肌少症和衰弱在慢性肾脏病患者营养和生活质量间的中介作用

The mediating role of sarcopenia and Frailty in nutrition and quality of life in patients with chronic kidney disease

目的探讨肌少症和衰弱在慢性肾脏病患者营养和生活质量间的中介作用,为制定针对性干预措施,提升患者生活质量做参考。方法采取便利抽样法抽取605例慢性肾脏病患者为研究对象,采用一般资料调查表、肌肉减少症五条目(SARC-F)问卷、Frail衰弱量表和MNA-SF简易微型营养评定量表进行调查。结果605例慢性肾脏病患者营养得分分别与衰弱、肌少症得分呈负相关(r=-0.581,r=-0.561,P<0.001),肌少症得分与衰弱得分呈正相关(r=0.760,P<0.001)。进一步采用回归分析对肌少症在营养与衰弱间的中介效应进行分析,结果显示,方程1中营养得分可以负向预测衰弱得分(β=-0.435,P<0.001),可解释因变量31.9%的变异;方程2中营养得分可负向预测肌少症得分(β=-0.763,P<0.001),可解释因变量30.8%的变异;方程3中营养得分(β=-0.157,P<0.001)与肌少症得分(β=0.365,P<0.001)分别对衰弱得分的负向与正向预测作用显著,可联合解释因变量61.2%的变异。Bootstrap法检验结果显示,营养到衰弱路径的总效应、直接效应及中介效应的95%CI均不包括0,肌少症在营养与衰弱之间的中介作用显著,且中介效应的效应值占总效应值的64.0%。结论肌少症和衰弱在慢性肾脏病患者营养和生活质量间起中介作用,要加强患者营养支持,增强体力,提高患者生存质量。

Objective To investigate the mediating role of sarcopenia and frailty between nutrition and quality of life in patients with chronic kidney disease(CKD),providing a reference for formulating targeted intervention measures to improve patients’quality of life.Methods 605 patients with CKD were selected using convenience sampling method.Data were collected using a general information questionnaire,the SARC-F questionnaire,the Frail Frailty scale and MNA-SF Mini-nutrition Rating Scale.Results The study found that nutritional scores were negatively correlated with scores of frailty and sarcopenia(r=-0.581,r=-0.561,P<0.001),while sarcopenia scores were positively correlated with frailty scores(r=0.760,P<0.001).Further regression analysis highlighted the mediating effect of sarcopenia between nutrition and frailty.Equation 1 showed that nutritional scores negatively predicted frailty scores(β=-0.435,P<0.001),explaining 31.9%of the variance.Equation 2 revealed that nutritional scores negatively predicted sarcopenia scores(β=-0.763,P<0.001),accounting for 30.8%of the variance.In equation 3,nutritional scores(β=-0.157,P<0.001)and sarcopenia scores(β=0.365,P<0.001)significantly predicted frailty scores,together explaining 61.2%of the variance.The Bootstrap method confirmed the significant total,direct,and indirect effects in the nutrition-frailty pathwaywith sarcopenia’s mediating effect accounting for 64.0%of the total effect.Conclusion Sarcopenia and frailty play significant mediating roles between nutrition and quality of life in CKD patients.Healthcare providers should implement personalized interventions based on patients’clinical characteristics,emphasizing nutritional support and physical strength enhancement to improve patients’quality of life.