中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (04): 307-312.doi: 10.3969/j.issn.1671-4091.2024.04.015

• 护理研究 • 上一篇    下一篇

维持性血液透析患者肌少症影响因素及预后研究

钟志聪    吴一帆    魏 琳   

  1. 410208 长沙，1湖南中医药大学护理学院 
    510120 广州，2广州中医药大学第二附属医院护理部 中医证候全国重点实验室
  • 收稿日期:2023-10-18 修回日期:2024-01-08 出版日期:2024-04-12 发布日期:2024-04-12
  • 通讯作者: 魏琳 E-mail:weilin22@126.com
  • 基金资助:
    国家重点研发计划项目(2019YFE0196300)；省部共建中医湿证国家重点实验室，2022年度第二批开放课题（SZ2022KF15）

The influencing factors and prognosis of sarcopenia in maintenance hemodialysis patients

ZHONG Zhi-cong, WU Yi-fan, WEI Lin   

  1. School of Nursing, Hunan University of Traditional Chinese Medicine, Changsha 410208, China; 2National Key Laboratory of Traditional Chinese Medicine Syndrome, Nursing Department, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
  • Received:2023-10-18 Revised:2024-01-08 Online:2024-04-12 Published:2024-04-12
  • Contact: 510120 广州，2广州中医药大学第二附属医院护理部 中医证候全国重点实验室 E-mail:weilin22@126.com

摘要： 目的 探讨维持性血液透析(maintenance hemodialysis，MHD)患者肌少症患病率、影响因素及生存预后。 方法 采用便利抽样法选取广州中医药大学第二附属医院透析科2021年12月─2023年8月177例MHD患者作为研究对象，分析肌少症发生情况，并进行单因素与多因素Logistic回归分析，探讨独立影响因素，采用 Kaplan-Meier 法分析MHD肌少症与非肌少症患者12个月生存预后。 结果 177例MHD患者中，65例发生肌少症(36.72%),112例未发生肌少症(63.28%)。多因素Logistic回归分析发现年龄(OR=1.078，95% CI：1.030～1.143，P=0.002)、透析龄(OR=1.019,95% CI：1.008～1.030，P=0.001)、合并糖尿病(OR=4.802,95% CI：1.484～15.603，P=0.009)、低体力活动水平(OR=4.222,95% CI：1.013～17.653，P=0.048)是肌少症发生的独立影响因素。随访12个月后MHD肌少症患者生存率为69.23%(45/65)，非肌少症患者生存率为89.29%(100/112)，Kaplan-Meier生存分析发现非肌少症组患者的总体生存率高于肌少症组(Log-rank χ2=11.272，P＜0.001)；四肢骨骼肌质量指数(appendicular skeletal mu-scle mass index,ASMI)达标组与不达标组患者总体生存率比较不存在显著差异(Log-rank χ2=2.374，P=0.123)；握力达标组患者总体生存率高于不达标组(Log-rank χ2=10.086，P=0.001)；5次起坐测试达标组患者总体生存率高于不达标组(Log-rank χ2=19.668，P＜0.001)。 结论 MHD患者肌少症患病率高，12个月生存率低，医护人员应尽早对此类人群进行肌少症筛查，及时采取有效的干预措施，改善其预后。

关键词: 血液透析, 肌少症, 影响因素, 生存率

Abstract: Objective  To investigate the prevalence, risk factors and survival prognosis of sarcopenia in maintenance hemodialysis(MHD)patients.  Methods  A total of 177 MHD patients from December 2021 to August 2023 were selected as the study objects by convenience sampling method. The incidence of sarcopenia was analyzed, and univariate and multivariate logistic regression analyses were performed to explore the independent influencing factors for sarcopenia. Kaplan-Meier curve was used to analyze the 12-month survival prognosis of MHD patients with and without sarcopenia.   Results   ①In the 177 MHD patients, sarcopenia was found in 65 patients(36.72%) and was not found in 112 patients(63.28%). ②Multivariate logistic regression showed that age (OR=1.078，95% CI:1.030～1.143，P=0.002),dialysis months (OR=1.019, 95% CI:1.008～1.030,P=0.001),diabetes mellitus(OR=4.802,95% CI:1.484～15.603,P=0.009), lower level of physical activity (OR=4.222,95% CI:1.013～17.653，P=0.048) were the independent factors for sarcopenia. ③After 12 months of follow-up, the survival rate of MHD patients with sarcopenia was 69.23% (45/65), and that of the patients without sarcopenia was 89.29% (100/112). Kaplan-Meier survival analysis found that the overall survival rate of non-sarcopenia group was significantly higher than that of sarcopenia group (log-rank test,χ2=11.272,P＜0.001). There was no significant difference in overall survival rate between appendicular skeletal muscle mass index (ASMI) compliant group and non-compliant group (log-rank test, χ2=2.374, P=0.123). The overall survival rate of grip strength compliant group was significantly higher than that of grip strength non-compliant group (log-rank test, χ2=10.086, P=0.001). The overall survival rate in the 5-time sitting-standing test compliant group was significantly higher than that in the non-compliant group (log-rank test, χ2=19.668,P＜0.001).   Conclusion   The prevalence of sarcopenia is higher in MHD patients, and the survival rate in the follow-up period of 12 months is low in in MHD patients with sarcopenia. Medical staff should make early diagnosis of sarcopenia in MHD patients and take effective intervention measures to improve their prognosis.

Key words: Hemodialysis, Sarcopenia, Influencing factor, Survival rate

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