维持性血液透析老年患者蛋白质能量消耗对衰弱的影响

Influence of protein energy wasting on frailty in elderly patients on maintenance hemodialysis

目的探讨维持性血液透析(maintenance hemodialysis,MHD)老年患者蛋白质能量消耗(protein-energy wasting,PEW)与衰弱的相关性及衰弱的影响因素。方法收集2021年9~12月在北京怀柔医院60岁及以上规律血液透析治疗的患者临床资料。据Fried评价标准,将患者分为衰弱组和非衰弱组,比较两组患者的差异,Spearman相关分析显示蛋白质能量消耗及衰弱的相关性。采用二元Logistic回归分析探讨MHD老年患者衰弱的影响因素。结果纳入81例患者,衰弱组患者36例(44.4%)。衰弱组年龄大、蛋白质能量消耗(PEW)比例高、透析月龄长、原发病为糖尿病肾病及超敏C反应蛋白(CRP)比例高,尿素氮清除指数(KT/V)、血红蛋白、人血白蛋白、体重指数、上臂围、上臂肌围(MAMC)低、与非衰弱组比差异均有统计学意义(均P<0.05)。Fried衰弱表型与年龄呈正相关(r=0.021,P=0.047),与血红蛋白(r=-0.329,P=0.003)、人血白蛋白(r=0.021,P=0.047)、体重指数(r=0.021,P=0.047)、肱三头肌皮褶厚度(TSF)(r=-0.274,P=0.013)、上臂围(r=-0.554,P<0.001)、MAMC(r=-0.293,P=0.008)呈负相关。用衰弱为因变量,构建Logistic回归方程。结果发现年龄、透析月龄、KT/V、人血白蛋白、CRP评分是老年MHD患者发生衰弱的独立影响因素。结论MHD老年患者PEW与衰弱并存且相互影响。临床医生应加强对老年透析患者衰弱及蛋白质能量消耗的评估,及早发现并干预,避免不良的临床结局。

Objective To explore the correlation between protein energy wasting(PEW)and frailty in elderly patients on maintenance hemodialysis(MHD)and influencing factors of frailty.Methods Clinical data of patients over 60 who had received regular hemodialysis treatment at Beijing Huairou Hospital between September to December 2021 were collected.According to Fried's evaluation criteria,patients were divided into a frailty group and a non-frailty group,and differences between the two groups were compared.Spearman correlation analysis was conducted to assess the correlation between protein energy wasting and frailty.Logistic regression was used to analyze the influencing factors of frailty in elderly patients on MHD.Results A total of 81 MHD patients enrolled in this study,with 36 in the frailty group.The frailty group was older,had a higher proportion of patients with PEW,and underwent more months of dialysis,with a higher proportion of patients with diabetic nephropathy as the primary disease,having high levels of C-reactive protein(CRP),and having low KT/V,hemoglobin,albumin,body mass index(BMI),mid-arm circumference(MAC)and mid-arm muscle circumference(MAMC),and the differences with the control group were statistically significant(all P<0.05).The Fried frailty phenotype was positively correlated with age(r=0.021,P=0.047),but negatively associated with HGB(r=-0.329,P=0.003),albumin(r=0.021,P=0.047),BMI(r=0.021,P=0.047),TSF(r=-0.274,P=0.013),MAC(r=-0.554,P<0.001)and MAMC(r=-0.293,P=0.008).A Logistic regression equation was constructed using frailty as the dependent variable.The results showed that age,months of dialysis,KT/V,serum albumin and CRP were independent factors influencing the development of frailty in elderly patients with MHD.Conclusions PEW and frailty coexist and interact with each other in elderly patients with MHD.Clinicians should place emphasis on the assessment of frailty and protein energy wasting in elderly dialysis patients and achieve early detection and intervention to avoid adverse clinical outcomes.