摘要
目的探讨不同低步速临界值对老年维持性血液透析(maintenance hemodialysis,MHD)患者不良结局的预测价值。方法该研究为前瞻性队列研究。收集2021年3月1日至6月30日在广州医科大学附属第三医院接受MHD治疗的老年(≥60岁)患者的临床资料,包括人口学特征、疾病相关资料和实验室检查结果等。随访时间为1年。采用6 m步行试验测定行走速度(m/s),以0.6 m/s、0.8 m/s、1.0 m/s作为步速的不同临界值进行分组,比较各组间临床资料的差异。采用Logistic回归模型分析低步速与老年MHD患者不良结局(跌倒及住院)发生风险的相关性。采用受试者工作特征(ROC)曲线探讨低步速预测老年MHD患者发生跌倒及住院风险的最佳临界值。结果108例老年MHD患者入选本研究,男57例,女51例,发生跌倒43例(39.8%),发生住院34例(31.5%)。按照步速分组的4组患者在年龄、Charlson合并症指数、合并高血压比例、日常生活需要家属支持比例、步行需要辅助器比例、跌倒比例及住院比例的差异均具有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,步速0.6~<0.8 m/s的患者发生跌倒的风险高于步速>1.0 m/s的患者(OR=3.973,95%CI 1.116~14.136,P=0.033);步速<0.6 m/s的患者发生住院的风险高于步速>1.0 m/s的患者(OR=9.147,95%CI 1.658~50.453,P=0.011)。以步速0.6 m/s、0.8 m/s、1.0 m/s作为分类变量的临界值进行Logistic回归分析,结果显示步速<0.8 m/s(以步速≥0.8 m/s为参照,OR=3.200,95%CI 1.099~9.318,P=0.033)为老年MHD患者发生跌倒的影响因素;步速<0.8 m/s及<0.6 m/s均为老年MHD患者发生住院的影响因素(以步速≥0.8 m/s为参照,OR=3.899,95%CI 1.355~11.216,P=0.012;以步速≥0.6 m/s为参照,OR=4.226,95%CI 1.107~16.140,P=0.035)。ROC曲线结果显示,步速<0.6 m/s、<0.8 m/s及<1.0 m/s预测跌倒风险的ROC曲线下面积分别为0.605(95%CI 0.493~0.717,P=0.065)、0.668(95%CI 0.562~0.774,P=0.003)和0.634(95%CI 0.529~0.739,P=
Objective To explore the predictive value of different critical values of slow gait speed on adverse outcomes in elderly maintenance hemodialysis(MHD)patients.Methods The study was a prospective cohort study.The clinical data of elderly patients(≥60 years old)who received MHD treatment in the Third Affiliated Hospital of Guangzhou Medical University from March 1 to June 30,2021 were collected,including demographic characteristics,diseases-related data and laboratory examination results.The follow-up period was one year.The six-meter walking test was used to measure the gait speed(m/s),and 0.6 m/s,0.8 m/s and 1.0 m/s were used as the different critical values of the gait speed for grouping.The differences of clinical data between different groups were compared.Logistic regression analysis method was used to assess the association of slow gait speed with adverse outcomes(falls and hospitalization)in elderly MHD patients.The receiver operating characteristic(ROC)curve was performed to evaluate the best critical value of slow gait speed to predict the risk of falls and hospitalization.Results A total of 108 elderly patients with MHD were included,with 57 males and 51 females.There were 43 patients(39.8%)of falls and 34 patients(31.5%)of hospitalization.There were statistically significant differences in age,Charlson's comorbidity index,and the proportions of hypertension,family support needed in daily life,walking aids needed,falls and hospitalization events among the four groups of the patients grouped according to gait speed(all P<0.05).Multivariate logistic regression analysis results showed that the risk of falls predicted by gait speed of 0.6-<0.8 m/s was higher than that by gait speed of>1.0 m/s(OR=3.973,95%CI 1.116-14.136,P=0.033).The risk of hospitalization predicted by gait speed<0.6 m/s was higher than that by gait speed>1.0 m/s(OR=9.147,95%CI 1.658-50.453,P=0.011).The logistic regression analysis was performed with the critical values of 0.6 m/s,0.8 m/s and 1.0 m/s as the classification variables,and the
作者
莫江彬
黄丽
秦军建
梁波
Mo Jiangbin;Huang Li;Qin Junjian;Liang Bo(Department of Nephrology,the Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2023年第2期119-125,共7页
Chinese Journal of Nephrology
关键词
肾透析
老年人
预后
步速
Renal dialysis
Aged
Prognosis
Gait speed
