维持性血液透析患者衰弱影响因素的Meta分析

Meta analysis of influencing factors of frailty in maintenance hemodialysis patients

目的更新维持性血液透析患者衰弱影响因素的系统评价,为制订维持性血液透析患者衰弱早期识别和干预方案提供参考。方法检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Cochrane Library、Web of Science、CINAHL、Embase数据库,从建库至2023年11月22日有关维持性血液透析患者衰弱影响因素的所有文献及其参考文献,由2名研究者按照标准独立筛选文献、提取资料和评价文献质量。本研究采用Stata 15.0软件对衰弱影响因素进行Meta分析。结果共纳入23篇文献,样本量为8644例。Meta分析结果显示,年龄、性别、糖尿病、周围血管疾病、心脏疾病、脑血管疾病、合并症、吸烟史、糖尿病肾病、跌倒史、抑郁、睡眠质量评分、营养评分、血红蛋白是衰弱的危险因素;血清白蛋白、日常活动能力评分、握力、体型标准是衰弱的保护因素(P<0.05)。体型偏瘦、运动锻炼、甲状旁腺激素和透析充分性与衰弱无关(P>0.05)。结论维持性血液透析患者衰弱影响因素较多,未来的研究可参考本研究结果,早期识别衰弱的高危人群,制订衰弱的干预方案,及早进行干预,改善患者的不良结局,提高患者的生存质量。

Objective To update the systematic review of the influencing factors of frailty in maintenance hemodialysis patients,and to provide references for early identification and intervention of frailty in maintenance hemodialysis patients.Methods Databases were searched incuding CNKI,Wanfang,VIP,SinoMed,PubMed,Cochrane Library,Web of Science,CINAHL,and Embase.The time limit was set from the date of database's establishment to November 22,2023.All studies and references about the influencing factors of frailty in maintenance hemodialysis patients were searched.After that,two researchers independently screened,extracted and evaluated the literature according to the criteria.Stata 15.0 software was employed for analysis.Results A total of 23 literature were included,with a sample size of 8644 cases.The results of meta-analysis showed that age,sex,diabetes,peripheral vascular disease,heart disease,cerebrovascular disease,comorbidities,smoking history,diabetic nephropathy,fall history,depression,sleep quality score,nutrition score and hemoglobin are risk factors for frailty;Serum albumin,daily activity score,grip strength and body size were protective factors for frailty(P<0.05).Meanwhile,underweight,exercise,parathyroid hormone and dialysis adequacy were not associated with frailty(P>0.05).Conclusion There are many factors influencing frailty in maintenance hemodialysis patients.Future studies can refer to the results of this study,identify the high-risk groups of faltering early,formulate faltering intervention programs,and intervene early to improve the clinical outcomes of patients,so as to improve the quality of life of patients.