维持性血液透析患者衰弱表型对日常生活活动能力的影响

Effect of frailty phenotype on activities of daily living in maintenance hemodialysis patients

目的:调查维持性血液透析(maintenance hemodialysis,MHD)患者衰弱和日常生活活动能力现状,探讨衰弱表型对日常生活活动能力的影响。方法:研究对象为2019年3月至2020年3月在浙江大学医学院附属第一医院肾脏病中心进行MHD的患者。采用横断面调查方法收集其人口学及实验室资料,分别采用Fried衰弱表型及日常生活活动能力量表评估衰弱及日常生活活动能力,分别在日常生活活动能力、躯体生活自理能力、工具性日常生活能力方面比较功能正常组与功能下降组间基本资料及不同衰弱表型的差异,采用Pearson相关分析及二元Logistic回归分析法分析衰弱与日常生活活动能力的相关性及日常生活活动能力的影响因素。结果:共676例MHD患者被纳入本研究,其中男性434例(64.2%),女性242例(35.8%);年龄(59.2±19.4)岁;中位透析龄59.0(25.3,110.0)个月;衰弱患者159例(23.5%),衰弱前期230例(34.0%),无衰弱287例(42.5%);日常生活活动能力下降者163例(24.1%),其中躯体生活自理能力下降者131例(19.4%),工具性日常生活能力下降者161例(23.8%)。Pearson相关分析结果显示,衰弱得分与日常生活活动能力得分(r=0.728,P<0.001)、躯体生活自理能力得分(r=0.669,P<0.001)和工具性日常生活能力得分(r=0.729,P<0.001)均呈正相关。二元Logistic回归分析结果显示,年龄大和衰弱表型中的身体活动量低、疲乏、步速减慢及握力低是患者日常生活活动能力、躯体生活自理能力及工具性日常生活活动能力的独立影响因素(均P<0.05)。结论:MHD患者衰弱的患病率为23.5%,24.1%患者的日常生活活动能力下降。年龄大和衰弱表型中的身体活动量低、疲乏、步速减慢及握力低是MHD患者的日常生活活动能力差、躯体生活自理能力差及工具性日常生活活动能力差的独立影响因素。

Objective To investigate the status of frailty and activities of daily living(ADL)in maintenance hemodialysis(MHD)patients,and to explore the effect of frailty phenotype on ADL.Methods The patients who underwent MHD in Kidney Disease Center of the First Affiliated Hospital from March 2019 to March 2020 were enrolled in this study.The demographic and laboratorial data were collected by cross-sectional survey method.Fried frailty phenotype scale and ADL scale were used to evaluate the frailty and ADL,respectively.The differences of basic data and different frailty phenotypes between the normal function group and the function decline group were compared in terms of ADL,physical self-maintenance ability and instrumental ADL ability.Pearson correlation analysis was used to analyze the correlation between frailty and ADL,and binary logistic regression analysis was used to analyze the influencing factors of ADL.Results A total of 676 MHD patients were included in this study,including 434 males(64.2%)and 242 females(35.8%).The age was(59.2±19.4)years old,and the median dialysis age was 59.0(25.3,110.0)months.There were 159 frailty patients(23.5%),230 pre-frailty patients(34.0%),and 287 non-frailty patients(42.5%).The ADL was decreased in 163 patients(24.1%),including 131 patients(19.4%)with decreased physical self-maintenance ability and 161 patients(23.8%)with decreased instrumental ADL ability.Pearson correlation analysis showed that the frailty score was positively correlated with total ADL score(r=0.728,P<0.001),physical self-maintenance ability score(r=0.669,P<0.001)and instrumental ADL ability score(r=0.729,P<0.001).Binary logistic regression analysis results showed that older age and lower physical activity,fatigue,slowed steps and lower grip strength in the frailty phenotypes were the independent influencing factors of ADL,physical self-maintenance ability and instrumental ADL ability(all P<0.05).Conclusions The prevalence of frailty is 23.5%in MHD patients,and 24.1%of MHD patients have decreased ADL.Elder age and lower physical activity,fatigue,reduced step counts,and lower grip strength in frailty phenotypes are the independent influencing factors for poor ADL,poor physical self-maintenance ability and poor instrumental ADL ability.