目的:构建维持性血液透析(maintenance hemodialysis, MHD)患者发生心力衰竭(heart failure, HF)的风险预测模型,分析MHD患者发生心力衰竭(HF)的因素,以早期识别并减少不良的预后。方法:回顾性收集2021~2023年青海大学附属医院住院MHD...目的:构建维持性血液透析(maintenance hemodialysis, MHD)患者发生心力衰竭(heart failure, HF)的风险预测模型,分析MHD患者发生心力衰竭(HF)的因素,以早期识别并减少不良的预后。方法:回顾性收集2021~2023年青海大学附属医院住院MHD患者的资料,以MHD患者是否发生HF为结局事件分为HF组(n = 59)和非HF组(n = 297),比较两组研究对象的基线特征,按照7:3的比例将MHD患者随机分为建模集(n = 250)和验证集(n = 106)。通过LASSO回归确定预测变量,通过二分类逻辑回归建立MHD患者发生HF的风险预测模型并开发列线图;采用受试者工作特征(ROC)曲线下面积评估模型的区分度。结果:建模集42例(16.8%)MHD患者发生HF,验证集17例(16.04%)患者发生HF。LASSO回归结合Logistic回归分析结果显示,高血压(OR = 4.05, 95% CI = 1.86~9.30)、C反应蛋白异常(OR = 3.04, 95% CI = 1.45~6.71)、透析频次3次/周(OR = 4.08, 95% CI = 1.80~9.97)、透析龄(OR = 1.18, 95% CI = 1.02~1.36)是MHD患者发生SF的独立影响因素(PObjective: To construct a risk prediction model for heart failure (HF) in patients on maintenance hemodialysis (MHD) and to explore the risk factors for heart failure (HF) in MHD patients so as to identify and reduce adverse prognosis at an early stage. Methods: Data of MHD patients hospitalized in the Affiliated Hospital of Qinghai University from 2021 to 2023 were collected. These patients were divided into the HF group (n = 59) and the non-HF group (n = 297) based on whether they developed HF as the outcome event. The baseline characteristics of the two groups were compared, and the patients were randomly divided into a modeling set (n = 250) and a validation set (n = 106) in a ratio of 7:3. The predictor variables were determined by LASSO regression, and a prediction model for HF in MHD patients was constructed by binary logistic regression and a nomogram was drawn. The area under the receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the model. Results: HF occurred in 42 (16.8%) MHD patients in the modeling set and 17 (16.04%) patients in the validation set. LASSO regression combined with Logistic regression analysis showed that hypertension (OR = 4.05, 95% CI = 1.86~9.30), abnormal C-reactive protein (OR = 3.04, 95% CI = 1.45~6.71), dialysis frequency 3 times/week (OR = 4.08, 95% CI = 1.80~9.97), and dialysis age (OR = 1.18, 95% CI = 1.02~1.36) were independent influencing factors for SF in MHD patients (P < 0.05). A risk prediction model including the above four influencing factors was constructed and a nomogram was drawn. The areas under the ROC curve of the prediction model in the modeling set and validation set were 0.785 (95% CI = 0.7124~0.8575) and 0.746 (95% CI = 0.6103~0.8821), respectively, with good discrimination. Conclusion: Hypertension, abnormal C-reactive protein, dialysis frequency 3 times/week, and dialysis age are independent risk factors for HF in MHD patients. The prediction model has good discrimination.展开更多
