握力变化对维持性血液透析患者长期预后的影响  

Influence of changes of handgrip strength on long-term prognosis in patients with maintenance hemodialysis

作　　者：张利平[1] 杨洁[1] 周新[2] 陈天怡 付晨[1] 左力[3] Zhang Liping;Yang Jie;Zhou Xin;Chen Tianyi;Fu Chen;Zuo Li(Department of Nephrology,Beijing Jishuitan Hospital,Beijing 100096,China;Department of Nutrition,Beijing Jishuitan Hospital,Beijing 100096,China;Department of Nephrology,Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京积水潭医院肾内科,北京100096 [2]北京积水潭医院营养科,北京100096 [3]北京大学人民医院肾内科,北京100044

出　　处：《中国医药》2022年第8期1206-1210,共5页China Medicine

基　　金：国家自然科学基金(81870524)。

摘　　要：目的探讨握力变化对维持性血液透析(MHD)患者长期预后的影响。方法纳入2015年7—8月在北京积水潭医院血液净化中心规律血液透析治疗并完成入组后基线和2年后握力测定的患者,根据握力变化值(2年后握力-基线握力)分为握力变小组(握力变化值<0 kg)和握力未变小组(握力变化值≥0 kg),以死亡或随访结束为观察终点,观察握力变化对患者预后的影响。采用Kaplan-Meier生存分析比较2组的生存差异,单因素及多因素Cox回归方法分析患者全因死亡的危险因素。结果 本研究共入组95例MHD患者,其中男52例、女43例,年龄(61±12)岁。以男性握力<27 kg、女性握力<16 kg为低握力诊断标准,入组时低握力患者38例(40.0%),2年后低握力患者40例(42.1%)。握力变小组45例,握力未变小组50例。随访至2021年8月,33例(34.7%)患者死亡。Kaplan-Meier生存分析显示,握力变小组患者总体生存率明显低于握力未变小组患者,差异有统计学意义(Log-rank χ^(2)=15.354,P<0.001);男性患者中握力变小组患者总体生存率明显低于握力未变小组患者,差异有统计学意义(Log-rank χ^(2)=16.060,P<0.001),女性患者中,2组总体生存率差异无统计学意义(Log-rank χ^(2)=1.879,P=0.170)。多因素Cox回归分析显示,低白蛋白水平、入组时握力较低及握力变小是MHD患者全因死亡的独立危险因素(均P<0.05)。握力变小组患者的死亡风险是握力未变小组患者的5.54倍(风险比=5.540,95%置信区间:2.042~15.029,P=0.001)。结论MHD患者低握力发生率较高,低握力及握力变小是MHD患者全因死亡的独立危险因素。Objective To investigate the influence of changes of handgrip strength(HGS) on long-term prognosis of patients with maintenance hemodialysis(MHD). Methods Patients who received MHD in Beijing Jishuitan Hospital from July to August 2015 and finished HGS determine at the baseline and 2 years late were enrolled. According to HGS change value(HGS 2 years late-HGS at baseline), patients were divided into HGS decreased group(HGS change value<0 kg), and HGS not decreased group(HGS change value ≥0 kg). The effect of HGS change on patients′ prognosis was observed with death or the end of follow-up as the endpoint. Kaplan-Meier survival analysis was used to compare the survival rate between the two groups. Univariate and multivariate Cox regression analysis was used to estimate the risk factors of mortality. Results A total of 95 MHD patients were enrolled, including 52 males and 43 females, and the average age was(61±12)years. Taking HGS <27 kg in male or HGS <16 kg in female as diagnostic standard, 38 patients(40.0%) had low HGS at baseline, and 40 patients(42.1%) had low HGS 2 years later. There were 45 cases of HGS decreased group and 50 cases of HGS not decreased group. Until August 2021, 33 patients(34.7%) died. Kaplan-Meier survival analysis showed that the total survival rate in HGS decreased group was lower than that in HGS not decreased group(Log-rank χ^(2)=15.354, P<0.001). In male patients, the difference was statistically significant(Log-rank χ^(2)=16.060, P<0.001), but there was no significant difference in female patients(Log-rank χ^(2)=1.879, P=0.170). Multivariate Cox regression analysis showed that lower albumin level, lower HGS level at enrollment, and HGS decreased were independent risk factors for all-cause death in MHD patients(hazard ratio=5.540, 95% confidence interval: 2.042-15.029, P=0.001). Conclusions The incidence of low HGS is higher in MHD patients. Low HGS level and HGS decreased are independent risk factors for all-cause death in MHD patients.

关 键 词：维持性血液透析 握力 全因死亡 

分 类 号：R459.5[医药卫生—治疗学]