Study on the trajectory and influencing factors of fatigue in maintenance hemodialysis patients
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摘要:
目的 探讨维持性血液透析（MHD）患者疲乏发展轨迹的潜在类别，并分析其影响因素。 方法 选取2024年2月—2025年1月于浙江大学医学院附属邵逸夫医院行维持性血液透析的171例患者，收集患者的一般资料、实验室指标、透析间期体重增加（IDWG）、疲乏程度评分、社会支持评分及共病指数。采用潜在类别增长混合模型(GMM）拟合MHD患者14天疲乏轨迹的潜在类别，采用logistic回归分析研究疲乏轨迹的影响因素。 结果 出现疲乏患者116例（67.84%），疲乏程度有4个轨迹：无疲乏组55例（32.16%）、疲乏持续组62例（36.26%）、疲乏缓解组39例（22.81%）和疲乏升高组15例（8.77%）。Logistic回归分析显示，性别为女性、年龄≥60岁、透析龄≥ 60个月、IDWG、共病指数增大是维持性血液透析患者疲乏的危险因素，社会支持（高评分）则可能是维持性血液透析患者疲乏的保护因素。 结论 维持性血液透析患者存在4种疲乏变化轨迹，且有群体异质性；性别为女性、年龄≥60岁、透析龄≥ 60个月、IDWG、共病指数增大是维持性血液透析患者疲乏的危险因素，社会支持（高评分）则可能是维持性血液透析患者疲乏的保护因素。 Abstract:Objective To study the trajectory of fatigue changes and its influencing factors in maintenance hemodialysis (MHD) patients. Methods A total of 171 patients undergoing maintenance hemodialysis at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from February 2024 to January 2025 were selected. Their general information, laboratory indicators, interdialysis weight gain (IDWG), fatigue score, social support score and comorbidity index were collected. Latent class growth mixture modeling (GMM) was used to fit the latent class of fatigue trajectory of MHD patients for 14 days, and logistic analysis was used to analyze the influencing factors of fatigue trajectory. Results There were 116 cases (67.84%) with fatigue patients, and the degree of fatigue had four trajectories: 55 cases (32.16%) in the "no fatigue group", 62 cases (36.26%) in the "persistent fatigue group", 39 cases (22.81%) in the "fatigue relief group", and 15 cases (8.77%) in the "elevated fatigue group". Logistic regression analysis showed that: female, age ≥60 years, dialysis age ≥60 months, IDWG, an increase in comorbidity index were risk factors for fatigue in maintenance hemodialysis patients, while social support (high score) was a protective factor for fatigue in maintenance hemodialysis patients. Conclusion There are four fatigue trajectories in maintenance hemodialysis patients, and there is population heterogeneity. female, age ≥60 years, dialysis age ≥60 months, IDWG, an increase in comorbidity index are risk factors for fatigue in maintenance hemodialysis patients, while social support (high score) is a protective factor for fatigue in maintenance hemodialysis patients. -
Key words:
- Hemodialysis /
- Fatigue /
- Change trajectory /
- Influence factors
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图 1 MHD患者疲乏变化轨迹
注：第1、3、5、8、10、12天为透析日。
Figure 1. The fatigue change trajectory of MHD patients
表 1 MHD患者疲乏轨迹潜在类别模型的拟合情况
Table 1. The fitting situation of the latent class model for the fatigue trajectory of MHD patients
模型 AIC BIC aBIC Entropy LMR BLRT 类别概率 1 7 582.664 7 594.712 7 588.251 1.000 2 7 562.893 7 556.438 7 547.366 0.893 ＜0.001 ＜0.001 0.639/0.361 3 7 558.375 7 548.752 7 536.974 0.846 0.021 ＜0.001 0.260/0.314/0.426 4 7 541.867 7 526.944 7 528.058 0.882 0.007 ＜0.001 0.172/0.097/0.433/0.298 5 7 549.169 7 536.278 7 540.749 0.875 0.152 0.089 0.095/0.267/0.138/0.379/0.121 
