AUTONOMIC FUNCTION AND POSTTRANSPLANT QUALITY OF LIFE

超过10,000名美国人分别接受肾脏和胰腺-肾脏移植 他们的主要目的是提高他们的生活质量。对大多数人来说， 这一目标在术后早期很快就实现了， 伴随着生物紊乱的突然和戏剧性的纠正 与终末期肾病和糖尿病有关。其中一些最重要的 与这两种疾病状态相关的严重生物错乱是 与自主神经系统有关，自主神经系统控制着几个关键的 身体机能。幸运的是，自主神经功能显著改善 在移植后。尽管在这方面的巨大进步 移植后的生活质量似乎归因于 纠正生物性错乱，如与 自主功能，这种关系还有待建立。这个 本研究的目的是阐明生物行为之间的联系 以下发生的自主神经功能和生活质量的变化 肾和胰肾联合移植。 大约190名肾脏和胰脏-肾脏移植接受者将 在六个月、十二个月和二十四个月之前和之后学习 移植。三份问卷将对功能(疾病)进行量化 影响概况)、与健康相关的(生活质量指数)和精神病 生活质量的情感维度(成人自我形象量表)。 自主功能将通过最先进的技术进行评估 用红外光体积描记仪测量1)血管运动功能 量化总脉搏幅度、姿势调节率和反射 血管收缩，2)心电和血液的心功能 量化R-R间期变化的压力记录，Valsalva 收缩压的比率和体位变化，3)胃功能 通过胃电描记来量化胃电节律性 心脏功率谱分析的自主神经平衡 速率变异性将肾上腺素和胆碱能活动量化为 以及昼夜自主节律性。这些测试的结果将 进行统计建模和因子分析，以确定 自主、人口和健康相关的贡献 以下不同时间间隔的生活质量特征 移植。 现有的移植生活质量研究通常采用 横截面设计，并一直停留在描述性的水平。我们的研究 移动到解释级别的查询，以便解释 生物行为联系是提高移植后质量的原因 生活。这一层面的研究在移植中尤为重要，因为 它将有助于我们理解移植如何改变 生活质量。对这种性质的了解将影响决策 关于移植应在何时进行的问题 终末期器官疾病才能提供最大的好处，并将 促进制定旨在最大限度地 移植后的生活质量。

Over 10,000 Americans receive kidney and pancreas-kidney transplants each year for the primary purpose of improving their quality of life. For most, this goal is quickly realized in the early postoperative period, and accompanies the sudden and dramatic correction of biological derangements associated with end-stage renal disease and diabetes. Some of the most severe biological derangements associated with both disease states are related to the autonomic nervous system which controls several critical body functions. Fortunately, autonomic function significantly improves following transplantation. Though the profound improvement in posttransplant quality of life would seem to be attributed to the correction of biological derangements such as those associated with autonomic function, this relationship has yet to be established. The purpose of this study is to explicate the biobehavioral linkages among changes in autonomic function and quality of life that occur following kidney and pancreas-kidney transplantation. Approximately 190 kidney and pancreas-kidney transplant recipients will be studied prior to and at six, twelve and twenty-four months after transplantation. Three questionnaires will quantify functional (Sickness Impact Profile), health related (Quality of Life Index), and psycho emotional (Adult Self-Image Scales) dimensions of quality of life. Autonomic function will be evaluated by state-of-the-art technologies measuring 1) vasomotor function by infrared photoplethysmography which quantifies total pulse amplitude, postural adjustment ratio, and reflex vasoconstriction, 2) cardiac function by electrocardiogram and blood pressure recordings which quantifies R-R interval variation, valsalva ratio, and postural change in systolic blood pressure, 3) gastric function by electrogastrography which quantifies rhythmicity of gastric contractions, and 4) autonomic balance by power spectral analysis of heart rate variability which quantifies adrenergic and cholinergic activity as well as circadian autonomic rhythmicity. Results of these tests will undergo statistical modeling and factor analysis to identify the contribution of autonomic-, demographic, and health-related characteristics to quality of life at various time intervals following transplantation. Extant quality of life research in transplantation has typically employed cross-sectional designs and has remained at a descriptive level. Our study moves to the explanatory level of inquiry in order to explicate the biobehavioral linkages responsible for improved posttransplant quality of life. Study at this level is particularly important in transplantation as it will contribute to our understanding of how transplantation alters quality of life. Knowledge of this nature will influence decisions regarding when transplantation should be undertaken during the course of end-stage organ disease in order to provide the greatest benefit, and will facilitate development of interventions designed to maximize posttransplant quality of life.