Abstract: Background　Patients with chronic kidney disease（CKD） stage 5D often suffer from different levels of functional disability，which causes physical and mental stresses，seriously impairing the prognosis and quality of life（QOL）．Most of treatments for such patients focus on improving their QOL and promoting clinical rehabilitation，by which they can return to normal daily activities.TCM treatment has great potential for improving the QOL of dialysis patients.Objective　To investigate the impact of TCM treatment on the QOL of patients with CKD stage 5D.Methods　Participants with CKD stage 5D were recruited from Department of Nephrology，Affiliated Hospital of Nanjing University of Chinese Medicine from January 2017 to January 2018 in accordance with the inclusion and exclusion criteria of the study.General data were collected，such as dialysis mode，essential information（gender，age，marital status，education level，employment status，primary disease，dialysis duration，comorbidity），laboratory inspection indicators，TCM treatment in the past half year，and types of TCM treatment（herbal decoction，Chinese patent medicine Baoshen Tablets，lavipeditum with herbs，acupoint plaster therapy，auriculotherapy with ear seeds，or moxibustion）．KDQOL-SFTM 1.3 was used in a survey to assess the QOL of patients.Results　Of the 140 participants，132 responded to the survey effectively，achieving a response rate of 94.29%.Among the 132 respondents，80 underwent hemodialysis（HD） and 52 underwent peritoneal dialysis（PD）；86（65.15%） received TCM treatment within six months，including 40 with HD and 46 with PD；60 received Chinese patent medicine，20 received Chinese herbal decoction，15 received lavipeditum with herbs，17 received auriculotherapy with ear seeds，15 received acupoint plaster therapy，and 9 received moxibustion.At least 2 types of TCM treatments were simultaneously administered to 12 HD patients，and 20 PD patients.The percentage of taking Baoshen Tablets was highest in HD patients，followed by that of receiving acupoint plaster therapy.The percentage of taking Baoshen Tablets was also highest in PD patients，followed by that of receiving herbal decoction.HD patients had lower KDTA dimension score than PD patients （P<0.05）．In KDTA dimension，HD patients had lower average item scores in terms of dialysis staff encouragement，and patient satisfaction compared with PD patients （P<0.05）．The KDTA dimension score achieved by those younger than 45 years was higher than that achieved by those aged 60-75，or aged greater than 75 years（P<0.05）．The KDTA dimension score achieved by those without comorbidity was higher than that achieved by those with 1，2 or 3 comorbidities（P<0.05）．Those with TCM treatment had higher KDTA dimension score than those without（P<0.05）．In KDTA dimension，those with TCM treatment had higher average item scores in terms of symptom/problems，effects of kidney disease on daily life，cognitive function，sexual function，sleep，support and encouragement of dialysis staff than those without（P<0.05）．HD patients had lower SF-36 dimension score than PD patients（P<0.05）．In SF-36 dimension，HD patients had lower item scores in terms of physical functioning（P<0.05）．The SF-36 dimension score achieved by those younger than 45 years was higher than that achieved by those aged 60-75，or aged greater than 75 years（P<0.05）．Those with primary education had lower SF-36 dimension score than those with secondary or tertiary education（P<0.05）．The SF-36 dimension score achieved by those without comorbidity was higher than that achieved by those with 1，2 or 3 comorbidities（P<0.05）．Those with TCM treatment had higher SF-36 dimension score than those without（P<0.05）．In SF-36 dimension，those with TCM treatment had higher item scores in terms of physical functioning，pain，general health perceptions，emotional well-being，role limitations caused by emotional health problems，and social functioning than those without（P<0.05）．Conclusion　Dialysis mode，age，education level，and comorbidity were associated with the QOL of patients with CKD stage 5D.TCM treatment has a positive effect on the improvement of the QOL of such patients.

Key words: Nephrosis, Quality of life, Dialysis, Therapeutics, Data collection

摘要： 背景　慢性肾脏病（CKD）5D期患者多伴有不同程度的功能障碍，其受到生理和心理的双重压力，严重影响其预后和生存质量（QOL）。目前对CKD 5D期患者的治疗更多在于提高其QOL、促进其临床康复，进而回归社会。中医药对提高透析患者QOL具有较大潜力。目的　调查中医治疗对CKD 5D期患者QOL的影响。方法　选取2017年1月—2018年1月于南京中医药大学附属医院肾科治疗的符合研究标准的CKD 5D期患者。收集患者的一般资料，包括透析方式、基本信息（性别、年龄、婚姻状况、文化程度、工作情况、原发病、透析龄、合并症）、实验室检查指标及是否接受中医治疗（近半年），其中中医治疗的具体方式包括中药煎剂、中成药制剂保肾片、中药足浴、穴位贴敷、耳穴埋籽、艾灸等；并采用肾脏疾病生存质量简表（KDQOL-SFTM 1.3）进行问卷调查，以评估患者的QOL。结果　共发放问卷140份，回收有效问卷132份，有效回收率94.29%。132例患者中，行血液透析（HD）80例，行腹膜透析（PD）52例；近半年接受中医治疗86例（占65.15%）（其中HD患者40例，PD患者46例；接受中成药制剂保肾片60例，中药煎剂20例，中药足浴15例，耳穴埋籽17例，穴位贴敷15例，艾灸9例），未接受中医治疗46例。HD患者中同时接受2种以上中医治疗的12例，PD患者中同时接受2种以上中医治疗的20例；HD患者与PD患者均是以服用中成药制剂保肾片为主，其次HD患者以穴位贴敷为主，PD患者以中药煎剂为主。HD患者肾脏透析相关生存质量（KDTA）、一般健康生存质量（SF-36）维度评分低于PD患者（P<0.05）。KDTA维度中，HD患者透析工作人员的支持鼓励、病人满意度条目评分低于PD患者（P<0.05）。SF-36维度中，HD患者生理机能条目评分低于PD患者（P<0.05）。60~75岁、>75岁患者KDTA、SF-36维度评分均低于<45岁患者（P<0.05）；中学文化程度、大学文化程度患者SF-36维度评分均高于小学文化程度患者（P<0.05）；1、2、3个合并症患者KDTA、SF-36维度评分均低于无合并症患者（P<0.05）。接受中医治疗患者KDTA、SF-36维度评分高于未接受中医治疗患者（P<0.05）。KDTA维度中，接受中医治疗患者症状/问题、肾脏病的影响、认知功能、性功能、睡眠、透析工作人员的支持鼓励条目评分高于未接受中医治疗患者（P<0.05）。SF-36维度中，接受中医治疗患者生理机能、躯体疼痛、一般健康状况、精神健康、情感职能、社会功能条目评分高于未接受中医治疗患者（P<0.05）。结论　透析方式、年龄、文化程度、合并症对CKD 5D患者QOL有影响，中医治疗对CKD 5D患者QOL的改善有积极作用。

关键词: 肾病, 生活质量, 透析, 中医治疗, 数据收集