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表 2 MHD患者的一般资料及疲乏轨迹潜在类别的单因素分析
Table 2. Univariate analysis of general data and potential categories of fatigue trajectories in MHD patients
项目 例数 无疲乏组(n=55) 疲乏持续组(n=62) 疲乏缓解组(n=39) 疲乏升高组(n=15) 统计量 P值 性别(例) 18.133a ＜0.001 男性 91 37 27 25 2 女性 80 18 35 14 13 年龄(例) 13.618a 0.034 ＜45岁 53 33 14 15 10 45~＜60岁 83 16 31 18 7 ≥60岁 35 6 17 6 6 透析龄(例) 28.240a <0. 001 < 36个月 84 35 25 23 1 36~ < 60个月 57 17 23 11 6 ≥60个月 30 3 14 5 8 教育程度(例) 54.118a <0.001 初中及以下 60 9 33 6 12 高中及中专 59 20 24 13 2 大专及以上 52 26 5 20 1 工作情况(例) 2.319a 0. 509 在职 67 22 28 12 5 不在职 104 33 34 27 10 婚姻状况(例) 5.307a 0. 505 未婚 13 5 3 3 2 已婚 141 48 35 32 26 离异或丧偶 17 2 5 4 6 居住情况(例) 2.247a 0.523 独居 36 8 15 9 4 与他人居住 135 47 47 30 11 医疗费支付方式(例) 2.279a 0. 892 职工医保 116 38 40 26 12 新农合 8 2 3 2 1 居民医保 47 15 19 11 2 实验室指标(x±s) PAB(mg/dL) 29.08±2.75 32.88±3.12 27.73±2.64 31.91±3.06 23.76±2.38 67.752b <0.001 Hb(g/L) 114.73±9.68 128.33±10.56 101.24±7.15 109.64±8.42 94.07±6.91 62.971b <0.001 CRP(mg/L) 13.94±2.38 8.07±1.82 14.63±2.86 13.03±2.11 16.67±3.94 68.457b <0.001 IDWG(x±s，kg) 2.85±0.74 2.52±0.35 2.96±0.79 2.68±0.52 3.27±0.86 8.193b <0.001 社会支持(x±s，分) 29.63±5.44 41.03±6.58 25.49±4.85 33.28±5.94 20.76±3.99 96.273b <0.001 共病指数(x±s，分) 3.54±0.82 2.27±0.43 3.94±0.88 2.99±0.74 5.32±1.08 86.736b <0.001 注：a为χ2值，b为F值。
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表 3 自变量赋值情况
Table 3. The assignment situation of independent variables
自变量 赋值方法 性别 男性=0，女性=1 年龄 ＜45岁=0，45~＜60岁=1，≥60岁=2 透析龄 < 36个月=0, 36~ < 60个月=1, ≥60个月=2 教育程度 大专及以上=0，高中及中专=1，初中及以下=2 PAB 以实际值赋值 Hb 以实际值赋值 CRP 以实际值赋值 IDWG 以实际值赋值 社会支持 以实际值赋值 共病指数 以实际值赋值
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表 4 MHD患者疲乏轨迹潜在类别的多分类logistic回归分析
Table 4. Multiclass logistic regression analysis of potential categories of fatigue trajectories in MHD patients
变量 B SE Waldχ2 P值 OR值 95% CI 疲乏持续组 女性 1.528 0.601 9.643 0.002 4.609 1.735~7.556 年龄≥60岁 1.907 0.732 13.088 <0.001 6.733 1.945~12.286 透析龄≥60个月 1.326 0.481 6.347 0.014 3.766 1.896~5.685 IDWG 1.166 0.943 17.256 <0.001 3.209 1.408~4.972 共病指数(增大) 0.794 0.262 5.913 0.012 2.212 1.502~2.987 社会支持(高评分) 0.647 0.382 4.385 0.031 1.910 1.399~2.524 疲乏缓解组 女性 0.903 0.476 7.241 0.028 2.407 1.454~3.306 年龄≥60岁 1.349 0.315 5.237 0.032 3.854 2.769~4.868 透析龄≥60个月 1.244 0.832 10.275 0.013 3.469 1.982~5.085 IDWG 0.947 0.325 6.009 0.018 2.578 1.462~3.637 共病指数(增大) 1.028 0.542 13.210 <0.001 2.795 1.642~3.808 社会支持(高评分) 1.154 0.772 5.093 0.041 2.869 1.825~3.706 疲乏升高组 女性 1.351 0.923 17.264 <0.001 3.861 2.147~6.294 年龄≥60岁 1.284 0.808 9.325 0.009 3.611 1.976~5.803 透析龄≥60个月 0.735 0.341 5.048 0.012 2.085 1.370~2.586 IDWG 1.562 0.814 7.559 0.007 4.768 2.742~5.507 共病指数(增大) 0.909 0.653 6.407 0.009 2.482 1.523~3.564 社会支持(高评分) 1.068 0.373 5.044 0.025 2.909 1.727~4.142
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