摘要目的 维持性透析患者运动能力的调查及相关因素分析.方法 收集2014年12月至2015年3月上海市同济医院肾内科规律透析患者的临床资料及相关血液检测指标,并对患者进行人体测量(上臂周径、三头肌皮褶厚度、腰围、臀围)及运动能力测定[握力、3m往返试验(3mTUG)、5次坐立试验],分成快组(3mTUG≤12 s)和慢组(3mTUG＞ 12 s)进行比较.采用相关性分析及多因素回归法分析透析患者运动能力的影响因素.结果 共纳入121例维持性透析患者,平均年龄(61.6±13.0)岁,中位透析龄31.7(12.3,69.0)个月.3mTUG快组80例,慢组41例;两组患者性别、透析模式、透析龄、体重指数(BMI)、上臂肌面积、腰臀比、血红蛋白、总胆固醇的差异均无统计学意义(均P＞ 0.05);快组患者年龄、合并糖尿病的比例低于慢组患者,白蛋白、前白蛋白、血磷、全段甲状旁腺素(iPTH)水平高于慢组(均P＜0.05);在运动能力方面,快组患者握力、3mTUG及5次坐立试验均优于慢组患者(均P＜0.05).单因素分析显示,握力与男性、上臂肌面积、BMI、血磷、年龄、糖尿病、总胆固醇相关(均P＜0.05);5次坐立试验与年龄、BMI、糖尿病、腰臀比、腹膜透析模式、透析龄、前白蛋白、血磷相关(均P＜0.05);3mTUG与年龄、糖尿病、腰臀比、腹膜透析模式、透析龄、前白蛋白、血磷、iPTH相关(均P＜ 0.05).多因素分析显示,男性、年龄、糖尿病、上臂肌面积是握力的独立相关因素;年龄、腹膜透析模式、BMI、糖尿病是5次坐立试验的独立相关因素;年龄、腹膜透析模式、糖尿病、腰臀比是维持性透析患者3mTUG的独立相关因素(均P＜0.05).结论 维持性透析患者运动能力下降.年龄及糖尿病是透析患者运动能力的独立相关因素;上臂肌面积是透析患者上肢运动能力的独立相关因素,而透析模式、BMI及腰臀比则是维持性透析患者下肢运动及平衡能力的独立相关因素.

abstractsObjective To investigate the exercise performance in maintenance dialysis patients,and analyze its correlative factors.Methods Maintenance dialysis patients admitted in Tongji Hospital of Shanghai from December 2014 to March 2015 were enrolled,with their baseline data and biochemical measurement being collected.The anthropometric indexes including arm circumference,triceps skinfold,waist circumference and hip circumference were detected.The exercise activity was assessed by hand grip test,timed up and go test (3mTUG) and five times sit-to-stand test (FTSST).Patients were divided into fast group (3mTUG≤12 s) and slow group (3mTUG ＞ 12 s).Univariate and multivariable analyses were used to evaluate the factors influencing exercise performance in maintenance dialysis.Results There were 121 patients enrolled:62 on peritoneal dialysis and 59 on hemodialysis,76 men and 45 women.Patients' average age was (61.6± 13.0) years and median dialysis age was 31.7(12.3,69.0) months.There was no statistical difference between fast group (n=80) and slow group (n=41) in gender,dialysis method,dialysis age,body mass index (BMI),arm muscle area (AMA),waist-hip ratio (WHR),hemoglobin (Hb) and total cholesterol (TC).Patients in fast group were younger,had higher serum albumin,prealbumin,serum phosphate and iPTH,and less prevalence of diabetes than those in slow group.In exercise activity,patients in fast group had better performance in handgrip,3mTUG and FTSST (all P ＜ 0.05).Univariate analysis showed that,handgrip was correlated with sex (male),AMA,BMI,age,diabetes,serum phosphorus and TC;scores in FTSST was correlated with age,BMI,diabetes,WHR,dialysis method,dialysis age,prealbumin and serum phosphorus;scores in 3mTUG was correlated with age,diabetes,WHR,dialysis method and dialysis age,prealbumin,serum phosphorus and iPTH (all P ＜ 0.05).Multiple stepwise regression analysis showed that sex (male),age,AMA and diabetes were independently correlated with handgrip in dialysis patients (all P ＜ 0.05);age,dialysis method,BMI and diabetes were independently correlated with scores in FTSST (all P ＜ 0.05);age,dialysis method,diabetes and WHR were independently correlated with scores in 3mTUG (all P ＜ 0.05).Conclusions The exercise performances of patients on maintenance dialysis are impaired.Age and diabetes are independent factor associated with the exercise performances of patients on maintenance dialysis.AMA is independently associated with upper limb movement,and dialysis method,BMI and WHR are independent factors associated with lower limb movement in dialysis patients.