维持性血液透析患者的衰弱情况及其影响因素

Assessment of frailty and its influence factors in maintenance hemodialysis patients

目的了解维持性血液透析（MHD）患者的衰弱情况及其影响因素，并且探讨衰弱评分与冠状动脉钙化的相关性。方法病例来自2015年1月至2016年1月在本院血液透析中心行MHD治疗的127例患者，收集入选患者的临床资料和血生化资料，采用衰弱症状学量表进行衰弱评分，多层螺旋计算机断层成像测定冠状动脉钙化积分（CACs）。根据不同衰弱评分分成无衰弱组、衰弱前期组和衰弱组，分析比较各组患者的临床资料、血生化资料及CACs。Spearman相关分析评估衰弱评分与各指标的相关性。多分类有序Logistic回归分析评估影响MHD患者衰弱的因素。结果入选127例MHD患者中无衰弱组46例（36．22％），衰弱前期组45例（35．43％），衰弱组36例（28．35％）。3组患者的年龄、糖尿病病史、血红蛋白、血白蛋白、血前白蛋白、血C反应蛋白（CRP）、血成纤维细胞生长因子23（FGF23）、左室舒张末内径差异均有统计学意义（均P〈0．05）；3组患者钙化程度差异有统计学意义（F=31．769，P〈0．001）。MHD患者衰弱评分与年龄（r=0．545，P〈0．001）、合并糖尿病（r=0．236，P=0．008）、CRP（r=0．245，P=0．006）、FGF23（r=0．189，P=0．034）、CACs（r=0．396，P〈0．001）呈正相关，与血红蛋白（r=-0．257，P=0．004）、血白蛋白（r=-0．380，P〈0．001）、血前白蛋白（r=-0．313，P〈0．001）呈负相关。年龄（OR=I．076）、CRP（OR=1．176）、白蛋白（OR=0．796）、合并冠状动脉钙化（OR=2．465）是MHD患者合并衰弱的影响因素（均P〈0．05）。结论MHD患者中衰弱发生率高，衰弱的发生和年龄、CRP、血白蛋白、合并冠状动脉钙化相关。

Objective To investigate the frailty in maintenance hemodialysis （MHD） patients and its influence factors. Methods A total of 127 adults undergoing hemodialysis from January 2015 and January 2016 in our center were recruited. Their clinical data and blood biochemical data were collected. Frailty was assessed using Fried＇s Frailty Phenotype. Quantification of coronary artery calcification （CACs） was determined by multi-slice spiral computed tomography （MSCT）. According to the frailty scores, patients were divided into non-frailty, pro-frailty and frailty group. Their in clinical and biochemical index as well as CACs were compared. The correlations of frailty scores with above index were assessed by Spearman＇s correlation. Multiple logistic regression analysis was applied to evaluate the effect factors of frailty on MHD patients. Results Among 127 selected patients, 46（36.22%） patients without frailty, 45（35.43%） patients with pro-frailty, and 36（28.35%） patients with frailty. The age, diabetes, haemoglobin, albumin, pre- albumin, C- reactive protein, fibroblast growth factor 23 （FGF23）, CACs and left ventricular end-diastolic dimension （LVEDD） of the 3 groups had statistical differences （all P 〈 0.05）. The degrees of calcification among 3 groups were also different statistically （F=31.769, P 〈 0.001）. In patients with MHD, frailty was positively correlated with age （r= 0.545, P 〈 0.001）, diabetes （r=0.236, P=0.008）, C- reactive protein （r=0.245, P=0.006）, FGF23 （r= 0.189, P=0.034） and CACs （r=0.396, P〈0.001）, while negatively correlated with haemoglobin （r=-0.257, P=0.004）, albumin （r=-0.380, P 〈 0.001）, pre-albumin （r=-0.313, P 〈 0.001）. Age （OR= 1.076）, C-reactive protein （0R=1.176）, albumin （OR=0.796） and artery calcification （OR=2.465） were independent influence factors for frailty in MHD patients （all P 〈 0.05）. Conclusions The prevalence of frailty is high among MHD patients. Frailty is associated with age, C- reactive protein, albumin and artery calcification in MHD patients.