握力对维持性血液透析患者长期生存的预测价值  

Value of handgrip strength in predicting the mortality of hemodialysis patients

作　　者：彭晓艳[1] 贾愚[4] 夏京华[1] 石涛[1] 陈伟[2] 鲁重美[3] 李雪梅[1] 陈丽萌[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院肾内科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院肠内肠外营养科,北京100730 [3]中国医学科学院北京协和医学院北京协和医院消化内科,北京100730 [4]中国医学科学院北京协和医学院北京协和医院护理学院,北京100730

出　　处：《中华肾脏病杂志》2015年第3期166-172,共7页Chinese Journal of Nephrology

基　　金：科技部“973”项目（2012CB517803）;国家自然科学基金（81170674,81470937）

摘　　要：目的 观察维持性血液透析（HD）患者死亡的危险因素,比较包括握力在内的不同营养评估指标对长期预后的预测价值.方法 收集2008年7～9月北京协和医院血液透析中心规律透析的108例患者的临床资料,通过主观综合性营养评估、人体测量和生化指标进行营养状态评价.随访72个月,以死亡为观察终点,单因素及多因素Cox回归分析患者全因和心脑血管死亡的危险因素,评价不同营养指标预测死亡的价值.结果 108例HD患者平均年龄（57.6± 13.0）岁,随访6年后,35例（32.4％）患者死亡,其中62.9％ （22/35）死于心脑血管事件.年龄增加、残余尿量少、血肌酐水平低、前白蛋白水平低和平均小腿围低是全因死亡的危险因素,握力较低人群的全因死亡风险（HR=2.842,95％CI 1.390 ～ 5.811）和心脑血管事件死亡风险（HR=2.826,95％CI 1.150～ 6.947）约为握力较高人群的2.8倍.调整性别、年龄、心脑血管及糖尿病史、体质量指数（BMI）、透析时间、尿素清除指数（Kt/V）、标准蛋白代谢率（nPCR）和前白蛋白后,低握力是全因死亡的独立危险因素（HR=2.505,95％CI 1.112～ 5.642）.握力用于预测男性和女性全因死亡的受试者工作特征曲线（ROC）下面积分别是0.705和0.682.结论 低握力是维持性血液透析患者死亡的独立危险因素.Objective To analyze the risk factors of mortality among patients treated by maintenance hemodialysis （MHD）,and identify whether handgrip strength （HGS） or other nutrient markers could predict the mortality independently.Methods One hundred and eight patients receiving regular MHD in Peking Union Medical College Hospital from July to September,2008 were involved.Baseline data including clinical data,nutrient data such as subjective global assessment,anthropometrics and biochemical measurement were collected.After being followed for 72 months,the patients＇ mortality and morbidity of cardiovascular event were recorded.Cox regression model was used to estimate the risk factors of mortality.Results The average age of 108 MHD patients was （57.6± 13.0） years.During the 6-years following up,35 patients died （32.4%）,of whom 62.9% died of cardiovascular events.Among variables,patients＇ age,residual urine volume,serum creatinine level,prealbumin level and mean leg circumference were risk factors for all-cause mortality.The patient with lower HGS bore higher risk for all-cause mortality （HR=2.842,95%CI 1.390-5.811） and cardiovascular death （HR=2.826,95%CI 1.150-6.947）.After adjusting gender,age,history of cardiovascular disease and diabetes,body mass index （BMI）,dialysis vintage,Kt/V,nPCR and prealbumin,lower handgrip strength was still an independent risk factor of all-cause mortality （HR=2.505,95%CI 1.112-5.642）.In prediction for all-cause mortality by HGS,the area under the receiver operating characteristic curve （ROC） were 0.705 and 0.682 among men and women respectively.Conclusion Lower handgrip strength can predict mortality of maintenance hemodialysis patients independently.

关 键 词：血液透析 握力 危险因素 生存分析 

分 类 号：R459.5[医药卫生—治疗学]