摘要
目的探索初始透析诱导期患者预后营养指数变化轨迹,分析不同轨迹的影响因素,并探讨不同轨迹与透析质量的相关关系。方法便利抽样法选取2023年6月至2024年10月南京医科大学第四附属医院收治的152例初始透析诱导期患者作为研究对象,采用基本信息调查问卷、预后营养指数分别在首次透析(T_(1))、透析1周后(T_(2))、透析2周后(T_(3))、透析1个月(T4)进行问卷调查,透析质量指标采取T4时的数据。采用潜类别增长模型识别预后营养指数变化轨迹,单因素及多因素Lo-gistic回归分析不同轨迹的影响因素,方差分析两两比较探讨不同轨迹与透析质量的关系。结果回收有效问卷148份,男性95例(64.19%),女性53例(35.81%)。初始透析诱导期患者预后营养指数存在3条不同轨迹,平均概率分别为0.962、0.958和0.968。3条轨迹类别分别为营养不良改善组(48.7%)、营养平稳组(27.4%)、营养不良加剧组(23.9%)。不同轨迹类别在年龄(P=0.022)、婚姻(χ^(2)=11.983,P=0.017)、体质指数(χ^(2)=9.856,P=0.043)及共病情况(χ^(2)=10.107,P=0.006)方面差异显著。初始透析1个月患者透析质量结果显示:尿素下降率在55.35%~80.24%,平均(68.25±6.11)%,尿素清除指数(1.26±0.25)、β2-微球蛋白(45.27±3.64)g/L。两两比较结果显示:营养平稳组患者的尿素下降率、尿素清除指数高于营养不良改善组(P<0.01)、高于营养不良加剧组(P<0.01),营养平稳组患者的β2-微球蛋白水平低于营养不良改善组(P<0.01)、低于营养不良加剧组(P<0.01)。结论不同轨迹受到患者自身年龄、婚姻、体质指数及共病情况等因素的综合影响,关注营养不良加剧的初始透析诱导期患者,制订个性化的营养干预方案,对改善透析质量、延长生存周期有积极意义。
Objective To explore the trajectory of prognostic nutritional index changes in patients during the initial dialysis induction period,analyze the influencing factors of different trajectories,and explore the correlation between different trajectories and dialysis quality.Method 152 patients in the initial dialysis induction period admitted to the Fourth Affiliated Hospitalof Nanjing Medical University from June 2023 to October 2024 were selected as the study objects by convenient sampling method.Basic information questionnaire and prognostic nutrition index were used to conduct questionnaire surveys at the first dialysis(T_(1)),1 week after dialysis(T_(2)),2 weeks after dialysis(T_(3))and 1 month after dialysis(Ta),and specific dialysis quality indicators were used as data from one month of dialysis at T。stage.The latent class growth model was used to identify the trajectories of prognostic nutritional index changes.Univariate and multivariate logistic regression analyses were conducted to analyze the influencing factors of different trajectories.Analysis of variance was used for pairwise comparisons to explore the relationship between different trajectories and dialysis quality.Result 148 valid questionnaires were recovered,95 men(64.19%)and 53 women(35.81%).There were three different trajectories of nutritional indices in patients during the initial dialysis induction period,with mean probabilities of 0.962,0.958and 0.968,respectively.The three trajectory categories were malnutrition improvement group(48.7%),nutritional plateauing group(27.4%),and malnutrition exacerbation group(23.9%),respectively.The different trajectory categories differed significantly in age(P=0.022),marriage(χ^(2)=11.983,P=0.017),BMI(χ^(2)=9.856,P=0.043),and co-morbidities(χ^(2)=10.107,P=0.006).The results of the quality of dialysis in patients in 1 month of initial dialysis showed that the rate of decrease in urea ranged from 55.35%to 80.24%,with a mean(68.25±6.11)%,urea clearance index(1.26±0.25),andβ2-microglobulin(45.27±3.64)g/L.The results of two-by-two comparison showed that the rate of urea decrease and urea clearance index of patients in the nutritional smooth group were higher than that of the malnutrition improvement group(P<0.01)and higher than that of the malnutrition exacerbation group(P<0.01),and theβ2-microglobulin of the patients in the nutritional smooth group was lower than that of the malnutrition improvement group(P<0.01)and lower than that of the malnutrition exacerbation group(P<0.01).Conclusion Different trajectories are affected by the combination of patients’own age,marriage,BMI and co-morbidities,etc.Paying attention to patients in the initial dialysis induction period in the malnutrition exacerbation group and formulating a personalized nutritional intervention plan has positive significance in improving the quality of dialysis and prolonging the survival cycle.
作者
葛舒霞
刘莹
陈勤
Ge Shuxia;Liu Ying;Chen Qin(Department of HemoDialysis Center,the Fourth Affiliated Hospital of Nanjing Medical University,Nanjing 210029,Jiangsu,China)
出处
《肿瘤代谢与营养电子杂志》
2025年第4期448-455,共8页
Electronic Journal of Metabolism and Nutrition of Cancer
基金
2023年度江苏省老年科研项目(LK2023040)。
关键词
初始透析诱导期
预后营养指数
曲线
轨迹
透析质量
纵向研究
影响因素
营养不良
Initial dialysis induction period
Prognostic nutritional index
Curve
Trajectory
Dialysis quality
Longitudinal study
Influencing factors
Malnutrition
