目的 分析老年维持性血液透析(maintenance hemodialysis，MHD)患者铁代谢水平与衰弱的关系，并评估其对衰弱的诊断价值。 方法 采用便利抽样法选取130例老年(年龄≥60周岁)MHD患者，收集临床资料及生化指标，采用衰弱症状评分表进行评分，分为非衰弱组(57例)与衰弱组(73例)，比较2组差异，并通过Logistic回归分析衰弱的危险因素，用受试者工作特征(receiver operating characteristic,ROC)曲线评估诊断效能。 结果 与非衰弱组相比，衰弱组患者的血红蛋白、白蛋白、尿酸及转铁蛋白饱和度(transferrin saturation,TSAT)水平更低(t=1.997、2.214、2.455、4.271，P=0.048、0.029、0.015、＜0.001)，血清铁蛋白(serum ferritin,SF)水平更高(t=-3.244，P=0.002)。多因素Logistic回归显示：SF(OR=1.004，95%CI：1.001～1.007，P=0.009)与TSAT(OR=0.846，95%CI：0.777～0.922，P＜0.001)为衰弱的独立危险因素。ROC曲线分析显示TSAT的AUC为0.747(95%CI：0.663～0.819)，SF为0.631(95%CI：0.542～0.714)。SF临界值为495.5 ng/ml，TSAT临界值为21.7%，二者联合可提高诊断效能[AUC为0.794(95%CI：0.710～0.860)]。 结论 铁代谢水平是老年MHD患者衰弱的影响因素，SF和TSAT联合的回归模型能够提高对衰弱的诊断效能，具有较高的临床应用价值。
Abstract
Objective To analyze the correlation between iron metabolism level and frailty in elderly patients undergoing maintenance hemodialysis (MHD), and to evaluate its diagnostic value for frailty. Methods A convenience sampling method was used to select 130 elderly MHD patients (aged≥60 years). Clinical data and biochemical indicators were collected. Frailty was assessed using a frailty symptom scale, and patients were divided into non-frailty group (57 cases) and frailty group (73 cases). Differences between the two groups were compared. Logistic regression was used to analyze risk factors for frailty, and receiver operating characteristic (ROC) curves were used to evaluate diagnostic performance. Results Compared with the non-frailty group, the frailty group had significantly lower levels of hemoglobin, albumin, uric acid, and transferrin saturation (TSAT) (t=1.997, 2.214, 2.455, 4.271; P=0.048, 0.029, 0.015, ＜0.001, respectively), and significantly higher serum ferritin (SF) levels (t=-3.244, P=0.002). Multivariate logistic regression showed that SF (OR=1.004, 95% CI: 1.001～1.007, P=0.009) and TSAT (OR=0.846, 95% CI: 0.777～0.922, P＜0.001) were independent risk factors for frailty. ROC curve analysis showed an AUC of 0.747 (95% CI: 0.663～0.819) for TSAT and 0.631 (95% CI: 0.542～0.714) for SF. The cut-off value for SF was 495.5 ng/ml, and for TSAT was 21.7%. The combination of the two improved diagnostic performance (AUC = 0.794, 95% CI: 0.710～0.860). Conclusion Iron metabolism levels are influencing factors for frailty in elderly MHD patients. The regression model combining SF and TSAT can improve the diagnostic performance for frailty and has high clinical application value.
关键词
老年 /
维持性血液透析 /
铁代谢 /
衰弱
Key words
Elderly /
Maintenance hemodialysis /
Iron metabolism /
Frailty
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基金
河北省卫生健康委员会医学科学研究课题项目(20230852)
