5种肌少症筛查工具在维持性血液透析患者中的应用效果比较  

Effectiveness comparison of the five screening tools for sarcopenia in maintenance hemodialysis patients

作　　者：王凯选 孙艳[2] 崔超[2] 王思义 石新茹 刘志梅[1] WANG Kai-xuan;SUN Yan;CUI Chao;WANG Si-yi;SHI Xin-ru;LIU Zhi-mei(Department of Nursing,Qingdao Municipal Hospital,Qingdao 266021,China;Blood Purification Center,Qingdao Municipal Hospital,Qingdao 266021,China;School of Nursing,Qingdao University,Qingdao 266071,China)

机构地区：[1]青岛市市立医院护理部,青岛266021 [2]青岛市市立医院血液净化中心,青岛266021 [3]青岛大学护理学院,青岛266071

出　　处：《中国血液净化》2023年第4期273-277,共5页Chinese Journal of Blood Purification

基　　金：青岛市2020年度医药科研指导计划(2020-WJZD011)。

摘　　要：目的比较5种肌少症筛查工具在维持性血液透析(maintenance hemodialysis,MHD)患者中的应用效果。方法便利选取2020年10月~2021年4月在青岛市市立医院血液净化中心接受MHD治疗的340例患者,应用肌少症5条目即力量、步行辅助、从椅子上起身、爬楼梯、跌倒(strength,assistence in walking,rise from a chair,climb stairs and falls,SARC-F)问卷、SARC-F结合小腿围(SARC-F combined with calf circumference,SARC-CalF)问卷、SARC-F结合老龄和体质量指数(SARCF adding elderly and body mass index information,SARC-F+EBM)问卷、迷你肌少症风险评估-7条目(mini sarcopenia risk assessment-7 items,MSRA-7)问卷及迷你肌少症风险评估-5条目(mini sarcopenia risk assessment-5 items,MSRA-5)问卷进行筛查。采用SPSS 22.0和MedCalc 19.6软件绘制受试者工作特征曲线,并计算曲线下面积(AUC);根据约登指数确定各筛查工具的最佳临界值,并计算各工具在原始和最佳临界值时的筛查性能指标。结果有84例(24.71%)患者诊断为肌少症。5种筛查工具对MHD患者肌少症筛查的AUC为0.759~0.872,SARC-CalF问卷的AUC分别高于SARC-F问卷(Z=2.506,P=0.012)、SARC-F+EBM问卷(Z=3.451,P=0.001)、MSRA-7问卷(Z=2.841,P=0.005)及MSRA-5问卷(Z=2.248,P=0.025),且其灵敏度(78.57%)、特异度(89.84%)等指标均较高,对应的最佳临界值为11分。结论SARC-CalF问卷的筛查准确性最高,且在最佳临界值时具有较高的灵敏度和特异度,更适合用于MHD患者肌少症的早期风险筛查。Objective To compare the effect of the five screening tools for sarcopenia in maintenance hemodialysis(MHD)patients.Methods A total of 340 patients treated with MHD in the Blood Purification Center of Qingdao Municipal Hospital from October 2020 to April 2021 were recruited by convenience sampling method.The five items for sarcopenia(strength,assistance with walking,rise from a chair,climb stairs and falls,SARC-F)questionnaire,SARC-F combined with calf circumference(SARC-CalF)questionnaire,SARC-F adding elderly and body mass index information(SARC-F+EBM)questionnaire,mini sarcopenia risk assessment-7 items(MSRA-7)questionnaire,and mini sarcopenia risk assessment-5 items(MSRA-5)questionnaire were used for the screening.Receiver operating characteristic curve was drawn and the area under the curve(AUC)was calculated using SPSS 22.0 and MedCalc 19.6 software.The optimal cut-off values of the five screening tools were determined according to the Yoden index.The performance indicators of the five screening tools at the original cut-off value and the optimal cut-off value were calculated.Results Eighty-four(24.71%)MHD patients were diagnosed with sarcopenia.The AUC of the five screening tools for the MHD patients ranged from 0.759 to 0.872.The AUC of SARC-CalF questionnaire was bigger than that of SARC-F questionnaire(Z=2.506,P=0.012),SARC-F+EBM questionnaire(Z=3.451,P=0.001),MSRA-7 questionnaire(Z=2.841,P=0.005)and MSRA-5 questionnaire(Z=2.248,P=0.025).Furthermore,SARC-CalF had higher sensitivity(78.57%)and specificity(89.84%),with the corresponding optimal cut-off value of 11 points.Conclusion SARC-CalF questionnaire has the highest accuracy for screening sarcopenia with higher sensitivity and specificity at the optimal cut-off value among the five screening tools.Therefore,SARC-CalF is suitable for the screening of early sarcopenia risk in MHD patients.

关 键 词：维持性血液透析 肌肉减少症 筛查 诊断性试验 

分 类 号：R459.5[医药卫生—治疗学]