摘要
目的:评估预后营养指数(prognostic nutritional index,PNI)与维持性血液透析(maintenance hemodialysis,MHD)患者机体功能依赖发生风险的关系。方法:该研究为横断面调查研究。收集2023年6—12月苏州大学附属第二医院MHD患者的临床资料。采用Katz及Lawton-Brody调查问卷表评估机体功能状态,将患者分为机体功能正常组和机体功能依赖组,并比较两组临床资料的差异。采用血清白蛋白和淋巴细胞计算PNI,按照PNI四分位数将患者分为Q1组(PNI≤44.3)、Q2组(44.349.8)4个亚组。采用Logistic回归分析法分析MHD患者PNI与机体功能依赖发生风险的关系,并进行亚组分析。使用受试者工作特征曲线(ROC曲线)评估PNI、血清白蛋白及淋巴细胞预测MHD患者机体功能依赖发生风险的效能。结果:该研究纳入206例MHD患者,年龄为(58.35±0.98)岁,男性132例(64.1%),合并糖尿病58例(28.2%),合并高血压179例(86.9%),合并心血管疾病36例(17.5%),发生机体功能依赖95例(46.1%)。与机体功能正常组比较,机体功能依赖组年龄(t=-6.87,P<0.001)、合并糖尿病比例(χ^(2)=6.58,P=0.010)及脉压(t=-3.17,P=0.002)均较高,舒张压(t=3.88,P<0.001)、血清肌酐(t=3.44,P=0.001)、血清白蛋白(t=4.09,P<0.001)及PNI(t=3.92,P<0.001)均较低。PNI Q1组(69.2%,36;52)患者机体功能依赖发生率显著高于Q2组(49.0%,25;51)、Q3组(34.0%,18;53)及Q4组(32.0%,16;50),组间比较差异均有统计学意义(均P<0.05)。Logistic回归分析结果显示,在校正年龄、合并糖尿病、脉压和血清肌酐等混杂因素后,PNI Q1组患者机体功能依赖发生风险是Q4组的3.217倍(OR=3.217,95%CI 1.229~8.422,P=0.017)。PNI预测MHD患者机体功能依赖发生风险的概率模型为logit(odds)=5.854-0.1283×PNI。PNI预测MHD患者机体功能依赖发生风险的ROC曲线下面积(AUC)为0.66(95%CI 0.58~0.73,P<0.001),略高于血清白蛋白(AUC=0.64,95%CI 0.54~0.73,P<0.001)。PNI预测机体功能依赖发生风险的最佳截断值为46.15,敏感度为72.07%,特异度为57.89%。结论:低PNI与MHD患者高机体功能依赖发生风险相关。
Objective To evaluate the relationship between prognostic nutritional index(PNI)and risk of functional dependence in patients receiving maintenance hemodialysis(MHD).Methods It was a cross-sectional survey study.The clinical data of MHD patients in the Second Affiliated Hospital of Soochow University from June to December 2023 were collected.The Katz and Lawton⁃Brody questionnaires were used to assess the functional status.The patients were divided into normal functional status group and functional dependence group,and the differences of the clinical data between the two groups were compared.Serum albumin and lymphocytes were used to determine PNI,and the patients were divided into four subgroups:Q1 group(PNI≤44.3),Q2 group(44.3<PNI≤47.2),Q3 group(47.2<PNI≤49.8)and Q4 group(PNI>49.8)according to the quartile of PNI.Logistic regression analysis method was used to analyze the relationship between PNI and risk of functional dependence in MHD patients,and subgroup analysis was conducted.The receiver-operating characteristic(ROC)curve was used to assess the efficacy of PNI,serum albumin,and lymphocytes in predicting the risk of functional dependence in MHD patients.Results A total of 206 MHD patients were included in this study,with age of(58.35±0.98)years old,and 132(64.1%)males.There were 58(28.2%)patients with diabetes,179(86.9%)patients with hypertension,and 36(17.5%)patients with cardiovascular diseases.There were 95(46.1%)patients developing functional dependence.Compared with normal functional status group,functional dependence group had higher age(t=-6.87,P<0.001),proportion of diabetes(χ^(2)=6.58,P=0.010),and pulse pressure(t=-3.17,P=0.002),and lower diastolic pressure(t=3.88,P<0.001),serum creatinine(t=3.44,P=0.001),serum albumin(t=4.09,P<0.001)and PNI(t=3.92,P<0.001).The incidence of functional dependence in PNI Q1 group(69.2%,36;52)was significantly higher than those in Q2 group(49.0%,25;51),Q3 group(34.0%,18;53)and Q4 group(32.0%,16;50),and the differences among groups were statistically significant(all P<0.05).Logistic regression analysis showed that after adjusting for confounding factors:age,diabetes,pulse pressure,and serum creatinine,the risk of functional dependence of PNI Q1 group was 3.217 folds higher than that in Q4 group(OR=3.217,95%CI 1.229-8.422,P=0.017).The risk probability model of PNI predicting the occurrence of functional dependence in MHD patients:logit(odds)=5.854-0.1283×PNI.The area under the ROC curve(AUC)for PNI predicting the risk of functional dependence in MHD patients was 0.66(95%CI 0.58-0.73,P<0.001),slightly higher than that of serum albumin(AUC=0.64,95%CI 0.54-0.73,P<0.001).The optimal cutoff value of PNI predicting the occurrence of functional dependence was 46.15,with sensitivity of 72.07%and specificity of 57.89%.Conclusion Low PNI is associated with high risk of functional dependence in MHD patients.
作者
孙词
宋锴
姜山
卢颖
尹沛然
李卫巍
Sun Ci;Song Kai;Jiang Shan;Lu Ying;Yin Peiran;Li Weiwei(Department of Nephrology,the Second Hospital Affiliated to Soochow University,Suzhou 215004,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2024年第9期691-697,共7页
Chinese Journal of Nephrology
关键词
肾透析
营养评价
功能状态
预后营养指数
机体功能依赖
Renal dialysis
Nutrition assessment
Functional status
Prognostic nutritional index
Functional dependence
