冠狀動脈繞道術後有無合併慢性腎臟疾病患者身體組成、身體活動與身體功能之比較研究

Abstract

研究背景和目標：近年來愈來越多研究顯示心臟病與腎臟病的密切相關，學者並定義所謂心腎症候群。慢性腎臟疾病逐漸被視為心血管疾病預後的獨立危險因子之一，而心血管疾病也是慢性腎臟疾病最嚴重的併發症之一。過去研究顯示心血管疾病，包括冠狀動脈繞道手術後患者以及慢性腎臟疾病患者，都可能發生身體組成改變，身體活動量降低，身體功能減退，以及生活品質不佳，但少有研究調查冠狀動脈繞道術後合併慢性腎臟疾病患者的各項變化。本研究針對冠狀動脈繞道者術後合併慢性腎病患者，評估其身體組成、身體活動、身體功能與生活品質；並分析患者之身體組成、身體活動、身體功能與生活品質之間的相關性。我們預期冠狀動脈繞道術後患者合併慢性腎臟疾病者較未合併腎臟疾病之患者，有較差的身體組成、身體功能與生活品質；而且身體活動量較高的患者有較佳的身體組成、身體功能與生活品質。 研究方法：本研究從心臟內外科門診招募60位年齡40至75歲冠狀動脈繞道術後之男性患者，其中30位合併慢性腎臟疾病，30位無慢性腎臟疾病診斷。測試項目包括以雙能X光吸收儀檢測身體組成，以台灣中文版國際身體活動量表-自填長版評估身體活動量，身體功能評估包括手握力、30秒坐站測試與六分鐘行走測驗，以及利用世界衛生組織生活品質問卷評估生活品質。採用SPSS套裝軟體進行資料建檔與分析。連續型變數使用相依樣本t-test檢驗兩組受試者間各變數的差異分析，類別型變數採用麥氏-包卡爾檢定分析。以皮爾森和史皮爾曼相關分析探討變項間的相關性。以多元迴歸分析法瞭解身體功能和生活品質的影響因子。有效水平標準定為p值小於0.05。 結果：本研究中兩組的基本資料相似。研究結果發現，冠狀動脈繞道術後患者合併慢性腎臟疾病患者之上肢淨體組織質量顯著低於無腎臟疾病的患者，而下肢脂肪百分比高於無腎臟病患者。身體功能和生活品質評估結果部分，經調整相關因素後，冠狀動脈繞道術後患者合併慢性腎臟疾病者仍顯著較未合併腎臟疾病之患者，有較差的30秒坐站次數及社會關係範疇之生活品質滿意度。另以逐步多元迴歸分析顯示，冠狀動脈繞道術後患者身體活動量愈高者，有較佳的身體功能和生活品質滿意度。 結論：冠狀動脈繞道術後合併慢性腎臟疾病患者較未合併腎臟疾病患者有較差的身體組成、身體功能與生活品質。患者身體活動量愈高，其身體功能與生活品質滿意度愈高。

Background and Purpose: It has been reported that cardiac disease and renal disease frequently coexisted. Recently, the term cardiorenal syndrome was used to describe the interaction between heart and kidney dysfunction. Chronic kidney disease (CKD) has become increasingly recognized as an independent risk factor of cardiovascular disease, and the cardiovascular disease is one of most severe complication in patients with CKD. Previous studies have showed the changes in body composition, physical inactivity, decreased physical function, and poor quality of life existed in patients with either cardiovascular disease or CKD. Patients concomitant with cardiovascular disease and kidney insufficiency were expected to significantly increase physical dysfunction. However, few studies addressed on these alterations in patients after coronary artery bypass grafting (CABG) with CKD were reported. The purposes of this study are: (1) to compare the body composition, physical activity, physical function, and quality of life between patients after CABG with and without CKD; and (2) to analyze the relationships among body composition, physical activity, and physical function in this population. It is expected that patients after CABG with CKD have the worse body composition, physical function, and quality of life than patients after CABG without CKD; and patients with higher physical activity levels have the better body composition, physical function, and quality of life. Methods: All subjects were recruited from the clinics of a medical center. Thirty male patients after CABG with CKD and 30 matched controls were recruited (ages between 40-75 years old). All the subjects underwent dual-energy x-ray absorptiometry examination for body composition evaluation. Physical activity and quality of life were assessed by using long form of International Physical Activity Questionnaire and World Health Organization Quality of Life Instrument (WHOQOL)-brief. Physical function measurements included grip strength, 30-second chair stand test and six minutes walking test (6MWT). SPSS was used for all statistical analysis. Pair t-test or McNemar-Bowker were applied to examine the differences of all variables between two groups. Pearson’s and Spearman’s correlation coefficients and multiple regression analysis were used to examine the correlations among the measured variables. P values below 0.05 were considered statistically significant. Results: The basic characteristics were similar between two groups. Patients after CABG with CKD exhibited lower lean mass in arms, and higher % fat mass in the legs as compared with those without CKD. Patients after CABG with CKD had lower 30-second chair stand test, and social relationships domain of quality if life than those without CKD, even after adjusting covariants. In addition, patients after CABG who had higher physical activity level had better physical function and quality of life. Conclusion: Patients after CABG with CKD had worse body composition, physical function, and QOL than their counterparts. The post-CABG patients with higher physical activity levels have significantly better physical function and QOL.