老年维持性血液透析患者衰弱发生情况及影响因素分析

Analysis on the development and influencing factors of frailty in elderly patients on maintenance hemodialysis

目的分析老年维持性血液透析患者衰弱的发生情况及影响因素。方法横断面研究,选取我院血液净化科146例老年维持性血液透析患者。采用自制人口学调查表收集患者的一般资料,简易体能测量表(SPPB)评估躯体功能,简易五项评分问卷(SARC-F)作为肌少症快速筛查的工具,采用医院焦虑抑郁量表(HADS)进行焦虑、抑郁的筛选检查。采用FRAIL衰弱量表进行衰弱评估,根据不同衰弱评分分成无衰弱组、衰弱前期组和衰弱组,并分析衰弱的相关影响因素。结果146例血液透析患者中,无衰弱组33例(22.6%),衰弱前期组86例(58.9%),衰弱组27例(18.5%),单因素分析显示:不同衰弱分组在性别(χ2=6.220,P=0.045)、年龄(F=5.197,P=0.007)、体型(χ2=31.927,P<0.001)、SARC-F分(χ2=24.283,P<0.001)、SPPB(χ2=26.773,P<0.001)差异有统计学意义。无衰弱组中肌少症高危患者3例(9.4%),衰弱前期组中肌少症高危13例(40.6%),衰弱期组中肌少症高危患者16例(50%),且衰弱不同分组中肌少症发生的情况比较差异有统计学意义(χ2=27.496,P<0.001)。多因素Logistic回归分析显示:年龄(OR=1.04,95%CI:0.99~1.08,P=0.049)、性别(OR=0.39,95%CI:0.17~0.87,P=0.021)、体型(OR=0.07,95%CI:0.01~0.50,P=0.008)、SARC-F(OR=0.14,95%CI:0.05~0.38,P<0.001)是老年维持性血液透析患者衰弱的独立影响因素(P<0.05)。结论衰弱在老年维持性血液透析患者中的发生率较高,衰弱的发生受性别、年龄、体型、肌少症的影响。

Objective To investigate the development and influencing factors of frailty in elderly patients on maintenance hemodialysis.Methods A cross-sectional survey involved 146 elderly patients on maintenance hemodialysis at the blood purification department of the First Affiliated Hospital of Xi'an Jiaotong University.A self-designed demographic questionnaire was used to collect general information of patients,the Simple Physical Performance Scale(SPPB)was used to assess physical function,the 5-item SARC-F was used as a tool for rapid screening of sarcopenia,and the Hospital Anxiety and Depression Scale(HADS)was used for screening of anxiety and depression.The FRAIL scale was used for frailty assessment and participants were divided into a no frailty group,a pre-frailty group and a frailty group according to different frailty scores.Relevant influencing factors of frailty were analyzed.Results Among 146 hemodialysis patients,33(22.6%)were in the non-frailty group,86(58.9%)in the pre-frailty group,and 27(18.5%)in the frailty group.Univariate analysis showed that there were statistically significant differences in sex(χ2=6.220,P=0.045),age(F=5.197,P=0.007),body type(χ2=31.927,P<0.001),SARC-F score(χ2=24.283,P<0.001)and SPPB score(χ2=26.773,P<0.001)between different groups.There were 3 patients(9.4%)at high risk for sarcopenia in the no frailty group,13 patients(40.6%)at high risk for sarcopenia in the pre-frailty group,and 16 patients(50%)at high risk for sarcopenia in the frailty group,and differences in the occurrence of sarcopenia between the different subgroups of frailty were statistically significant(χ2=27.496,P<0.001).Multifactorial Logistic regression analysis showed that age,(OR=1.04,95%CI:0.99-1.08,P=0.049),sex(OR=0.39,95%CI:0.17-0.87,P=0.021),body size(OR=0.07,95%CI:0.01-0.50,P=0.008),SARC-F(OR=0.14,95%CI:0.05-0.38,P<0.001)were independent influencing factors of frailty in elderly maintenance hemodialysis patients(P<0.05).Conclusions The incidence of frailty is high in elderly patients on maintenance hemodialysis,and the development of frailty is affected by age,body mass index and sarcopenia.