摘要
目的 调查维持性血液透析(maintenance hemodialysis,MHD)患者认知衰弱(cognitive frailty,CF)的现状,分析其影响因素.方法 便利选取2022年7月-10月的258例MHD患者作为研究对象,采用蒙特利尔认知评估量表、衰弱表型、临床痴呆评定量表进行CF的评估,通过单因素和多因素Logistic回归分析确定CF的危险因素,然后建立MHD患者CF风险预测模型并绘制列线图.采用曲线下面积和校准图来评价列线图的性能.结果 所调查MHD患者CF的发生率为16.67％,多因素Logistic回归结果显示小腿围(OR=0.938,95％CI:0.883～0.996,P=0.038)、五次坐立测试时间(OR=1.098,95％CI:1.023～1.178,P=0.009)、肌少症筛查量表得分(OR=1.558,95％CI:1.242～1.954,P＜0.001)、老年抑郁量表得分(OR=1.218,95％CI:1.075～1.380,P=0.002)是MHD患者CF的独立影响因素,建立可视化列线图模型,模型的ROC曲线下面积为0.842(95％CI:0.779～0.905)及Hosmer和Lemeshow拟合优度检验x2=5.163,P=0.740.结论 MHD患者CF发生率较高,医护工作者应予以重视,加强肌少症、抑郁的筛查及相关躯体测量,早期识别及干预,延缓CF的发生及进展.
Abstract
Objective This study aimed to investigate the current status of cognitive frailty(CF)in main-tenance hemodialysis(MHD)patients and to analyze the influencing factors for CF.Methods A total of 258 MHD patients from July to October 2022 were recruited by a convenient sampling method.CF was assessed using the Montreal cognitive assessment(MoCA),frailty phenotype assessment,and clinical dementia rating(CDR)scale.Univariate and multivariate logistic regression analyses were conducted to identify the risk fac-tors for CF.A CF risk prediction model was then developed,and a nomogram was constructed.The perfor-mance of the nomogram was assessed using area under the curve and calibration plots.Results The preva-lence of CF in the surveyed MHD patients was 16.67％.Multivariate logistic regression revealed that the calf muscle circumference(OR=0.938,95％CI:0.883～0.996,P=0.038),five-times-sit-to-stand test(OR=1.098,95％CI:1.023～1.178,P=0.009),the sarcopenia screening scale of SARC-F score(OR=0.938,95％CI:0.883～0.996,P=0.038),and the geriatric depression scale of GDS-15 score(OR=0.938,95％CI:0.883～0.996,P=0.038)were the independent factors influencing CF in MHD patients.Univariate and multivariate logistic re-gression analyses were conducted to identify the risk factors for CF,and a CF risk prediction model and a no-mogram were then developed.The performance assessment of the nomogram showed that the area under the curve was 0.842(95％CI:0.779～0.905)and the Hosmer and Lemeshow goodness of fit test was x2=5.163 and P=0.740.Conclusion The prevalence of CF is high in MHD patients.Healthcare professionals should prioritize the sarcopenia and depression screening and the related somatic measures to enable early identifica-tion and intervention of CF,thus delaying the onset and progression of CF in MHD patients.
基金项目
四川省卫生健康委医学科技项目(2021)(21PJ173)
德阳市人民医院孵化课题(2022)(FHT202212)
NETL
NSTL
万方数据