基于老年综合评估的老年慢性肾脏病非透析衰弱患者的多学科干预  

CGA-guided multidisciplinary intervention for frail non-dialysis elderly patients with chronic kidney disease

作　　者：梁玉儿 常晶[2] 高云 王艳非 孙倩美[1] Liang Yu'er;Chang Jing;Gao Yun;Wang Yanfei;Sun Qianmei(Department of Nephrology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020;Department of Comprehensive Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院肾内科,北京100020 [2]首都医科大学附属北京朝阳医院综合科,北京100020

出　　处：《中华老年医学杂志》2025年第4期490-497,共8页Chinese Journal of Geriatrics

基　　金：院多学科临床研究创新团队项目(CYDXK202213);北京市医管局科研培育计划(PX2022009)。

摘　　要：目的探讨基于老年综合评估(Comprehensive Geriatric Assesment,CGA)的多学科干预治疗慢性肾脏病非透析衰弱患者的疗效及对衰弱水平的影响。方法采用随机对照研究方法,选取北京朝阳医院2020年至2021年收治的230例非透析慢性肾脏病3~5期老年衰弱患者,采用随机数表法分为干预组和对照组,每组115例。干预组进行12个月的基于CGA的多学科干预,对照组采取常规治疗。比较两组衰弱转归率、再住院率和全因病死率,记录治疗前和治疗后12个月患者Fried衰弱评分和CGA的变化。结果干预组治疗后Fried评分(2.7±1.2比3.6±1.8,t=97.47,P<0.01)较对照组显著降低,握力[(20.6±8.5)kg比(13.5±8.1)kg,t=6.57,P<0.01]、微营养评估量表(MNA-SF)评分(10.7±4.0比9.1±4.2,t=29.03,P<0.01)、简易精神状态量表(MMSE)评分(24.3±8.6比19.3±9.6,t=96.35,P<0.01)、简易机体功能评估(SPPB)评分(6.8±3.2比3.5±2.9,t=71.97,P<0.01)、日常生活能力量表(ADL)评分(5.4±1.6比3.9±1.6,t=5.75,P<0.01)和体重[(67.2±11.2)kg比(64.0±11.8)kg,t=2.02,P=0.045]较对照组显著提高。干预组衰弱转归率(32.2%比8.0%,χ^(2)=21.40,P<0.01)较对照组高,全因病死率(11.3%比22.6%,χ^(2)=5.22,P=0.022)较对照组降低;干预组和对照组简版老年人抑郁量表(GDS)评分(6.3±3.7比6.0±4.3,t=24.29,P>0.05)和再住院率(25.2%比36.5%,χ^(2)=3.44,P>0.05)、估算肾小球滤过率(eGFR)[(44.1±19.2)ml·(min·1.73m^(2))^(-1)比(39.8±19.0)ml·(min·1.73m^(2))^(-1),t=1.76,P>0.05]和使用工具日常生活能力量表(IADL)评分(5.2±2.2比4.6±2.2,t=1.49,P>0.05)比较差异无统计学意义。结论应用多学科干预治疗老年慢性肾脏病3~5期非透析衰弱患者,有望改善甚至逆转患者衰弱状态,降低全因病死率,改善患者预后。Objective To investigate the effects of Comprehensive Geriatric Assessment(CGA)-guided multidisciplinary interventions on frail non-dialysis elderly patients with chronic kidney disease,while also assessing the influence of different levels of frailty.Methods This study is a randomized controlled trial conducted between 2020 and 2021,involving 230 frail,non-dialysis elderly patients with chronic kidney disease stages 3-5,treated at our hospital.Participants were randomly assigned to either an intervention group or a control group using a random number table method,with 115 patients in each group.The intervention group received multidisciplinary treatment over a period of 12 months,while the control group received standard care.We compared Fried frailty scores,re-hospitalization rates,and all-cause mortality between the two groups,and documented changes in CGA both before treatment and 12 months after treatment.Results After 12 months of treatment,the Fried frail phenotype score was significantly lower in the intervention group(2.7±1.2)compared to the control group(3.6±1.8,t=97.47,P<0.01).Additionally,grip strength in the intervention group was higher(20.6±8.5 kg)than in the control group(13.5±8.1 kg,t=6.57,P<0.01).The scores for the Mini Nutritional Assessment-Short Form(MNA-SF)(10.7±4.0 vs.9.1±4.2,t=29.03,P<0.01),Mini-Mental State Examination Scale(MMSE)(24.3±8.6 vs.19.3±9.6,t=96.35,P<0.01),and Short Physical Performance Battery(SPPB)(6.8±3.2 vs.3.5±2.9,t=71.97,P<0.01)were also significantly higher in the intervention group.Furthermore,the Activity of Daily Living(ADL)score was greater in the intervention group(5.4±1.6)than in the control group(3.9±1.6,t=5.75,P<0.01),as was weight(67.2±11.2 kg vs.64.0±11.8 kg,t=2.02,P=0.045).The frailty reversal rate was significantly higher in the intervention group(32.2%vs.8.0%,χ^(2)=21.4,P<0.01),and the all-cause mortality rate was lower in this group(11.3%vs.22.6%,χ^(2)=5.22,P=0.022).However,there were no significant differences observed in the Geriatric Depr

关 键 词：多学科干预 慢性肾脏病 衰弱 非透析 老年综合评估 

分 类 号：R692[医药卫生—泌尿科学]