维持性血液透析患者肌少症发生风险预测模型的构建

Development of a risk prediction model of sarcopenia in patients under maintenance haemodialysis

目的探讨血液透析患者肌少症发生的危险因素的风险预测模型的构建。方法纳入2020年1月至2020年12月于本院进行维持性血液透析治疗的246例患者为研究对象,根据患者是否发生肌少症分为肌少症组(n=58)和非肌少症组(n=188),比较分析两组患者临床资料差异,使用多因素Logistic回归方程分析血液透析患者肌少症发生的危险因素,建立Logistic回归预测模型,并通过绘制风险Nomogram图进行可视化。结果血液透析患者肌少症发生率为23.58%;Logistic回归分析显示,高年龄、较长透析龄、营养状况差是血液透析患者肌少症发生的危险因素(均P<0.05),高四肢骨骼肌量、高肌肉力量是血液透析患者肌少症发生的保护因素(均P<0.05)。风险Nomogram图分析显示,基于血液透析患者肌少症发生的危险因素预测血液透析患者肌少症发生的C-index为0.919;ROC曲线分析显示曲线下面积为0.924,敏感性为91.30%,特异度为77.38%,尤登指数为0.687。结论年龄、透析龄、营养状况及四肢骨骼肌量、肌肉力量是血液透析患者肌少症发生的影响因素,可用于预测血液透析患者肌少症发生。

Objective To explore the risk factors of the haemodialysis-induced sarcopenia in patients under maintenance haemodialysis and the nursing measures to be taken.Methods A total of 246 patients who received maintenance haemodialysis in our hospital between January and December 2020 were included as study subjects.The patients were divided into a sarcopenia group(n=58)and a non-sarcopenia group(n=188).Clinical data of all patients were analysed by single factor analysis for intergroup comparisons.Multi-factor logistic regression equation was employed to analyse the risk factors for the haemodialysis-induced sarcopenia.A logistic regression prediction model was then established,and a Nomogram was plotted for visualisation purpose.Results The incidence rate of sarcopenia in patients under maintenance haemodialysis was 23.58%.Multivariate logistic regression analysis showed that age,years of haemodialysis and nutrition status score were the risk factors for sarcopenia of the patients(all P<0.05).However,large amount of muscle and high muscular strength in limbs were the protective factors(all P<0.05).With the risk Nomogram,based on risk factors for predicting sarcopenia,the C-index was at 0.919 for development of sarcopenia.Of the ROC curve,the area under the curve was 0.924,with 91.30%of sensitivity,77.38%of specificity and the Euden index at 0.687.Conclusions Age,years of haemodialysis,nutrition status score and muscle mass and high muscle strength in limbs are the influencing factors to the occurrence of sarcopenia in the patients under haemodialysis.Above risk factors can be jointly used in the prediction of haemodialysis-induced sarcopenia.