摘要
背景 慢性肾脏疾病成为全球关注的重点问题,而我国肾病患病率为全球最高.约有 89.5%的患者需要进行血液透析.近年来,维持性血液透析(MHD)患者衰弱的患病率明显上升,严重影响了患者的生活质量及预后.目的 通过Meta分析探讨我国MHD患者衰弱患病率及影响因素.方法 系统检索中国知网、维普网、中国生物医学文献数据库、万方数据知识服务平台、Web of Science、PubMed、Cochrane Library、Embase、CINAHL数据库中有关中国MHD患者衰弱患病率及影响因素的横断面研究和队列研究,检索时限为建库至 2023 年 7 月.由 2 名研究者独立进行文献筛选、资料提取及质量评价,使用Stata 15.0 软件进行Meta分析.结果 纳入 32 篇文献,包括6 746 例患者,其中衰弱患者 2 566 例,涉及影响因素 37 项.Meta分析结果显示:我国MHD患者衰弱患病率为 37.4%(95%CI=30.3%～44.5%).年龄(OR=1.09,95%CI=1.06～1.13)、年龄>60 岁(OR=3.81,95%CI=2.31～6.30)、女性(OR=2.13,95%CI=1.47～3.08)、独 居(OR=2.42,95%CI=1.22～4.80)、睡 眠(OR=1.28,95%CI=1.08～1.50)、抑郁(OR=1.97,95%CI=1.26～3.08)、透析龄(OR=3.25,95%CI=1.82～5.79)、社会支持(低水平)(OR=1.99,95%CI=1.39～2.86)、合 并 并 发 症(OR=1.79,95%CI=1.40～2.30)、营 养 不 良(OR=1.17,95%CI=1.07～1.28)、Charlson合并症指数(CCI)(OR=1.32,95%CI=1.01～1.71)、C反应蛋白(CRP)(OR=1.15,95%CI=1.09～1.21)、血红蛋白(Hb)<110 g/L(OR=2.70,95%CI=1.67～4.36)、合并糖尿病(OR=2.16,95%CI=1.48～3.16)、合并脑血管疾病(OR=2.66,95%CI=1.85～3.82)、合并冠心病(OR=3.50,95%CI=2.15～5.70)是MHD衰弱的危险因素(P<0.05);高经济收入(OR=0.02,95%CI=0.01～0.14)、社会支持(高水平)(OR=0.86,95%CI=0.76～0.97)、营养良好(OR=0.47,95%CI=0.26～0.85)、日常生活能力(ADL)(OR=0.80,95%CI=0.70～0.91)、血清白蛋白(ALB)(OR=0.84,95%CI=0.77～0.91)、Hb≥110 g/L(OR=0.70,95%CI=0.54～0.90)、25-羟维生素D[25-(OH)VD](OR=0.69,95%CI=0.49～0.98)是MHD衰弱的保护因素(P<0.05).结论 我国MHD患者衰弱患病率处于较高水平,其中年龄、女性、独居、经济收入、睡眠、抑郁、透析龄、社会支持、合并并发症、营养风险评分、ADL、CCI、CRP、ALB、Hb、25-(OH)VD、合并糖尿病、合并脑血管疾病和合并冠心病为我国MHD患者衰弱的主要影响因素,今后需要对血液透析衰弱的患者做到早筛查、早干预,减缓或避免其发生.
Abstract
Background Chronic kidney disease has become a major global concern,and the prevalence of kidney disease in China is the highest in the world.About 89.5%of patients require hemodialysis.In recent years,the prevalence of frailty in maintenance hemodialysis(MHD)patients has risen significantly,seriously affecting the quality of life and prognosis of patients.Objective To explore the prevalence of frailty and the influencing factors of maintenance hemodialysis patients in China through Meta-analysis.Methods Cross-sectional and cohort studies on the prevalence and influencing factors of frailty in Chinese MHD patients were systematically searched in CNKI,VIP,CBM,Wanfang Data,Web of Science,PubMed,Cochrane Library,Embase,and CINAHL databases.The search deadline was from the respective databases to July 2023.Literature screening,data extraction and quality assessment were performed independently by two researchers.Stata 15.0 was used for meta-analysis.Results Thirty-two papers were included,and including 6 746 patients,among which 2 566 experienced frailty,involving 37 influencing factors.Meta-analysis showed that the prevalence of frailty in MHD patients in China was 37.4%(95%CI=30.3%-44.5%).Age(OR=1.09,95%CI=1.06-1.13),age>60 years(OR=3.81,95%CI=2.31-6.30),female(OR=2.13,95%CI=1.47-3.08),living alone(OR=2.42,95%CI=1.22-4.80),sleep(OR=1.28,95%CI=1.08-1.50),depression(OR=1.97,95%CI=1.26-3.08),age on dialysis(OR=3.25,95%CI=1.82-5.79),social support(low level)(OR=1.99,95%CI=1.39-2.86),comorbidities(OR=1.79,95%CI=1.40-2.30),malnutrition(OR=1.17,95%CI=1.07-1.28),Charlson Comorbidity Index(CCI)(OR=1.32,95%CI=1.01-1.71),C-reactive protein(CRP)(OR=1.15,95%CI=1.09-1.21),hemoglobin(Hb<110 g/L)(OR=2.70,95%CI=1.67-4.36),comorbid diabetes(OR=2.16,95%CI=1.48-3.16),comorbid cerebrovascular disease(OR=2.66,95%CI=1.85-3.82),comorbid coronary heart disease(OR=3.50,95%CI=2.15-5.70)were risk factors for frailty MHD(P<0.05);economic income(OR=0.02,95%CI=0.01-0.14),social support(high level)(OR=0.86,95%CI=0.76-0.97),well nutrition(OR=0.47,95%CI=0.26-0.85),ability to perform activities of daily living(ADL)(OR=0.80,95%CI=0.70-0.91),serum albumin(ALB)(OR=0.84,95%CI=0.77-0.91),Hb≥110 g/L(OR=0.70,95%CI=0.54-0.90),25-hydroxyvitamin D[25-(OH)VD](OR=0.69,95%CI=0.49-0.98)were protective factors for MHD frailty(P<0.05).Conclusion The prevalence of frailty in MHD patients in China is at a high level,in which age,female,living alone,economic income,sleep,depression,age on dialysis,social support,comorbidities,nutritional risk scores,ADL,CCI,CRP,ALB,Hb,25-(OH)VD,comorbid diabetes mellitus,comorbid cerebrovascular disease,and comorbid coronary heart disease are mainly factors influencing of MHD frailty patients in China,and in the future,there is a need for early screening and intervention to slow down or avoid the occurrence of hemodialysis frailty in patients.
基金项目
成都市科技计划(2022-YF05-01595-SN)
维普
万方数据