.7±9.1 岁）。使用 36 项简明健康调查问卷（SF-36）和我们的原始 15 项问卷评估 QOL。
使用线性混合模型，肾动脉栓塞术前 SF-36 生理成分综合评分（PCS）、心理成分综合评分（MCS）和角色/社会成分综合评分（RCS）的最小二乘均数分别为 38.21（95%置信区间 36.50-39.91）、48.45（47.05-49.86）和 43.04（40.70-45.37）。术后 1 年，这些评分分别改善至 42.0（40.22-43.77；与 TAE 前比较，P＜0.001）、51.25（49.78-52.71；P=0.001）和 49.67（47.22-52.12；P＜0.001）。术后，患者的腹胀、食欲减退和烧心症状明显改善，发热、躯体疼痛和睡眠障碍也略有改善，但有统计学意义。便秘和使用镇痛药/助眠药/缓泻药的评分无显著改善。SF-36 评分和所有特定症状评分（躯体疼痛、打鼾和便秘除外）均与身高调整后的总肾脏体积的逐渐下降显著相关。
在血液透析的 ADPKD 患者中，肾动脉栓塞术可有效改善腹胀、食欲、烧心和 SF-36 评分（MCS 和 RCS 评分），但对睡眠障碍、便秘和体力（PCS 评分）无影响。
