| 许 静,许贤荣,马 晴,陈吕静,孙 彬.尿毒症维持性血液透析患者衰弱的影响因素分析及其对认知功能和微炎症状态的影响[J].,2023,(15):2852-2856 |
| 尿毒症维持性血液透析患者衰弱的影响因素分析及其对认知功能和微炎症状态的影响 |
| Analysis of the Influencing Factors of Frailty in Uremic Maintenance Hemodialysis Patients and Their Effects on Cognitive Function and Micro Inflammatory State |
| 投稿时间：2023-01-28 修订日期：2023-02-24 |
| DOI：10.13241/j.cnki.pmb.2023.15.010 |
| 中文关键词: 尿毒症 维持性血液透析 衰弱 影响因素 认知功能 微炎症 |
| 英文关键词: Uremic Maintenance hemodialysis Frailty Influencing factors Cognitive function Micro inflammatory |
| 基金项目:江苏省卫健委科研项目（H2017023） |
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| 中文摘要: |
| 摘要 目的：探讨尿毒症维持性血液透析（MHD）患者衰弱的影响因素，分析其对认知功能和微炎症状态的影响。方法：回顾性分析2020年4月~2022年7月期间江苏省人民医院收治的105例尿毒症MHD 患者的临床资料，根据衰弱评分将患者分为无衰弱组（n=38）、衰弱前期组（n=34）、衰弱组（n=33）。根据病例资料获取患者的一般资料和实验室资料，对比三组一般资料和实验室资料、认知功能情况；采用多因素Logistic回归分析尿毒症MHD患者衰弱的影响因素。结果：无衰弱组、衰弱前期组、衰弱组的年龄、透析龄、吸烟史、饮酒史、运动情况、合并症、白蛋白（ALB）、血红蛋白（Hb）、前白蛋白（PA）、尿素氮（BUN）、血肌酐（Scr）、25-羟维生素D[25-（OH）D]、甲状旁腺激素（PTH）组间对比有差异（P<0.05）。衰弱组的C反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）高于无衰弱组、衰弱前期组，且衰弱前期组高于无衰弱组（P<0.05）。衰弱组的简易精神状态检查量表（MMSE）评分低于无衰弱组、衰弱前期组，且衰弱前期组低于无衰弱组（P<0.05）。衰弱组的认知功能障碍（POCD）发生率高于无衰弱组、衰弱前期组，且衰弱前期组高于无衰弱组（P<0.05）。多因素Logistic回归分析结果显示：并发症、ALB偏低、Hb偏低、PA偏低、25-（OH）D偏低、CRP偏高、IL-6偏高、TNF-α偏高、MMSE评分偏低是尿毒症MHD患者衰弱危险因素，而经常运动是其保护因素（P<0.05）。结论：尿毒症MHD患者衰弱的发生率较高，可导致患者认知功能下降，微炎症程度升高，与并发症、ALB、Hb、PA、25-（OH）D、CRP、IL-6、TNF-α、MMSE评分、运动情况等多种因素相关。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the influencing factors of frailty in uremic maintenance hemodialysis (MHD) patients, and analyze their effects on cognitive function and micro inflammatory state. Methods: The clinical data of 105 uremic MHD patients who were admitted to Jiangsu Provincial People's Hospital from April 2020 to July 2022 were analyzed retrospectively. The patients were divided into non-frailty group (n=38), pre-frailty group (n=34) and frailty group (n=33) according to the frailty score. The general data and laboratory data of patients were obtained according to the case data, and the general data, laboratory data and cognitive function in the three groups were compared. Multivariate Logistic regression was used to analyze the influencing factors of frailty in uremic MHD patients. Results: There were differences in age, dialysis age, smoking history, drinking history, exercise status, complications, albumin (ALB), hemoglobin (Hb), prealbumin (PA), urea nitrogen (BUN), blood creatinine (Scr), 25-hydroxyvitamin D[25-(OH)D] and parathyroid hormone (PTH) in the non-frailty group, pre-frailty group and frailty group (P<0.05). The C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in frailty group were higher than those in non-frailty group and pre-frailty group, and the pre-frailty group was higher than the non-frailty group (P<0.05). The score of the Mental State Examination Scale (MMSE) in the frailty group was lower than that in the non-frailty group and the pre-frailty group, and the pre-frailty group was lower than the non-frailty group (P<0.05). The incidence of cognitive dysfunction (POCD) in the frailty group was higher than that in the non-frailty group and pre-frailty group, and the pre-frailty group was higher than the non-frailty group (P<0.05). Multivariate Logistic regression analysis showed that complications, lower ALB, lower Hb, lower PA, lower 25-(OH)D, higher CRP, higher IL-6, higher TNF-α and lower MMSE score were the risk factors of frailty in uremic MHD patients, and regular exercise was the protective factor (P<0.05). Conclusion: There is a high incidence of frailty in uremic MHD patients, which can lead to decreased cognitive function and increased micro inflammatory state, which is related to complications, ALB, Hb, PA, 25-(OH)D, CRP, IL-6, TNF-α, MMSE score, exercise conditions and other factors. |
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