中青年维持性血液透析患者体力活动水平及影响因素分析

王英伟; 张耕瑞; 刘新宇; 杨阳

doi:10.16766/j.cnki.issn.1674-4152.002682

中青年维持性血液透析患者体力活动水平及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002682

1.
南阳市中心医院介入导管室，河南南阳 473000
2.
南阳市中心医院血液透析室
3.
南阳市疾病预防控制中心，河南南阳 473000

基金项目:

河南省医学科技攻关项目 192103210065

详细信息

通讯作者:
王英伟, E-mail: q26285092huiwe@163.com

中图分类号: R459.5
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- 文章访问数: 226
- HTML全文浏览量: 130
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2021-07-25
- 网络出版日期: 2022-11-30

Analysis of the level of physical activity and influencing factors of the young and middle-aged maintenance haemodialysis patients

1.
Interventional Catheterization Laboratory, Nanyang Central Hospital, Nanyang, Henan 473000, China

摘要

摘要: 目的了解中青年维持性血液透析(MHD)患者体力活动水平，分析中青年MHD患者体力活动水平的影响因素。方法选取2020年5—12月南阳市4所医院血液净化科的267例中青年MHD患者，使用基本资料调查问卷和国际体力活动量表(IPAQ)中文版短问卷收集相关资料，分析体力活动水平，并运用多因素logistic回归分析研究其影响因素。结果共调查267例MHD患者，体力活动充足81例，占30.34%，体力活动不足186例，占69.66%；随着透析龄的延长，体力活动不足构成比逐渐增加(Z=5.459，P＜0.001)。多因素logistic回归分析结果显示，透析龄(OR=1.726，P=0.002)、家庭月收入(OR=1.213、1.457，均P＜0.001)、透析频率(OR=1.572，P＜0.001)、透析模式(OR=1.425，P＜0.001)、营养水平(OR=1.253，P＜0.001；OR=0.634，P=0.021)、合并症指数(OR=1.715，P＜0.001)、血肌酐水平(OR=1.919，P＜0.001)、血尿素氮水平(OR=1.895，P＜0.001)、血红蛋白水平(OR=1.172，P=0.004)、血钙水平(OR=0.435，P=0.038)、脑钠肽水平(OR=3.186，P＜0.001)是中青年MHD患者体力活动水平的影响因素(均P＜0.05)。结论 MHD患者是体力活动水平不足高危人群，体力活动水平主要受透析充分性、营养水平、透析频率及模式、家庭经济水平和合并症等因素影响，提示临床应重视MHD患者营养和体力活动水平评估和干预。
- 维持性血液透析 /
- 中青年 /
- 体力活动 /
- 影响因素
Abstract: Objective To explore the level of physical activity of young and middle-aged maintenance haemodialysis (MHD) patients and analyse its influencing factors. Methods A total of 267 young and middle-aged patients with MHD treated in the blood purification department of four hospitals in Nanyang from May to December 2020 were enrolled. The basic data questionnaire and the international physical activity questionnaire (IPAQ) were used in collecting relevant data and analysing the level of physical activity, and influencing factors were examined through multiple-factor logistic regression analysis. Results A total of 267 cases of MHD were investigated: 81 cases were adequately physically active (30.34%), and 186 cases were insufficiently physically active (69.66%). As dialysis age increased, the proportion of insufficient physical activity gradually increased (Z=5.459, P < 0.001). The results of multivariate logistic regression analysis showed that dialysis age (OR=1.726, P=0.002), family monthly income (OR=1.213, 1.457, all P < 0.001), dialysis frequency (OR=1.572, P < 0.001), dialysis mode (OR=1.425, P < 0.001), nutritional level (OR=1.253, P < 0.001; OR=0.634, P=0.021), comorbidity index (OR=1.715, P < 0.001), blood creatinine level (OR=1.919, P < 0.001), blood urea nitrogen level (OR=1.895, P < 0.001), hemoglobin level (OR=1.172, P=0.004), blood calcium level (OR=0.435, P=0.038) and brain natriuretic peptide level (OR=3.186, P < 0.001) were influential factors of physical activity of young and middle-aged patients with MHD (all P < 0.05). Conclusion Patients with MHD consitute a high-risk group of insufficient physical activity. The level of physical activity is mainly affected by adequacy of dialysis, nutritional level, frequency and mode of dialysis, family economics and comorbidities. It is suggested that the evaluation and intervention of nutrition and physical activity in MHD patients should be emphasized.
- Maintenance haemodialysis /
- Young and middle-aged /
- Physical activity /
- Influencing factors

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表 1 不同透析龄的中青年MHD患者体力活动水平分布情况[例(%)]

Table 1. Distribution of physical activity levels in young and middle-aged MHD patients with different dialysis ages

透析龄	例数	体力活动充足	体力活动不足
6~12个月	41	33(12.36)	8(2.99)
13~36个月	93	21(7.87)	72(26.97)
＞36个月	133	27(10.11)	106(39.71)
注：不同透析龄患者体力活动水平比较，χ²=57.780，P＜0.001；随着透析龄延长，体力活动不足呈线性增长趋势，χ_趋势²=38.093，P_趋势＜0.001。

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表 2 中青年MHD患者体力活动水平影响因素单因素分析

Table 2. Univariate analysis of influencing factors in young and middle-aged MHD patients with physical activity level

