维持性血液透析患者计时站立行走测试时间延长的影响因素分析

doi:10.3969/j.issn.1006-7795.2025.01.020

摘要/Abstract

摘要： 目的探讨维持性血液透析（maintenance hemodialysis，MHD）患者计时站立行走测试（time up and go test，TUG）时间延长的影响因素。方法采用横断面调查法，选取2023年6月1日至2024年1月31日于首都医科大学附属北京潞河医院规律血液透析、数据完整且可配合的患者,分别采用简易精神状态检查表(Minimum Mental State Examination，MMSE)、5次起坐试验（5 times sit to stand，STS-5）、TUG量表评估患者认知功能、下肢肌肉力量、平衡及步态功能；根据TUG结果进行分组，即TUG≤12 s，判定为TUG正常组；TUG＞12 s判定为TUG延长组，采用多因素Logistic 回归法分析患者TUG延长组的影响因素，以受试者工作特征(receiver operating characteristic，ROC)曲线分析影响因素对TUG延长患者的预测价值。结果本研究共纳入146例MHD患者，TUG延长组86例，TUG正常组60例，两组的性别、年龄、合并高血压、合并糖尿病、血糖、教育水平、MMSE评分、C反应蛋白、血白蛋白、血肌酐、血钠、全段甲状旁腺素、低密度脂蛋白胆固醇、血尿酸、STS-5、单次尿素氮清除指数（urea clearance index，Kt/V）差异具有统计学意义(P＜0.05)；进一步行多因素Logistic回归分析显示，高龄、女性、低MMSE评分、低Kt/V以及STS-5时间延长是发生TUG延长的独立危险因素(P＜0.05)；ROC曲线显示，年龄、性别、MMSE总分、STS-5时间预测MHD患者发生TUG延长的曲线下面积（area under the curve，AUC）分别为0.825、0.678、0.777、0.836（P＜0.01），具有较高的预测价值，Kt/V预测患者发生TUG延长的AUC为0.602（P=0.037），有一定的预测价值；以上5项指标作为整体模型预测MHD患者发生TUG延长的AUC为0.923（P＜0.01）结论 MHD 患者的年龄、性别、MMSE评分、STS-5时间延长、Kt/V的水平与合并TUG延长相关，是发生TUG延长的独立危险因素，可能成为预测TUG延长的生物学指标。

关键词: 维持性血液透析, 计时站立行走测试, 认知, 横断面研究

Abstract: Objective To explore the influence factors of timed up and go test (TUG) in patients with maintenance hemodialysis (MHD). Methods Cross-sectional investigation method was used to select patients who underwent regular hemodialysis in Beijing Luhe Hospital, Capital Medical University from June 1, 2023 to January 31, 2024, with complete data and cooperation. The patients were respectively treated with a simple mental state checklist and 5 times sit to stand test (STS-5) and TUG scale were used to assess cognitive function, lower limb muscle strength, balance and gait function. Grouping was carried out according to the results of TUG. If TUG ≤ 12s, it is judged as the TUG normal group; if TUG > 12s, it is judged as the TUG prolonged group. Multi-factor Logistic regression was used to analyze the influencing factors in the TUG prolonged group, and the predictive value of influencing factors to TUG prolonged patients was analyzed by receiver operating characteristic (ROC) curve. Results A total of 146 patients with MHD were included in this study, including 86 patients in TUG prolonged group and 60 patients in TUG normal group. Gender, age, combined hypertension, combined diabetes, blood glucose, education level, Minimum Mental State Examination (MMSE) score, C-reactive protein were compared between groups. Serum albumin, serum creatinine, serum sodium, whole parathyroid hormone, low density lipoprotein-cholesterol, serum uric acid, STS-5 results, and single urea clearance index（Kt/V） had statistical differences (P<0.05). Multivariate Logistic regression showed that old age, female, low MMSE score, low Kt/V, and STS-5 duration were independent risk factors for TUG prolonged (P<0.05). ROC curve showed that the area under the curve （AUC）of age, gender, total MMSE score and STS-5 time in predicting TUG prolongation in MHD patients were 0.825, 0.678, 0.777 and 0.836, respectively (P<0.01), which had high predictive value. The AUC of Kt/V in predicting TUG prolongation was 0.602 (P=0.037), has a certain predictive value;AUC of TUG prolongation in MHD patients predicted by the above 5 indicators as a global model was 0.923 (P<0.01).Conclusions The age, gender, MMSE score, STS-5 prolongation and Kt/V level of MHD patients are independent risk factors for TUG prolongation, and may be biological indicators for predicting TUG prolongation.

Key words: maintenance hemodialysis, timed up and go test(TUG), cognition, cross-sectional study

中图分类号:

R692.5

张晓, 张伟, 王尊理, 温暖, 刘聪慧, 李忠心. 维持性血液透析患者计时站立行走测试时间延长的影响因素分析[J]. 首都医科大学学报, 2025, 46(1): 130-135.

Zhang Xiao, Zhang Wei, Wang Zunli, Wen Nuan, Liu Conghui, Li Zhongxin. Analysis of influencing factors of time prolongation of time up and go test in maintenance hemodialysis patients[J]. Journal of Capital Medical University, 2025, 46(1): 130-135.

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