高通量血液透析对老年终末期肾脏病患者衰弱的影响

doi:10.3969/j.issn.1004-583X.2021.04.007

摘要/Abstract

摘要：

目的分析高通量血液透析(high-flux hemodialysis, HFHD)与低通量血液透析(low-flux hemodialysis, LFHD)对老年终末期肾脏病(end-stage renal disease, ESRD)患者衰弱的影响。方法 2018年11月-2019年5月收治的86例年龄>60岁ESRD患者。透析前评估患者衰弱状况,将衰弱和非衰弱患者分别按照奇数入LFHD组,偶数入HFHD组,每组43例。收集两组治疗前后的一般资料及辅助检查结果,对比衰弱发生率的差异及影响因素。结果与LFHD组相比, HFHD组的衰弱发生率低(P<0.05), 血磷(P)、甲状旁腺激素(PTH)、β₂-微球蛋白(β₂-MG)、维生素B₁₂(VitB₁₂)、甘油三酯(TG)、肌酐(SCr)、尿素(Urea)、白蛋白(ALB)均明显下降(P<0.05);而血红蛋白(Hb)、高密度脂蛋白胆固醇(HDL-C)、红细胞压积(HCT)均显著增加(P<0.05)。Logistic回归分析显示年龄、P 、PTH、β₂-MG、 Hb、ALB是两组衰弱的共同影响因素(P<0.05)。结论高通量血液透析对老年ESRD患者的衰弱状况有改善作用。

关键词: 衰弱, 高通量血液透析, 因素分析, 统计学, 老年人

Abstract:

Objective To analyze the effects of high-flux hemodialysis(HFHD) and low-flux hemodialysis(LFHD) on the frailty of elderly patients with end-stage renal disease(ESRD). Methods The study involved 86 patients with ESRD over 60 years who were treated from Nov 2018 to May 2019. The debilitating condition of the patients were assessed before dialysis, the patients were divided into LFHD group and HFHD group according to odd and even ways, 43 cases in each group; and the general information and auxiliary examination results between the two groups before and after treatment were collected to compare the difference in the incidence of frailty and influencing factors. Results The incidence of frailty(P<0.05), blood phosphorus(P), parathyroid hormone(PTH), β₂-microglobulin(β₂-MG), vitamin B₁₂(VitB₁₂), triglyceride(TG), creatinine(SCr),urea (Urea) and albumin(ALB) in HFHD group were significantly decreased than those in LFHD group(P<0.05), while hemoglobin(Hb), high-density lipoprotein(HDL-C) and hematocrit(HCT) in HFHD group significantly increased than those in LFHD group (P<0.05). Logistic regression analysis showed that age, P, PTH, β₂-MG, Hb, ALB were the common influencing factors of frailty in both groups(P<0.05). Conclusion HFHD can improve the frailty of elderly ESRD patients.

Key words: frailty, high flux hemodialysis, factors analysis, statistics, elderly

中图分类号:

R692.5

张金金, 靳蕊霞, 孙伟. 高通量血液透析对老年终末期肾脏病患者衰弱的影响[J]. 临床荟萃, 2021, 36(4): 328-331.

Zhang Jinjin, Jin Ruixia, Sun Wei. High-flux hemodialysis in the frailty of elderly patients with end-stage renal disease[J]. Clinical Focus, 2021, 36(4): 328-331.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.04.007

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I4/328

图/表 7

参考文献 13

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组别	例数	K(mmol/L)		Na(mmol/L)		Ca(mmol/L)		P(mmol/L)
组别	例数	治疗前	透析后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
HFHD	43	4.26±0.69	3.77±0.80^*	138.49±4.59	140.37±4.78	2.10±0.18	2.08±0.09	2.15±0.40	1.89±0.33^*
LFHD	43	4.40±0.80	3.71±0.41^*	139.16±3.44	138.16±3.07	2.13±0.13	2.09±0.17	2.12±0.44	2.20±0.51^*
t值		-0.888	0.267	-0.771	-1.698	-0.942	-3.730	0.350	-3.002
P值		0.377	0.791	0.443	0.089	0.346	0.710	0.727	0.003

组别	例数	K(mmol/L)		Na(mmol/L)		Ca(mmol/L)		P(mmol/L)
组别	例数	治疗前	透析后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
HFHD	43	4.26±0.69	3.77±0.80^*	138.49±4.59	140.37±4.78	2.10±0.18	2.08±0.09	2.15±0.40	1.89±0.33^*
LFHD	43	4.40±0.80	3.71±0.41^*	139.16±3.44	138.16±3.07	2.13±0.13	2.09±0.17	2.12±0.44	2.20±0.51^*
t值		-0.888	0.267	-0.771	-1.698	-0.942	-3.730	0.350	-3.002
P值		0.377	0.791	0.443	0.089	0.346	0.710	0.727	0.003

组别	例数	Urea(mmol/L)		SCr(mmol/L)		UA(mmol/L)		VitB₁₂ (pmol/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
HFHD	43	26.86±8.53	23.62±4.65^*	862.77±264.91	647.33±88.54^*	441.47±152.55	335.16±130.64^*	404.48±146.47	268.49±112.37^*
LFHD	43	26.81±4.14	25.45±3.30^*	822.88±157.41	709.60±120.81^*	433.79±98.52	342.07±117.31^*	421.44±59.36	458.93±123.09
t值		-0.082	2.155	-0.268	2.675	-0.086	-0.258	0.679	-7.921
P值		0.935	0.037	0.789	0.011	0.931	0.797	0.499	0.000

组别	例数	Urea(mmol/L)		SCr(mmol/L)		UA(mmol/L)		VitB₁₂ (pmol/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
HFHD	43	26.86±8.53	23.62±4.65^*	862.77±264.91	647.33±88.54^*	441.47±152.55	335.16±130.64^*	404.48±146.47	268.49±112.37^*
LFHD	43	26.81±4.14	25.45±3.30^*	822.88±157.41	709.60±120.81^*	433.79±98.52	342.07±117.31^*	421.44±59.36	458.93±123.09
t值		-0.082	2.155	-0.268	2.675	-0.086	-0.258	0.679	-7.921
P值		0.935	0.037	0.789	0.011	0.931	0.797	0.499	0.000

组别	例数	PTH(pg/ml)		β₂-MG (mg/L)			RBC(×10¹²/L)		WBC(×10⁹/L)
组别	例数	治疗前	治疗后	治疗前	治疗后		治疗前	治疗后	治疗前	治疗后
HFHD	43	404.48±146.47	268.49±112.37^*	31.67±8.75		19.71±5.04^*	7.10±2.51	7.22±2.31^*	7.10±2.51	7.22±2.31
LFHD	43	421.44±59.36	458.93±123.09^*	32.76±6.33		34.85±5.87	7.18±2.37	7.31±1.70	7.18±2.37	7.31±1.70
t值		-1.339	7.493	-0.664		12.832	-0.174	1.398	-0.142	-0.212
P值		0.181	0.000	0.509		0.000	0.862	0.166	0.888	0.832