【摘要】目的探讨老年维持性血液透析患者衰弱相关的因素。方法选取2017 年4 月～2019 年4 月在山西医科大学第一医院规律行维持性血液透析(maintenance hemodialysis,MHD)治疗的92 例患者，采用衰弱症状学量表进行衰弱评分，根据不同衰弱评分分成无衰弱组、衰弱前期组和衰弱组，分析比较患者一般资料、实验室指标及抑郁状态。采用Spearman 秩相关分析评估衰弱评分与各指标的相关性，多因素Logistic 回归分析影响老年维持性血液透析患者衰弱的因素。结果入选的92 例老年MHD 患者中无衰弱组32 例(34.78% )，衰弱前期组29 例(31.52% )，衰弱组31 例(33.70% )。3 组间患者的年龄(F =23.094, P ＜0.001)、透析龄(F = 11.405, P =0.003)、血红蛋白(F =16.327,P ＜0.001)、白蛋白(F =15.347,P＜0.001)、血前白蛋白(F =6.759,P =0.002)、C 反应蛋白(F =7.851,P =0.001)、25-羟维生素D(F=18.367,P＜0.001)、尿素(F=5.017,P =0.009)、肌酐(F=4.985,P=0.009)、抑郁(χ2=10.549,P =0.005)差异均有统计学意义(均P＜0.05)；老年MHD 患者衰弱评分与C 反应蛋白(r=0.327,P =0.001)、尿素(r = 0.285, P =0.006)、血肌酐(r=0.322,P =0.002)、抑郁(r=0.503,P＜0.001) 呈正相关，与透析龄(r=- 0.468,P＜0.001)、血红蛋白(r=- 0.533,P＜0.001)、白蛋白(r=- 0.473,P＜0.001)、前白蛋白(r=- 0.281,P =0.007)、25-羟维生素D(r =- 0.524,P＜0.001)呈负相关。透析龄(OR=11.000,95% CI: 0.888～0.970,P=0.001)、血红蛋白(OR =13.189,95% CI:0.803～0.936,P＜0.001)、白蛋白(OR=8.158,95% CI:0.591～0.907,P=0.004)、C 反应蛋白(OR=6.650,95% CI:1.099～2.002,P =0.010)、25-羟维生素D(OR= 16.392, 95% CI:0.666～0.868,P＜0.001)、抑郁(OR=3.939,95% CI:1.015～10.457,P=0.047)是老年MHD 患者衰弱的影响因素(均P＜0.05)。结论老年MHD 患者中衰弱发生率高，衰弱的发生和透析龄、血红蛋白、血白蛋白、C 反应蛋白、25羟维生素D、抑郁相关。
【Abstract】Objective The purpose of this study was to explore the factors relating to frailty in elderly maintenance hemodialysis (MHD) patients. Method A total of 92 patients with regular MHD in the First Hospital of Shanxi Medical University from April 2017 to April 2019 were recruited. Frailty scores were estimated by a frailty symptom scale. The patients were then divided into non-frailty group, pre-frailty group and frailty group according to the frailty scores. General conditions, laboratory indicators and depression status of the patients were analyzed and compared between the groups. Spearman rank correlation analysis was used to evaluate the correlation between frailty scores and other indicators. Multivariate logistic regression analysis was conducted to analyze the risk factors for frailty in elderly MHD patients. Result Among the 92 elderly MHD patients, 32 cases were in the non-frailty group (34.78%), 29 cases in the pre-frailty group (31.52%), and 31 cases in the frailty group (33.70%). Age (F=23.094 P＜0.001), dialysis age (F=11.405, P=0.003), hemoglobin (F=16.327, P<0.001), serum levels of albumin (F=15.347, P＜0.001), prealbumin (F=6.759, P=0.002), C- reactive protein (CRP) (F=7.851, P=0.001), 25- hydroxyvitamin D (F=18.367, P<0.001), urea (F=5.017, P=0.009) and creatinine (F=4.985, P=0.009), and depression (χ2=10.549, P=0.005) were statistically significant between the three groups. Frailty scores were positively correlated with C- reactive protein (r=0.327, P= 0.001),urea(r=0.285, P=0.006), creatinine (r=0.322,P=0.002) and depression (r=0.503, P<0.001), and were negatively correlated with dialysis age (r=- 0.468, P＜0.001), hemoglobin (r=- 0.533, P＜0.001), serum albumin (r=0.281, P=0.007) and serum 25-hydroxyvitamin D (r=0.524, P<0.001). Dialysis age (OR= 11.000, 95% CI=0.888～0.970, P=0.001), hemoglobin (OR=13.189, 95% CI=0.803～0.936, P<0.001), serum levels of albumin (OR=8.158, 95% CI=0.591～0.907, P=0.004), C- reactive protein (OR=6.650, 95% CI= 1.099～2.002, P=0.010) and 25- hydroxyvitamin D (OR=16.392, 95% CI=0.666～0.868, P<0.001), and depression (OR=3.939, 95% CI=1.015～10.457, P=0.047) were the influencing factors for frailty in elderly MHD patients. Conclusion The prevalence of frailty was higher in elderly MHD patients. Frailty was related to hemoglobin, serum levels of albumin, CRP and 25-hydroxyvitamin D, depression and dialysis vintage.
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