目的探讨透析中关节活动度运动对维持性血液透析(maintenance hemodialysis,MHD)患者的影响。方法选取2023年4月─10月南昌大学第一附属医院血液透析中心的MHD患者为研究对象,由研究者随机投掷硬币将东湖院区和象湖院区随机分为试验组...目的探讨透析中关节活动度运动对维持性血液透析(maintenance hemodialysis,MHD)患者的影响。方法选取2023年4月─10月南昌大学第一附属医院血液透析中心的MHD患者为研究对象,由研究者随机投掷硬币将东湖院区和象湖院区随机分为试验组和对照组,对照组患者给予常规护理,试验组患者在常规护理的基础上实施透析中关节活动度运动。比较2组患者干预前后的疲乏量表-14(fatigue scale-14,FS-14)得分、6分钟步行试验(6 minutes walk test,6MWT)、30秒坐立试验(30-second sit-to-stand test,30s-STS)和简短生活质量量表得分(36-item short form health survey,SF-36)差异。结果透析中关节活动度运动干预后试验组患者的FS-14得分低于对照组(Z=-7.782,P<0.001),6MWT(t=5.812,P<0.001)、30s-STS(t=6.111,P<0.001)、SF-36得分(t=2.583,P=0.012)高于对照组。结论透析中关节活动度运动可有效缓解患者的疲乏症状,提高运动能力、生活质量。展开更多
目的分析维持性血液透析(maintenance hemodialysis,MHD)患者肌少症及肌少性肥胖的患病率及相关危险因素。方法选取2023年1月─2024年1月于首都医科大学附属北京友谊医院肾内科行MHD患者107例,进行肌少症的单因素及多因素分析,再根据体...目的分析维持性血液透析(maintenance hemodialysis,MHD)患者肌少症及肌少性肥胖的患病率及相关危险因素。方法选取2023年1月─2024年1月于首都医科大学附属北京友谊医院肾内科行MHD患者107例,进行肌少症的单因素及多因素分析,再根据体脂比(男性:≥30%,女性:≥40%)分为肌少性肥胖组和非肌少性肥胖组,比较临床资料。结果MHD患者肌少症患病率为33.6%。肌少症患者与非肌少症患者相比年龄更大(t=2.426,P=0.009)、体质量指数(body mass index,BMI)更低(t=-3.541,P=0.001)、糖尿病患病率(χ^(2)=4.466,P=0.035)、冠心病患病率更高(χ^(2)=4.306,P=0.038);改良定量主观整体评估(modified quantitative subjective global assessment,MQSGA)评分更高(Z=-6.192,P<0.001)。Logistic回归分析显示行血液透析滤过(hemodialysis with diffusion and filtration,HDF)(OR=0.167,95%CI:0.041~0.683,P=0.013)、高BMI(OR=0.234,95%CI:0.074~0.736,P=0.013)是MHD肌少症保护因素;容量负荷重(OR=4.951,95%CI:1.030~23.790,P=0.046)、MQSGA评分高(OR=10.794,95%CI:3.060~38.071,P<0.001)高是危险因素。MHD患者肌少性肥胖患病率15.9%,与非肌少性肥胖患者相比,肌少症患者BMI低(F=2.433,P=0.007),但体脂比高(F=-5.661,P=0.007)、HDF比例低(χ^(2)=8.758,P=0.003)、中性粒细胞与淋巴细胞计数比值(neutrophil to lymphocyte ratio,NLR)高(F=-1.008,P=0.006)。结论MHD患者肌少症及肌少性肥胖患病率高,医护人员应早识别并采取针对性的干预措施。展开更多
文摘目的:构建维持性血液透析(maintenance hemodialysis, MHD)患者发生心力衰竭(heart failure, HF)的风险预测模型,分析MHD患者发生心力衰竭(HF)的因素,以早期识别并减少不良的预后。方法:回顾性收集2021~2023年青海大学附属医院住院MHD患者的资料,以MHD患者是否发生HF为结局事件分为HF组(n = 59)和非HF组(n = 297),比较两组研究对象的基线特征,按照7:3的比例将MHD患者随机分为建模集(n = 250)和验证集(n = 106)。通过LASSO回归确定预测变量,通过二分类逻辑回归建立MHD患者发生HF的风险预测模型并开发列线图;采用受试者工作特征(ROC)曲线下面积评估模型的区分度。结果:建模集42例(16.8%)MHD患者发生HF,验证集17例(16.04%)患者发生HF。LASSO回归结合Logistic回归分析结果显示,高血压(OR = 4.05, 95% CI = 1.86~9.30)、C反应蛋白异常(OR = 3.04, 95% CI = 1.45~6.71)、透析频次3次/周(OR = 4.08, 95% CI = 1.80~9.97)、透析龄(OR = 1.18, 95% CI = 1.02~1.36)是MHD患者发生SF的独立影响因素(PObjective: To construct a risk prediction model for heart failure (HF) in patients on maintenance hemodialysis (MHD) and to explore the risk factors for heart failure (HF) in MHD patients so as to identify and reduce adverse prognosis at an early stage. Methods: Data of MHD patients hospitalized in the Affiliated Hospital of Qinghai University from 2021 to 2023 were collected. These patients were divided into the HF group (n = 59) and the non-HF group (n = 297) based on whether they developed HF as the outcome event. The baseline characteristics of the two groups were compared, and the patients were