老年血液透析患者合并新型冠状病毒感染后衰弱变化及影响因素的探究  

Frailty trajectory and risk factors in elderly hemodialysis patients after SARS-CoV-2 infection

作　　者：杨一帆 杨华昱[1] 刁宗礼[2] 刘旭[2] 姚兰[1] 王丽妍[2] 石小天 李旭 马清[1] Yang Yifan;Yang Huayu;Diao Zongli;Liu Xu;Yao Lan;Wang Liyan;Shi Xiaotian;Li Xu;Ma Qing(Department of Geriatrics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Nephrology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院老年医学科,北京100050 [2]首都医科大学附属北京友谊医院肾内科,北京100050

出　　处：《中华老年医学杂志》2025年第2期167-172,共6页Chinese Journal of Geriatrics

基　　金：首都卫生发展科研专项(首发2022-2-2028)。

摘　　要：目的探究老年维持性血液透析(MHD)患者合并新型冠状病毒感染后衰弱的变化轨迹及其影响因素。方法前瞻性队列研究。选取2022年12月1日至2022年12月31日在北京友谊医院进行血液透析治疗≥3个月,完成基线衰弱评估(T0),并且合并新型冠状病毒感染的老年患者。衰弱评估采用Fried衰弱表型,将患者分为无衰弱、衰弱前期及衰弱。随访6个月,分别于感染后1个月(T1)、3个月(T2)及6个月(T3)进行衰弱评估。应用重复测量数据的方差分析探究衰弱变化轨迹。采用logistic回归模型分析非衰弱患者进展为衰弱的影响因素。结果研究共纳入幸存老年MHD患者130例,年龄66(63,71)岁,男性62例(47.7%)。感染后6个月时,幸存患者的衰弱评分基本恢复至基线水平,其中72例(55.4%)患者能够维持或改善至无衰弱或衰弱前期,9例(6.9%)患者进展为衰弱前期,18例患者(13.8%)进展为衰弱,31例(23.8%)患者维持衰弱状态。多因素logistic回归分析结果显示,低握力(OR=6.30,95%CI:1.48~26.73)及全因住院(OR=5.01,95%CI:1.19~21.03)是非衰弱患者进展为衰弱的危险因素(P<0.05)。结论多数幸存老年MHD患者在合并新型冠状病毒感染后6个月时衰弱状态恢复至基线水平或较前改善。低握力及全因住院的非衰弱患者更容易进展为衰弱期。Objective To investigate the trajectory of frailty in elderly patients on maintenance hemodialysis(MHD)following SARS-CoV-2 infection and its associated risk factors.Methods This prospective cohort study focused on elderly patients who underwent baseline frailty assessment(T0)during hemodialysis treatment at Beijing Friendship Hospital for over 3 months between December 1st,2022,and December 31th,2022,and were diagnosed with SARS-CoV-2 infection.The Fried Frailty Phenotype was evaluated at 1 month(T1),3 months(T2),and 6 months(T3)post-infection.Frailty trajectory after infection was analyzed using repeated measurement ANOVA.Patients were divided into stable/improvement or exacerbation groups based on their frailty status at T0 and T3,with logistic regression analysis employed to identify risk factors for different frailty trajectories.Results A total of 130 elderly maintenance hemodialysis patients,with a median age of 66 years(range:63-71 years)and 62 males(47.7%),were included in the study.Six months after the infection,a majority of surviving patients saw their frailty scores return to baseline levels.Specifically,72 patients(55.4%)either maintained or improved to robust or pre-frail states,while 9 patients(6.9%)progressed to a pre-frail state,18 patients(13.8%)progressed to a frail state,and 31 patients(23.8%)remained in a frail state.Results from multivariate logistic regression analysis indicated that low grip strength(OR:6.30,95%CI:1.48-26.73)and all-cause hospitalization(OR:5.01,95%CI:1.19-21.03)were identified as risk factors for non-frail patients transitioning to frailty(P<0.05).Conclusions The majority of elderly maintenance hemodialysis patients who survived SARS-CoV-2 infection returned to their baseline level of frailty or showed improvement within 6 months.Non-frail patients with low grip strength or those who were hospitalized were more likely to deteriorate towards frailty.

关 键 词：新型冠状病毒感染 血液透析 衰弱 

分 类 号：R511[医药卫生—内科学] R692.5[医药卫生—临床医学]