老年维持性血液透析病人内在能力与人体成分的相关性研究

doi:10.3969/j.issn.1003-9198.2025.11.011

摘要/Abstract

摘要： 目的了解老年维持性血液透析(maintenance hemodialysis, MHD)病人内在能力(intrinsic capacity,IC)的现状,及其与人体成分的相关性。方法纳入2024年7—9月在东南大学附属中大医院血液净化中心行规律透析的门诊老年MHD病人。于透析当日进行IC评估,并于当日透析后进行人体成分分析。采用logistic回归分析IC下降的影响因素,运用R软件构建老年MHD病人IC下降的风险预测模型并绘制列线图;采用加强Bootstrap法和验证集进行内部验证,采用ROC曲线下面积、校准曲线评价模型的预测性能。结果共纳入133例老年MHD病人,其中IC较好者22例,IC欠佳者111例。与IC较好者相比,IC欠佳的老年MHD病人具有较高的浮肿指数(细胞外水/身体总水分比值)、脂肪指数(FTI)以及较低的骨骼肌指数(SMI)、相位角(PA),差异均有统计学意义(P<0.05)。多因素logistic回归分析结果发现,年龄增加、SMI下降、白蛋白下降是老年MHD病人IC下降的独立危险因素。预测模型的ROC曲线下面积为0.94(95%CI:0.90~0.97),灵敏度为83%、特异度为90%。结论老年MHD病人作为长期与疾病共存的一个特殊群体,也是发生IC下降的高危人群。高龄、低SMI和低白蛋白水平是老年MHD病人IC下降的独立危险因素,制定针对性综合干预策略,对提高老年MHD病人生活质量、改善预后具有十分重要的临床意义。

关键词: 老年人, 血液透析, 人体成分, 骨骼肌指数, 内在能力

Abstract: Objective To investigate the current status of intrinsic capacity(IC) and its correlation with body composition in the elderly patients undergoing maintenance hemodialysis(MHD). Methods The elderly outpatients receiving regular dialysis at the Blood Purification Center of Zhongda Hospital, Southeast University from July to September 2024 were enrolled in this study. IC was assessed on the day of dialysis, and body composition analysis was performed after dialysis on the same day. Multivariate logistic regression analysis was used to identify the influencing factors of IC decline. R software was employed to construct a nomogram of risk prediction model for IC decline in the elderly MHD patients. Internal validation was conducted using the enhanced Bootstrap method and a validation set, and the predictive performance of the model was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC) and calibration curve. Results A total of 133 elderly MHD patients were enrolled with 22 cases presenting with good IC, and 111 cases presenting with poor IC. The elderly MHD patients with poor IC had a higher edema index (extracellular water/total body water), fat tissue index (FTI), and lower skeletal muscle index (SMI) and phase angle (PA), compared with those in the elderly MHD patients with good IC (P<0.05). Multivariate logistic regression analysis showed that increased age, decreased SMI, and decreased albumin were independent risk factors for IC decline in the elderly MHD patients. The AUC of the training set was 0.94 (95%CI: 0.90-0.97), with a sensitivity of 83% and a specificity of 90%. Conclusions The elderly MHD patients, as a special group living with long-term diseases, are at high risk of IC decline. Age, SMI, and albumin are independent risk factors affecting IC in the elderly MHD patients. Formulating targeted comprehensive intervention strategies is of great clinical significance for improving the quality of life and prognosis of the elderly MHD patients.

Key words: aged, hemodialysis, body composition, skeletal muscle index, intrinsic capacity

中图分类号:

R 692.5

孙振洲, 李梦婷, 张留平, 潘梦娇, 闫晓伟. 老年维持性血液透析病人内在能力与人体成分的相关性研究[J]. 实用老年医学, 2025, 39(11): 1125-1129.

SUN Zhenzhou, LI Mengting, ZHANG Liuping, PAN Mengjiao, YAN Xiaowei. Correlation between intrinsic capacity and body composition in elderly patients with maintenance hemodialysis[J]. Practical Geriatrics, 2025, 39(11): 1125-1129.

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