维持性血液透析患者无望感与肌少症的相关性研究

Relationship between hopelessness and sarcopenia in maintenance hemodialysis patients

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者无望感与肌少症之间的关系,以期为肌少症的早期预防及干预提供参考。方法采用便利抽样法,对青岛市市立医院血液净化中心收治的308例MHD患者使用一般资料调查表、改良定量主观整体评估(modified quantitative subjective global assessment,MQSGA)问卷、Beck无望感量表(Beck hopelessness scale,BHS)进行调查,并通过体格检测评估肌少症状况。采用多因素Logistic回归分析无望感对肌少症的影响。结果在308例被调查对象中,78例(25.3%)患有肌少症;BHS得分为4.0(1.0,8.0)分,155例(50.3%)BHS>3分,即存在无望感。未纳入混杂因素前BHS>3分是MHD患者肌少症的危险因素(OR=3.656,95%CI:2.079~6.429,P<0.001);在此基础上,自变量增加性别、年龄、透析龄、是否合并糖尿病、MQSGA得分后,BHS>3分仍是MHD患者肌少症的危险因素(调整OR=2.372,95%CI:1.227~4.588,P<0.001)。结论存在无望感是MHD患者发生肌少症的独立危险因素,医护人员应重视BHS>3分的MHD患者肌少症的预防。

Objective To analyze the relationship between hopelessness and sarcopenia in maintenance hemodialysis(MHD)patients and to provide the references for early prevention and intervention of sarcopenia.Methods A survey was conducted in 308 MHD patients treated in a blood purification center in a tertiary hospital in Qingdao by convenience sampling.General information questionnaire,modified quantitative subjective global assessment(MQSGA)questionnaire and Beck hopelessness scale(BHS)were used for the investigation.Sarcopenia was diagnosed by physical examination.Multivariate logistic regression analysis was performed to analyze the effect of hopelessness on sarcopenia.Results Of the 308 respondents,78(25.3%)had sarcopenia and the BHS score was 4.0(1.0,8.0).BHS>3 defining the presence of hopelessness was found in 155(50.3%)respondents.BHS>3 before the inclusion of confounders was a risk factor for sarcopenia in MHD patients(OR=3.656,95%CI:2.079~6.429,P<0.001).On the basis of this model and after inclusion of the independent variables of gender,age,duration of hemodialysis,with or without diabetes and MQSGA score,BHS>3 was still a risk factor for sarcopenia in MHD patients(adjusted OR=2.372,95%CI:1.227~4.588,P<0.001).Conclusion Hopelessness is an independent risk factor for sarcopenia in MHD patients.Medical staff should pay attention to the prevention of sarcopenia in MHD patients with BHS>3.