目的 比较维持性血液透析(maintenance hemodialysis,MHD)动静脉内瘘右利手患者与成年健康个体之间上肢功能的差异。 方法 横断面研究，纳入北京市6家血液透析中心的MHD动静脉内瘘且右利手患者，收集人口学资料、生化资料、握力及简易上肢功能检查(simple test for evaluating hand function,STEF)等上肢功能指标。MHD患者及成年健康个体上肢功能的比较采用t检验。 结果 共入组MHD患者90例，其中男性51例(56.7%)，年龄(59.63±10.60)岁，中位透析龄62.50(24.00,113.00)个月。将入组的MHD患者按照性别及年龄分组，与成年同年龄段健康人群的握力相比，35～40岁组[女性：(20.27±1.10)kg比28 kg,t=-9.968,P=0.064；男性：(25.85±8.38)kg比45 kg,t=-4.998,P=0.038]、41～50岁组[女性：(20.37±9.25)kg比28 kg,t=-1.844,P=0.139；男性：(27.59±10.43)kg比43 kg,t=-4.433,P=0.002]、51～60岁组[女性：(17.99±8.84)kg比26 kg,t=-2.717,P=0.026；男性：(25.64±9.04)kg比40 kg,t=-4.205,P=0.006]及61～70岁组[女性：(14.11±9.45)kg比23 kg,t= -3.880,P=0.001；男性：(27.41±9.22)kg比36 kg,t=-4.837,P＜0.001]握力均存在下降。STEF各项目操作时间均高于中国健康人群。 结论 动静脉内瘘患者的握力及灵活性与健康人群相比均存在下降。
王欣欣
,
孙超
,
黎爽
,
郑涵絮
,
顾国燕
,
宋晓朵
,
于海艳
,
尹咏梅
,
吴海虹
,
田欣
,
管月红
,
尚云霄
,
赵爽
,
黄富表
,
马迎春
. 成年维持性血液透析患者动静脉内瘘上肢功能与健康个体比较的研究[J]. 中国血液净化, 2023
, 22(10)
: 785
-789
.
DOI: 10.3969/j.issn.1671-4091.2023.10.015
Objective To compare the upper limb function between right-handed maintenance hemodialysis (MHD) patients with arteriovenous fistula (AVF) or AVF graft and healthy adults. Method The right-handed MHD patients with AVF or AVF graft for blood access from six hemodialysis centers in Beijing were enrolled in this cross-sectional study. Demographic and biochemical data, grip strength, and the operation time of Simple Test for Evaluating Hand Function (STEF) were collected. t-test was used to compare the upper limb function between MHD patients and healthy adults. Results A total of 90 MHD patients were enrolled, 51 patients were males, the mean age was 59.63±10.60 years, and the median dialysis vintage was 62.50 (24.00, 113.00) months. The MHD patients were divided into 8 groups by gender and age. The grip strength of MHD patients vs. healthy adults in the age groups were 35-40 years old (female: 20.27±1.10 vs. 28kg, t=-9.968, P=0.064; male: 25.85±8.38 vs. 45kg, t=-4.998, P=0.038), 41-50 years old (female: 20.37±9.25 vs. 28kg, t=-1.844, P=0.139; male: 27.59±10.43 vs. 43kg, t=-4.433, P=0.002), 51～60 years old (female: 17.99±8.84 vs. 26kg, t=-2.717, P=0.026; male: 25.64±9.04 vs. 40kg, t=-4.205, P=0.006), and 61～70 years old (female: 14.11±9.45 vs. 23kg, t=-3.880, P=0.001; male: 27.41±9.22 vs. 36kg, t=-4.837, P<0.001), indicating grip strength decreased in MHD patients as compared with healthy adults of the same age range. The operation time of each STEF items increased in MHD patients than in Chinese healthy adults (P<0.05). Conclusions The grip strength and flexibility were lower in MHD patients with AVF or AVF graft than in healthy people.
参考文献
[1] 中国医院协会血液净化中心分会血管通路工作组. 中国血液透析用血管通路专家共识（第2版）[J]. 中国血液净化, 2019, 18(6):365-381. DOI: 10.3969.
[2] 张兰, 孙超, 程艳娇, 等. 维持性血液透析患者生理功能和生活质量的横断面调查及影响因素分析[J]. 中国血液净化, 2019, 18(4):237-241.
[3] Vachharajani TJ, Taliercio JJ, Anvari E. New Devices and Technologies for Hemodialysis Vascular Access: A Review[J]. Am J Kidney Dis, 2021, 78(1):116-124. DOI: 10.1053/j.ajkd.2020.11.027.
[4] Bohannon RW. Muscle strength: clinical and prognostic value of hand-grip dynamometry[J]. Curr Opin Clin Nutr Metab Care, 2015, 18(5):465-470. DOI: 10.1097/MCO.0000000000000202.
[5] Leong DP, Teo KK, Rangarajan S, et al. Reference ranges of handgrip strength from 125,462 healthy adults in 21 countries: a prospective urban rural epidemiologic (PURE) study[J]. J Cachexia Sarcopenia Muscle, 2016, 7(5):535-546. DOI: 10.1002/jcsm.12112.
[6] 曹丽辉，黄富表，徐筱婧媛. 中国人简易上肢功能检查测试结果分析[J]. 中国康复理论与实践, 2021, 27(6):730-736. DOI: 10.3969.
[7] Grubbs V, Wasse H, Vittinghoff E, et al. Health status as a potential mediator of the association between hemodialysis vascular access and mortality[J]. Nephrol Dial Transplant, 2014, 29(4):892-898. DOI: 10.1093/ndt/gft438.
[8] Nath KA, Katusic ZS. Predicting the Functionality and Form of a Dialysis Fistula[J]. J Am Soc Nephrol, 2016, 27(12):3508-3510. DOI: 10.1681/ASN.2016050569.
[9] Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia[J]. J Am Med Dir Assoc, 2014, 15(2):95-101. DOI: 10.1016/j.jamda.2013.11.025.
[10] 吴曼, 魏玉虾, 余灿清, 等. 中国10个地区成年人骨骼肌质量和手握力的描述性分析[J]. 中华流行病学杂志, 2019, 40(04):376-381.
[11] Auyeung TW, Lee SW, Leung J, et al. Age-associated decline of muscle mass, grip strength and gait speed: a 4-year longitudinal study of 3018 community-dwelling older Chinese[J]. Geriatr Gerontol Int, 2014, 14 Suppl 1:76-84. DOI: 10.1111/ggi.12213.
[12] Stenvinkel P, Carrero JJ, von Walden F, et al. Muscle wasting in end-stage renal disease promulgates premature death: established, emerging and potential novel treatment strategies[J]. Nephrol Dial Transplant, 2016, 31(7):1070-1077. DOI: 10.1093/ndt/gfv122.
[13] Pinto AP, Ramos CI, Meireles MS, et al. Impact of hemodialysis session on handgrip strength[J]. J Bras Nefrol, 2015, 37(4):451-457. DOI: 10.5935/0101-2800.20150072.
[14] Irie K, Iseki H, Okamoto S, et al. Development of the modified simple test for evaluating hand function (modified STEF): Construct, reliability, validity, and responsiveness[J]. J Hand Ther, 2019, 32(3):388-394. DOI: 10.1016/j.jht.2017.09.007.
[15] LI L WULJ. Human Development Science [M][M]. Beijing: People's Medical Publishing House .