因素	例数	体力活动充足 (n=81)	体力活动不足 (n=186)	统计量	P值
性别[例(%)]
男性	118	41(34.75)	77(65.25)	1.945^a	0.163
女性	149	40(26.85)	109(73.15)
年龄[例(%)]
18~＜30岁	23	11(47.83)	12(52.17)	0.281^b	0.779
30~＜40岁	68	17(25.00)	51(75.00)
40~＜50岁	81	20(24.69)	61(75.31)
50~＜60岁	95	33(34.74)	62(65.26)
文化程度[例(%)]
小学及以下	19	10(52.63)	9(47.37)	0.417^b	0.677
初中	61	14(22.95)	47(77.05)
高中及中专	105	33(31.43)	72(68.57)
大专及以上	82	24(29.27)	58(70.73)
家庭月收入[例(%)]
＜3 000元	73	36(49.32)	37(50.68)	4.663^b	＜0.001
3 000~≤5 000元	90	28(31.11)	62(68.89)
＞5 000元	104	17(16.35)	87(83.65)
透析龄[例(%)]
6~≤36个月	134	54(40.29)	80(59.71)	12.631^a	＜0.001
＞36个月	133	27(20.30)	106(79.70)
透析频率[例(%)]
＜3次/周	82	17(20.73)	65(79.27)	5.167^a	0.023
≥3次/周	185	64(34.59)	121(65.41)
透析模式[例(%)]
高通量透析	117	48(41.03)	69(58.97)	11.258^a	＜0.001
低通量透析	150	33(22.00)	117(78.00)
原发病[例(%)]
慢性肾小球肾炎	111	32(28.83)	79(71.17)	2.217^a	0.529
高血压肾病	74	22(29.73)	52(70.27)
糖尿病肾病	62	18(29.03)	44(70.97)
其他肾功能损伤	20	9(45.00)	11(55.00)
营养水平[例(%)]
营养良好	156	55(35.26)	101(64.74)	2.672^b	0.008
轻度营养不良	54	18(33.33)	36(66.67)
中度营养不良	36	7(19.44)	29(80.56)
重度营养不良	21	1(4.76)	20(95.24)
合并症指数(x±s)	267	4.23±1.75	4.82±2.27	2.084^c	0.038
血肌酐(x±s, μmol/L)	267	969.75±117.38	1 128.94±261.28	5.253^c	＜0.001
血尿素氮(x±s, mmol/L)	267	25.34±9.85	33.75±13.28	5.117^c	＜0.001
血红蛋白(x±s, g/L)	267	93.16±10.15	109.24±15.31	8.656^c	＜0.001
血清白蛋白(x±s, g/L)	267	40.18±3.75	39.74±3.38	0.946^c	0.345
血磷(x±s, mmol/L)	267	1.83±0.51	1.91±0.53	1.147^c	0.253
血钾(x±s, mmol/L)	267	5.07±0.64	5.23±0.69	1.779^c	0.076
血钙(x±s, mmol/L)	267	2.57±0.33	2.18±0.21	11.611^c	＜0.001
脑钠肽(x±s, pg/mL)	267	381.64±47.86	469.16±56.71	12.132^c	＜0.001
注：^a为χ²值，^b为Z值，^c为t值。

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表 3 变量赋值情况

Table 3. Variable assignment

变量	赋值方法
透析龄	6~≤36个月=0，＞36个月=1
家庭月收入	＜3 000元/月=0，3 000~≤5 000元/月=1，＞5 000元/月=2
透析频率	≥3次/周=0，＜3次/周=1
透析模式	高通量透析=0，低通量透析=1
营养水平	营养良好=0，轻度营养不良=1，中度营养不良=2，重度营养不良=3
合并症指数	以实际值赋值
血肌酐	以实际值赋值
血尿素氮	以实际值赋值
血红蛋白	以实际值赋值
血钙	以实际值赋值
脑钠肽	以实际值赋值
体力活动不足	否=0，是=1

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表 4 中青年MHD患者体力活动水平影响因素的多因素logistic回归分析

Table 4. Multivariate logistic regression analysis of influencing factors in young and middle-aged MHD patients with physical activity level

变量	B	SE	Wald χ²	P值	OR值	95% CI
透析龄(＞36个月)	0.547	0.174	9.961	0.002	1.726	1.231~2.432
家庭月收入
3 000~≤5 000元	0.215	0.138	11.431	＜0.001	1.213	1.085~1.362
＞5 000元	0.273	0.121	9.264	＜0.001	1.457	1.197~1.938
透析频率(＜3次/周)	0.495	0.158	10.173	＜0.001	1.572	1.218~2.107
透析模式(低通量透析)	0.486	0.146	9.934	＜0.001	1.425	1.107~2.143
营养水平
轻度营养不良	0.384	0.313	1.511	0.231	0.682	0.381~1.215
中度营养不良	0.513	0.221	5.371	0.021	0.634	0.372~1.267
重度营养不良	0.225	0.064	13.127	＜0.001	1.253	1.128~1.516
合并症指数	0.547	0.175	9.971	＜0.001	1.715	1.229~2.416
血肌酐	0.653	0.188	12.293	＜0.001	1.919	1.341~2.768
血尿素氮	0.661	0.182	12.314	＜0.001	1.895	1.363~2.785
血红蛋白	0.417	0.146	8.972	0.004	1.172	0.975~1.682
血钙	-0.841	0.402	4.337	0.038	0.435	0.199~0.964
脑钠肽	1.235	0.351	13.167	＜0.001	3.186	1.793~6.597

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