老年血液透析和腹膜透析患者蛋白质能量消耗的危险因素分析

目的分析老年血液透析和腹膜透析患者的蛋白质能量消耗(PEW)的危险因素,为预防该类患者PEW以及预后改善提供依据.方法根据国际肾脏营养与代谢学会关于PEW诊断标准共纳入上海市第八人民医院肾内科、复旦大学附属中山医院老年科、上海交通大学附属第六人民医院肾内科2016年5月至2020年6月行腹膜透析(PD)和血液透析(HD)治疗未发生PEW的老年患者112例为非PEW组,同期纳入114例发生PEW的患者归为PEW组;比较两组患者一般资料、生化指标、人体学测量、生物电阻抗等指标的差异,采用二分类Logistic回归分析老年HD和PD患者发生PEW的独立危险因素.结果PEW组与非PEW组比较,PEW组平均年龄更高(t=0.951、P<0.001),≥65岁者占比更高(χ²=17.161、P<0.001),体质指数更低(t=6.740、P<0.001),糖尿病肾病发生率更高(χ²=14.176、P<0.001),血液透析率更高(χ²=4.543、P=0.033),透析月龄更长(t=2.306,P=0.023),转铁蛋白、血清前白蛋白、血清总蛋白、血红蛋白水平、总胆固醇、体细胞质量指数更低(t=6.262、13.405、9.507、8.341,4.610、5.599、2.499,均P<0.05),高敏C反应蛋白水平、水分比更高(t=6.380、4.519,均P<0.001),上臂肌围更小(t=5.418、P=0.000).二分类Logistic回归分析结果显示,≥65岁、透析龄、血清白蛋白、高敏C反应蛋白水平是HD治疗的老年患者PEW发生的独立影响因素(OR=2.762、0.182、2.694、2.980,P=0.023、0.007、0.009、0.027);≥65岁、体质指数、血红蛋白水平是PD治疗的老年患者发生PEW的独立影响因素(OR=2.452、0.671、0.962,P=0.013、0.000、0.000).结论HD老年患者的PEW发生率较PD者低,临床应根据影响因素进行干预,预防PEW的发生.

Analysis of risk factors associated with protein-energy wasting in elderly hemodialysis and peritoneal dialysis patients

Objective To analyze the risk factors for protein-energy wasting(PEW)in elderly patients undergoing hemodialysis(HD)and peritoneal dialysis(PD),in order to provide evidence for the prevention of PEW and improve the prognosis in these patients.Methods According to the diagnostic criteria for PEW proposed by the International Society for Renal Nutrition and Metabolism,112 elderly patients who had undergone PD and HD without PEW from May 2016 to June 2020 in the renal medicine department of the Eighth People's Hospital of Shanghai,the geriatric medicine department of Zhongshan Hospital Affiliated to Fudan University and the renal medicine department of the Sixth People's Hospital Affiliated to Shanghai Jiaotong University were included as the non-PEW group.During the same period,114 cases with PEW were recruited as the PEW group.Differences in general patient data,biochemical test values,anthropometric measurements,bioelectrical impedance and other index values were compared between the two groups.Independent risk factors for PEW in elderly HD and PD patients were analyzed by using binary Logistic regression analysis.Results Compared with the non-PEW group,the PEW group had a higher mean age(t=0.951,P<0.001),a higher proportion of patients aged≥65 years(χ²=17.161,P<0.001),a lower body mass index(t=6.740,P<0.001),a higher incidence of diabetic nephropathy(χ²=14.176,P<0.001),a higher hemodialysis rate(χ²=4.543,P=0.033),and a longer duration(months)of dialysis(t=2.306,P=0.023).Levels of serum transferrin,prealbumin,total protein,hemoglobin and total cholesterol and body cell mass index were lower(t=6.262,13.405,9.507,8.341,4.610,5.599 and 2.499,all P<0.05),high-sensitivity C-reactive protein levels and the body water percentage were higher(t=6.380,4.519,both P<0.001),and the upper arm muscle circumference was smaller(t=5.418,P=0.000)in the PEW group than in the non-PEW group.Binary Logistic regression analysis showed that age≥65 years,dialysis duration,serum albumin and high-sensitivity C-reactive protein levels were independent influencing factors for PEW in elderly HD patients(OR=2.762,0.182,2.694 and 2.980,P=0.023,0.007,0.009 and 0.027).Age≥65 years,body mass index and the hemoglobin level were independent influencing factors for PEW in elderly PD patients(OR=2.452,0.671 and 0.962,P=0.013,0.000 and 0.000).Conclusions The incidence of PEW is lower in elderly HD patients than in elderly PD patients.Clinical intervention should be carried out based on influencing factors,in order to prevent the occurrence of PEW.