AUTONOMIC FUNCTION AND POSTTRANSPLANT QUALITY OF LIFE

超过10，000名美国人接受肾脏和胰肾移植 年，主要目的是提高生活质量。对大多数人来说， 这一目标在术后早期迅速实现， 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。一些最 与这两种疾病状态相关的严重生物紊乱是 与自主神经系统有关，自主神经系统控制着几个关键的 身体功能。幸运的是，自主神经功能显著改善 移植后。虽然在这方面的巨大进步 移植后的生活质量似乎归因于 纠正生物紊乱，例如与 自主功能，这种关系尚未建立。 的 本研究的目的是阐明生物行为之间的联系 自主神经功能和生活质量的变化， 肾和胰肾移植。 大约190名肾脏和胰肾移植受者将 研究之前和之后6个月、12个月和24个月 移植三份问卷将量化功能（疾病 影响概况）、健康相关（生活质量指数）和心理 情绪（成人自我形象量表）生活质量的维度。 自主神经功能将通过最先进的技术进行评估 1）通过红外光电体积描记术测量血管功能， 量化总脉冲幅度、姿势调整率和反射 血管收缩，2）通过心电图和血液检查的心脏功能 量化R-R间期变化的压力记录，valsalva 收缩压比值和体位变化，3）胃功能 通过胃电描记术量化胃电节律， 收缩，以及4）通过心脏功率谱分析的自主平衡 速率变异性，其量化肾上腺素能和胆碱能活性， 以及昼夜自主节律。这些测试的结果将 进行统计建模和因素分析，以确定 自主神经、人口统计学和健康相关 不同时间间隔的生活质量特征 移植 移植中现存的生活质量研究通常采用 横截面设计，并一直保持在一个描述性的水平。我们的研究 进入解释性的探究层次， 生物行为联系负责改善移植后的质量， 生活这一水平的研究在移植中特别重要， 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 关于在移植过程中何时应该进行移植， 终末期器官疾病，以提供最大的好处，并将 促进制定干预措施， 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.