血尿素氮与肌酐比值对维持性血液透析患者衰弱的预测价值

Predictive value of blood urea nitrogen/creatinine ratio for frailty in maintenance hemodialysis patients

目的探讨血尿素氮与肌酐比值(blood urea nitrogen/serum creatinine ratio,BUN/Cr)对维持性血液透析患者衰弱的预测价值。方法本研究为单中心横断面研究,纳入2022年5月─2023年11月在山西省汾阳医院行维持性血液透析治疗的患者,根据衰弱量表(fatigue、resistance、ambula-tion、illness、loss of weight,FRAIL)评分,将患者分为衰弱组(FRAIL评分≥3分)、非衰弱组(FRAIL评分≤2分)。收集相关资料,采用单因素分析和二元Logistic回归分析筛选维持性血液透析患者衰弱的影响因素。采用受试者工作特征曲线(ROC)分析BUN/Cr对衰弱的诊断价值。结果共纳入247例患者,衰弱组101例,非衰弱组146例。衰弱组患者年龄、透析龄、C反应蛋白、血尿素氮和BUN/Cr均高于非衰弱组(t/χ^(2)/Z=9.042、-4.612、-2.649、3.096、14.724,P分别为<0.001、<0.001、0.008、0.002、<0.001),衰弱组体质量指数、血红蛋白、血清白蛋白、血肌酐和尿素清除指数水平均低于非衰弱组(t/χ^(2)/Z=-2.294、-2.769、-8.936、-13.126、-5.097,P分别为0.022、0.006、<0.001、<0.001、<0.001)。二元Logistic回归分析结果显示:年龄(OR=1.060,95%CI:1.015~1.107,P=0.009)、透析龄(OR=1.283,95%CI:1.022~1.612,P=0.032)、血清白蛋白(OR=0.841,95%CI:0.748~0.945,P=0.004)、C反应蛋白(OR=1.641,95%CI:1.039~2.591,P=0.033)、尿素清除指数(OR=0.013,95%CI:0.001~0.251,P=0.004)及BUN/Cr(OR=3.478,95%CI:1.455~8.310,P=0.005)是维持性血液透析患者衰弱的独立危险因素。ROC曲线提示BUN/Cr诊断维持性血液透析患者衰弱的最佳临界值为9.42,曲线下面积为0.929(95%CI:0.896~0.962,P<0.001)。结论BUN/Cr对维持性血液透析患者衰弱的发生具有较好的预测价值,可为临床医护人员识别衰弱提供新视角。

Objective To explore the predictive value of blood urea nitrogen/creatinine ratio(BUN/Cr)for frailty in maintenance hemodialysis(MHD)patients.Methods This study was a single centered and cross-sectional study that included 247 patients undergoing MHD treatment in a tertiary hospital in Shanxi province from May 2022 to November 2023.They were divided based on the score of FRAIL scoring system(FRAIL:fatigue,resistance,ambulation,illness,and loss of weight)into two groups,frailty group(FRAIL score≥3,n=101)and non-frailty group(FRAIL score≤2,n=146).Their relevant information was collected.Univariate and binary logistic regression were used to find out the influencing factors for frailty in the MHD patients.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of BUN/Cr for frailty in MHD patients.Results Age,dialysis age,C-reactive protein,blood urea nitrogen and BUN/Cr were higher in frail group than in non-frail group(t/χ^(2)/Z=9.042,-4.612,-2.649,3.096 and 14.724 respectively;P<0.001,<0.001,0.008,0.002 and<0.001 respectively).Body mass index,hemoglobin,serum albumin,creatinine,and urea clearance index were lower in frail group than in non-frail group(t/χ^(2)/Z=-2.294,-2.769,-8.936,-13.126 and-5.097 respectively;P=0.022,0.006,<0.001,<0.001 and<0.001 respectively).Binary logistic regression demonstrated that age(OR=1.060,95%CI:1.015~1.107,P=0.009),dialysis age(OR=1.283,95%CI:1.022~1.612,P=0.032),serum albumin(OR=0.841,95%CI:0.748~0.945,P=0.004),C-reactive protein(OR=1.641,95%CI:1.039~2.591,P=0.033),urea clearance index(OR=0.013,95%CI:0.001~0.251,P=0.004),and BUN/Cr(OR=3.478,95%CI:1.455~8.310,P=0.005)were the independent risk factors for frailty in the MHD patients.ROC curve suggested that the optimal value of BUN/Cr for the diagnosis of frailty in MHD patients was 9.42,with the area under the curve of 0.929(95%CI:0.896~0.962,P<0.001).Conclusion BUN/Cr has a better prediction value for the presence of frailty in MHD patients.It also provides a new perspective for medical professionals to identify frailty.