中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (04): 272-276.doi: 10.3969/j.issn.1671-4091.2024.04.007

• 临床研究 • 上一篇    下一篇

维持性血液透析患者认知衰弱的现状及影响因素分析

易子涵   邹兆华   程新杰   徐兴英   周  娜   罗 欢   卿 伟   

  1. 618000 德阳，德阳市人民医院1护理部 2肾内科 
    646000 泸州，3西南医科大学护理学院
  • 收稿日期:2023-11-02 修回日期:2024-02-02 出版日期:2024-04-12 发布日期:2024-04-12
  • 通讯作者: 卿伟 E-mail:307507834@qq.com
  • 基金资助:
    2021年四川省卫健委医学科技项目(21PJ173)； 2022年德阳市人民医院孵化课题(FHT202212)

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

YI Zi-han, ZOU Zhao-hua, CHENG Xin-jie, XU Xing-ying, ZHOU Na, LUO Huan, QING Wei   

  1. Department of Nursing and 2Department of Nephrology, People’s Hospital of Deyang City, Deyang 618000, China; 3School of Nursing, Southwest Medical University, Luzhou 646000, China
  • Received:2023-11-02 Revised:2024-02-02 Online:2024-04-12 Published:2024-04-12
  • Contact: 618000 德阳，德阳市人民医院2肾内科 E-mail:307507834@qq.com

摘要： 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χ2=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。

关键词: 维持性血液透析, 认知衰弱, 危险因素, 列线图

Abstract: 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 c2=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.

Key words: Maintenance hemodialysis; , Cognitive frailty; , Risk factors; , Nomogram

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