终末期肾病维持性血液透析患者症状负担的影响因素分析

Analysis of the factors affecting symptom burden in patients with end-stage renal disease undergoing maintenance hemodialysis

摘要:

目的 分析终末期肾病维持性血液透析（MHD）患者症状负担的影响因素。方法 回顾性分析2021年10月—2023年10月丽水市中医院收治的96例终末期肾病患者的临床资料，根据透析患者症状负担量表的评分结果，将患者分为高分组与低分组，每组48例。收集两组患者性别、年龄、文化程度、工作状态、婚姻状态、原发疾病、透析频率等基本资料，并比较两组患者的营养状况（白蛋白、血红蛋白）、肾功能［尿素氮（BUN）、血清肌酐（Scr）］。采用多因素一般Logistic回归分析筛选终末期肾病MHD患者高症状负担的影响因素，建立症状负担影响因素预测模型，绘制校准曲线和受试者工作特征（ROC）曲线评估预测模型的拟合效果。结果 高分组年龄大于低分组（P <0.05），与低分组相比，高分组中家庭人均月收入低于2 000元、病程长、自费、每周透析3次的患者占比更高（P <0.05）。高分组患者的白蛋白和血红蛋白水平均低于低分组（P <0.05），BUN和Scr水平均高于低分组（P <0.05）。多因素一般Logistic分析结果显示：年龄大［O^R =1.384（95% CI：1.139，1.681）］、透析频率高［O^R =68.743（95% CI：4.761，992.474）］、白蛋白水平低［O^R =1.384（95% CI：1.139，1.681）］、血红蛋白水平低［O^R =0.820（95% CI：0.707，0.951）］、BUN水平高［O^R =1.676（95% CI：1.129，2.489）］、Scr水平高［O^R =1.111（95% CI：1.034，1.194）］均是影响终末期肾病MHD患者症状负担的危险因素（P <0.05）。校准曲线平均绝对误差为0.056，表明模型的预测准确性高，预测误差小；ROC曲线表明模型预测准确性为0.989（95% CI：0.974，1.000），敏感性为93.8%（95% CI：0.828，0.987），特异性为97.9%（95% CI：0.889，0.999）。结论 年龄、透析频率、营养状况、肾功能均是影响终末期肾病MHD患者症状负担情况的重要因素。

Abstract:

Objective To analyze the factors influencing the symptom burden in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis (MHD).Methods A retrospective analysis was conducted on the clinical data of 96 ESRD patients treated at our hospital from October 2021 to October 2023. Based on the median score of the Dialysis Symptom Burden Index (DFSSBI), patients were divided into two groups: a high-score group and a low-score group, with 48 patients in each. Data collected included gender, age, educational level, employment status, marital status, primary disease, and dialysis frequency. The nutritional status (albumin, hemoglobin), and renal function [blood urea nitrogen (BUN), serum creatinine (Scr)] of both groups were compared. Logistic regression analysis was used to identify the factors influencing high symptom burden in ESRD MHD patients, and a calibration curve was used to assess the fit of the predictive model.Results The group with higher scores had an older age than the group with lower scores. Compared to the lower score group, a higher proportion of patients in the high score group had a monthly household income below 2000 yuan, longer disease duration, self-pay, and underwent dialysis three times a week (P < 0.05). Patients in the high score group also had lower levels of albumin and hemoglobin, but higher levels of BUN, and Scr than those in the low score group (P < 0.05). Multivariable logistic regression analysis indicated that older age [O^R =1.384 (95% CI: 1.139, 1.681)], higher dialysis frequency [O^R =68.743 (95% CI: 4.761, 992.474)], lower albumin levels [O^R =0.673 (95% CI: 0.484, 0.935) ], lower hemoglobin levels [O^R =0.820 (95% CI: 0.707, 0.951)], and higher BUN levels [O^R =1.676 (95% CI: 1.129, 2.489), higher Scr levels[O^R =1.111 (95% CI: 1.034, 1.194)] were risk factors for symptom burden in ESRD patients undergoing maintenance hemodialysis (P < 0.05). The calibration curve had an average absolute error of 0.056, indicating high predictive accuracy and low prediction error; the ROC curve showed a predictive accuracy of 0.989 (95% CI：0.974, 1.000), with a sensitivity of 93.8% (95% CI: 0.828, 0.987), and a specificity of 97.9% (95% CI: 0.889, 0.999).Conclusion Age, dialysis frequency, nutritional status, and renal function are significant factors affecting the symptom burden in patients with ESRD undergoing MHD.