randomly divided into a modeling set (n = 250) and a validation set (n = 106) in a ratio of 7:3. The predictor variables were determined by LASSO regression, and a prediction model for HF in MHD patients was constructed by binary logistic regression and a nomogram was drawn. The area under the receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the model. Results: HF occurred in 42 (16.8%) MHD patients in the modeling set and 17 (16.04%) patients in the validation set. LASSO regression combined with Logistic regression analysis showed that hypertension (OR = 4.05, 95% CI = 1.86~9.30), abnormal C-reactive protein (OR = 3.04, 95% CI = 1.45~6.71), dialysis frequency 3 times/week (OR = 4.08, 95% CI = 1.80~9.97), and dialysis age (OR = 1.18, 95% CI = 1.02~1.36) were independent influencing factors for SF in MHD patients (P < 0.05). A risk prediction model including the above four influencing factors was constructed and a nomogram was drawn. The areas under the ROC curve of the prediction model in the modeling set and validation set were 0.785 (95% CI = 0.7124~0.8575) and 0.746 (95% CI = 0.6103~0.8821), respectively, with good discrimination. Conclusion: Hypertension, abnormal C-reactive protein, dialysis frequency 3 times/week, and dialysis age are independent risk factors for HF in MHD patients. The prediction model has good discrimination.
文摘目的探讨透析中关节活动度运动对维持性血液透析(maintenance hemodialysis,MHD)患者的影响。方法选取2023年4月─10月南昌大学第一附属医院血液透析中心的MHD患者为研究对象,由研究者随机投掷硬币将东湖院区和象湖院区随机分为试验组和对照组,对照组患者给予常规护理,试验组患者在常规护理的基础上实施透析中关节活动度运动。比较2组患者干预前后的疲乏量表-14(fatigue scale-14,FS-14)得分、6分钟步行试验(6 minutes walk test,6MWT)、30秒坐立试验(30-second sit-to-stand test,30s-STS)和简短生活质量量表得分(36-item short form health survey,SF-36)差异。结果透析中关节活动度运动干预后试验组患者的FS-14得分低于对照组(Z=-7.782,P<0.001),6MWT(t=5.812,P<0.001)、30s-STS(t=6.111,P<0.001)、SF-36得分(t=2.583,P=0.012)高于对照组。结论透析中关节活动度运动可有效缓解患者的疲乏症状,提高运动能力、生活质量。
文摘目的分析维持性血液透析(maintenance hemodialysis,MHD)患者肌少症及肌少性肥胖的患病率及相关危险因素。方法选取2023年1月─2024年1月于首都医科大学附属北京友谊医院肾内科行MHD患者107例,进行肌少症的单因素及多因素分析,再根据体脂比(男性:≥30%,女性:≥40%)分为肌少性肥胖组和非肌少性肥胖组,比较临床资料。结果MHD患者肌少症患病率为33.6%。肌少症患者与非肌少症患者相比年龄更大(t=2.426,P=0.009)、体质量指数(body mass index,BMI)更低(t=-3.541,P=0.001)、糖尿病患病率(χ^(2)=4.466,P=0.035)、冠心病患病率更高(χ^(2)=4.306,P=0.038);改良定量主观整体评估(modified quantitative subjective global assessment,MQSGA)评分更高(Z=-6.192,P<0.001)。Logistic回归分析显示行血液透析滤过(hemodialysis with diffusion and filtration,HDF)(OR=0.167,95%CI:0.041~0.683,P=0.013)、高BMI(OR=0.234,95%CI:0.074~0.736,P=0.013)是MHD肌少症保护因素;容量负荷重(OR=4.951,95%CI:1.030~23.790,P=0.046)、MQSGA评分高(OR=10.794,95%CI:3.060~38.071,P<0.001)高是危险因素。MHD患者肌少性肥胖患病率15.9%,与非肌少性肥胖患者相比,肌少症患者BMI低(F=2.433,P=0.007),但体脂比高(F=-5.661,P=0.007)、HDF比例低(χ^(2)=8.758,P=0.003)、中性粒细胞与淋巴细胞计数比值(neutrophil to lymphocyte ratio,NLR)高(F=-1.008,P=0.006)。结论MHD患者肌少症及肌少性肥胖患病率高,医护人员应早识别并采取针对性的干预措施。
