维持性血液透析患者疲乏发生率及其影响因素

Incidence of maintenance hemodialysis patients with fatigue and its related factors

目的调查维持性血液透析（MHD）患者的疲乏发生率，分析其相关影响因素。方法选取2016年1月至2017年3月间于新疆医科大学第一附属医院、新疆伊犁哈萨克自治州友谊医院和伊犁州中医院3家透析中心接受MHD患者289例为研究对象。用国际标准疲乏评定量表（FAI）评估疲乏状况，计算MHD患者疲乏发生率；用主观综合性营养评估（SGA）评定量表评估患者蛋白能量消耗（PEW）状况。按照FAI评分将患者分为疲乏组和非疲乏组，比较两组患者临床资料、血生化指标的差异；用Logistic回归法分析MHD患者发生疲乏的危险因素。结果MHD患者疲乏发生率为83．0％，蛋白能量消耗发生率为62．6％。疲乏组患者的血总胆固醇值低于非疲乏组（P〈O．05），两组间SGA评分值间的差异亦有统计学意义（P〈0．001）。单因素Logistic回归分析结果显示，高SGA评分（OR=I．312，95％CI为1．163—1．481，P〈0．001）、低血总胆固醇（OR=O．661，95％CI为0．496—0．880，P=0．005）是疲乏发生的危险因素。多因素Logistic回归分析结果显示，高SGA评分（OR=5．286，95％CI为2．078-13．442，P〈0．001）是疲乏的独立危险因素。结论MHD患者疲乏和蛋白能量消耗的发生率高，蛋白能量消耗是疲乏发生的独立危险因素。

Objective To investigate the incidence of fatigue in maintenance hemodialysis （MHD） patients and its related factors. Methods A total of 289 patients on MHD between January 2016 and March 2017 in hemodialysis centers of the First Affiliated Hospital of Xinjiang Medical University, Xinjiang Yili Kazak Autonomous Prefecture Friendship Hospital, and Yili Prefecture Hospital were enrolled. Internationally standard fatigue rating scale （FAI） was applied to assess the incidence of fatigue in MHD patients, and subjective comprehensive nutrition assessment （SGA） protein energy wasting rating scale was used to assess protein energy wasting （PEW） conditions. All patients were divided into the fatigue group and the non-fatigue group according to the FAI score. The clinical data and the blood biochemical indicators in two groups were compared. The risk factors of fatigue in MHD patients were analyzed by logistic regression method. Results The incidence of fatigue was 83.0% in MHD patients, and the rate of PEW was 62.6%. Blood total cholesterol in the fatigue group was lower than that of the non- fatigue group （P 〈 0.05）. The difference between SGA scores of two groups had statistical significance （P 〈 0.001）. Single factor logistic regression analysis results showed that higher SGA score （0R=1.312, 95%CI： 1.163-1.481, P 〈 0.001）, lower blood total cholesterol （OR= 0.661, 95% CI： 0.496-0.880, P=0.005） were risk factors of fatigue in MHD patients. Muhivariable logistic regression analysis results showed that higher SGA score （0R=5.286, 95%CI： 2.078-13.442, P 〈 0.001） was an independent risk factor of fatigue in MHD patients. Conelus｜ons The incidence of fatigue and PEW are high in MHD patients. PEW is an independent risk factor of fatigue in MHD patients.