维持性血液透析患者认知衰弱的现状及影响因素分析

Influencing factors and interventional measures for cognitive frailty in patients on maintenance hemodialysis

目的调查维持性血液透析(maintenance hemodialysis,MHD)患者认知衰弱(cognitive frailty,CF)的现状,分析其影响因素。方法便利选取2022年7月─10月的258例MHD患者作为研究对象,采用蒙特利尔认知评估量表、衰弱表型、临床痴呆评定量表进行CF的评估,通过单因素和多因素Logistic回归分析确定CF的危险因素,然后建立MHD患者CF风险预测模型并绘制列线图。采用曲线下面积和校准图来评价列线图的性能。结果所调查MHD患者CF的发生率为16.67%,多因素Logistic回归结果显示小腿围(OR=0.938,95%CI:0.883~0.996,P=0.038)、五次坐立测试时间(OR=1.098,95%CI:1.023~1.178,P=0.009)、肌少症筛查量表得分(OR=1.558,95%CI:1.242~1.954,P<0.001)、老年抑郁量表得分(OR=1.218,95%CI:1.075~1.380,P=0.002)是MHD患者CF的独立影响因素,建立可视化列线图模型,模型的ROC曲线下面积为0.842(95%CI:0.779~0.905)及Hosmer和Lemeshow拟合优度检验χ^(2)=5.163,P=0.740。结论MHD患者CF发生率较高,医护工作者应予以重视,加强肌少症、抑郁的筛查及相关躯体测量,早期识别及干预,延缓CF的发生及进展。

Objective This study aimed to investigate the current status of cognitive frailty(CF)in maintenance hemodialysis(MHD)patients and to analyze the influencing factors for CF.Methods A total of 258 MHD patients from July to October 2022 were recruited by a convenient sampling method.CF was assessed using the Montreal cognitive assessment(MoCA),frailty phenotype assessment,and clinical dementia rating(CDR)scale.Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for CF.A CF risk prediction model was then developed,and a nomogram was constructed.The performance of the nomogram was assessed using area under the curve and calibration plots.Results The prevalence of CF in the surveyed MHD patients was 16.67%.Multivariate logistic regression revealed that the calf muscle circumference(OR=0.938,95%CI:0.883~0.996,P=0.038),five-times-sit-to-stand test(OR=1.098,95%CI:1.023~1.178,P=0.009),the sarcopenia screening scale of SARC-F score(OR=0.938,95%CI:0.883~0.996,P=0.038),and the geriatric depression scale of GDS-15 score(OR=0.938,95%CI:0.883~0.996,P=0.038)were the independent factors influencing CF in MHD patients.Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for CF,and a CF risk prediction model and a nomogram were then developed.The performance assessment of the nomogram showed that the area under the curve was 0.842(95%CI:0.779~0.905)and the Hosmer and Lemeshow goodness of fit test was χ^(2)=5.163 and P=0.740.Conclusion The prevalence of CF is high in MHD patients.Healthcare professionals should prioritize the sarcopenia and depression screening and the related somatic measures to enable early identification and intervention of CF,thus delaying the onset and progression of CF in MHD patients.