摘要
目的了解维持性血液透析患者的衰弱现状,探讨其对预后的影响。方法 2010年5月—2013年4月抽取驻马店市第一人民医院、驻马店市中心医院行长期规律维持性血液透析治疗的425例患者作为研究对象。应用衰弱表型(frailty phenotype,FP)对其进行衰弱评估,随访5年内全因死亡情况。结果 (1)最终纳入380例维持性血液透析患者,衰弱评分(2.33±1.53)分,衰弱、衰弱前期和无衰弱发生率分别是44.2%、42.1%和13.7%。衰弱、衰弱前期和无衰弱组维持性血液透析患者的5年累计生存率分别是38.0%、82.5%和90.4%(P<0.001)。(2)在校正了年龄、血清白蛋白、C反应蛋白、Charlson合并症指数及肾小球滤过率估算值等协变量的干扰后,衰弱评分仍是维持性血液透析患者5年生存的独立预测因子(HR=1.311,P<0.001)。(3)衰弱评分预测维持性血液透析患者5年死亡的ROC曲线下面积为0.805,与随机面积0.5比较,差异有统计学意义(P<0.001);以衰弱评分2.5作为切点,预测死亡的敏感性、特异性和一致率分别是0.757、0.738和74.5%。结论维持性血液透析患者具有较高的衰弱患病率,衰弱是影响患者预后的独立危险因素,衰弱评分可以为患者预后的评估提供有价值的信息,建议对维持性血液透析患者开展常规衰弱筛查、评估,并采取有效干预措施,以最大限度改善预后。
Objective To investigate the prevalence of frailty among maintenance hemodialysis （MHD） patients,and the effect of frailty on the prognosis. Methods A total of 425 MHD inpatients from two tertiary grade A hospitals between May 2010 and April 2013 was assessed using a frailty phenotype （FP）. All of them were followed up for 5 years to observe the occurrence of all-cause mortality. Results （1） Clinical data of 380 patients were analyzed. The mean FP score was 2.33±1.53. The prevalence of frailty, pre-frailty and non-frailty were 44.2%, 42.1% and 13.7% respectively. The cumulative survival rate of 5 years in frailty, pre-frailty and non-frailty patients was 38.0%, 82.5% and 90.4% respectively（P〈0.001）. （2） FP score was an independent predictor for 5-year survival rate in MHD inpatients after adjustment of age, albumin（ALB）, C-reactive protein（CRP）, Charlson comorbidity index（CCI） and estimated glomerular filtration rate（eGFR） （HR=1.311, P〈0.001）. （3） The area under receiver operating characteristic （ROC） curves （AUC） of FP score which was used to predict the mortality of MHD patients for 5-year survival rate was 0.805, and when compared that with the random areas of 0.5, the difference was statistically significant （P〈0.001）. When the cut off value of FP score was 2.5 （Youden index was the biggest）,the sensitivity,specificity and concordance rate were 0.757, 0.738 and 74.5%, respectively. Conclusion The prevalence of frailty in MHD patients is high. Frailty is an independent risk factor on the prognosis in MHD patients and FP score can provide valuable information for predicting the prognosis. It is suggested that frailty screening, assessment and intervention should be implemented in the management of MHD patients,which may improve the prognosis maximally.
作者
杜兰玉
胡霞
王向弘
刘海娜
任磊
朱晓秀
段幼萍
DU Lan-yu;HU Xia;WANG Xiang-hong;LIU Hai-na;REN Lei;ZHU Xiao-xiu;DUAN You-ping(Blood Purification Center,The First People＇s Hospital of Zhumadian,Zhumadian 463000,China;Blood Purification Center,the Central Hospital of Zhumadian,Zhumadian 463000,China;Blood Purification Center,The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China)
出处
《护理学报》
2018年第20期37-41,共5页
Journal of Nursing（China）
关键词
维持性血液透析
衰弱
预后
管理
maintenance hemodialysis
frailty
prognosis
management
