初始血液透析患者的衰弱状态及中医辨证分析  

Investigation of Frailty in Patients on Initial Hemodialysis and Analysis of Their Traditional Chinese Medicine Syndrome Types

作　　者：黄玮莹 朱琴 梁晓晨 陈刚毅[2] HUANG Wei-Ying;ZHU Qin;LIANG Xiao-Chen;CHEN Gang-Yi(The First Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China)

机构地区：[1]广州中医药大学第一临床医学院,广东广州510405 [2]广州中医药大学第一附属医院,广东广州510405

出　　处：《广州中医药大学学报》2020年第10期1864-1870,共7页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广州中医药大学第一附属医院“创新强院”工程系列项目(编号:2017TD07)。

摘　　要：【目的】对初始血液透析患者的衰弱情况进行调查,分析影响其衰弱的相关因素及其中医辨证分型,旨在为管理初始血液透析患者提供参考。【方法】以2018年11月至2019年11月在广州中医药大学第一附属医院肾病科血液净化区初始透析的人群作为研究对象,应用衰弱筛查(FRAIL)积分量表对其衰弱状态进行评估,搜集相关指标并对其进行中医辨证分型;采用Logistic回归分析进一步探讨初始血液透析患者衰弱的影响因素。【结果】(1)纳入研究的162例初始血液透析患者中,衰弱中位评分为2(1,3)分,其中衰弱占比为48.77%(79/162),非衰弱占比为51.23%(83/162)。(2)采用单因素分析方法,得出年龄、合并糖尿病、合并慢性心力衰竭、共病指数、肌酐(CREA)、血清铁(Fe)、转铁蛋白饱和度(TS)、白细胞计数(WBC)、B型脑钠肽(BNP)、血清白蛋白(ALB)可能是衰弱的相关因素(P<0.05或P<0.01)。(3)二元Logistic回归分析得出,年龄、WBC、血红蛋白(HGB)、BNP与初始血液透析患者的衰弱密切相关(P<0.05或P<0.01)。(4)中医辨证分型方面,在本虚证中,2组患者均以脾肾阳虚证为主,但各证型差异均无统计学意义(P>0.05);而在标实证中,2组患者均以湿热证为主,且在湿热证和水气证上差异有统计学意义(P<0.05)。【结论】初始血液透析患者中衰弱普遍存在,纠正贫血、预防感染、提前管理及改善心功能可望减少初始血液透析患者衰弱的发生,同时注重运用清热祛湿法或利水渗湿法祛邪或许对减少初始血液透析患者衰弱的发生有益。Objective To investigate the frailty in patients on initial hemodialysis,and to analyze the associated factors of the frailty and the distribution of traditional Chinese medicine(TCM)syndromes in patients on initial hemodialysis,so as to provide a reference for the management of frail patients on initial hemodialysis. Methods The population undergoing initial dialysis for blood purification in the Nephrology Department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from November of 2018 to November of 2019 served as the research object. The FRAIL score scale was used to evaluate their frailty. The related indicators of the frailty were collected and the syndrome types were differentiated. Logistic regression analysis was adopted for the investigation of the associated factors of the frailty of patients on initial hemodialysis. Results(1)A total of 162 patients were included in the study,and the mean frailty scores were 2(1,3). The frailty proportion in the initial hemodialysis patients accounted for 48.77%(79/162)and the non-frailty proportion accounted for 51.23%(83/162).(2)The results of the single factor analysis showed that the age,being complicated with diabetes,being complicated with chronic heart failure,comorbidity index,creatinine,serum ferritin,transferrin saturation(TS),white blood cell(WBC)count,brain natriuretic peptide(BNP),and serum albumin may be related to the frailty.(3)The results of two-dimensional Logistic regression analysis showed that the age,WBC count,hemoglobin(HGB)and BNP were closely related to the frailty in patients on initial hemodialysis(P<0.05 or P<0.01).(4)In respect of the classification of TCM syndromes, spleen and kidney yang deficiency was predominated in the syndromes of deficiency in the origin of the frailty group and the non-frailty group, and the difference was not statistically significant among various deficiency syndrome types(P>0.05). The damp-heat syndrome was predominated in the syndromes of excess in the superficiality of the frailty

关 键 词：初始血液透析 衰弱 相关影响因素 中医辨证分析 

分 类 号：R692.5[医药卫生—泌尿科学]