透析患者维生素D水平与衰弱表型的相关性分析
|
摘要
目的研究各年龄段透析患者的维生素D水平与衰弱表型的关系。方法采用化学发光免疫测定法测定91例病情稳定的血液透析患者血清甲状旁腺激素和25-羟基维生素D水平。评估以下5种衰弱表型:虚弱,迟缓,低水平的身体活动,自我报告的疲惫和无意识的体质量减轻。根据衰弱表型评分情况分为衰弱组、中度衰弱组、正常组。结果各组间25-羟基维生素D和血红蛋白水平差异有统计学意义(分别为r=-0.308,P=0.004;r=-0.396,P=0.002);然而在体质量指数(BMI)、年龄、维持透析时间和甲状腺激素水平方面差异无统计学意义(P>0.05)。结论衰弱综合征是诱发透析患者早期致残的高危因素,维生素D缺乏与衰弱综合征密切相关。
Objective To study the relationship between the vitamin D levels and frailty phenotype in various age groups of dialysis patientss.Methods Serum parathyroid hormone and 25-hydroxy vitamin D levels in 91 hemodialysis patients with stable disease condition were determined by using chemiluminometric immunoassays.The five frailty phenotypes were assessed:weakness,slowness,low levels of physical activity,self-reported exhaustion,and unconscious weight loss.According to the frailty scores,they were divided into the frailty group,moderate frailty group and normal group.Results There were statistically significant differences in 25-hydroxy vitamin D and hemoglobin levels among the groups(r=-0.308,P=0.004;r=-0.396,P=0.002);however,no statistical differences were observed in the aspects of body mass index(BMI),age,maintenance dialysis durations and thyroid hormones levels.Conclusion Frailty syndrome is a high risk factor for inducing early disability in dialysis patients,and vitamin D deficiency is closely correlated to frailty syndrome.
Objective To study the relationship between the vitamin D levels and frailty phenotype in various age groups of dialysis patientss.Methods Serum parathyroid hormone and 25-hydroxy vitamin D levels in 91 hemodialysis patients with stable disease condition were determined by using chemiluminometric immunoassays.The five frailty phenotypes were assessed:weakness,slowness,low levels of physical activity,self-reported exhaustion,and unconscious weight loss.According to the frailty scores,they were divided into the frailty group,moderate frailty group and normal group.Results There were statistically significant differences in 25-hydroxy vitamin D and hemoglobin levels among the groups(r=-0.308,P=0.004;r=-0.396,P=0.002);however,no statistical differences were observed in the aspects of body mass index(BMI),age,maintenance dialysis durations and thyroid hormones levels.Conclusion Frailty syndrome is a high risk factor for inducing early disability in dialysis patients,and vitamin D deficiency is closely correlated to frailty syndrome.
引文
[1]CLEGG A,YOUNG J,ILIFFE S,et al.Frailty in elderly people[J].Lancet,2013,381(9868):752-762.
[2]GALE C R,COOPER C,SAYER AA.Prevalence of frailty and disability:findings from the English Longitudinal Study of Ageing[J].Age Ageing,2015,44(1):162-165.
[3]CHOWDHURY R,PEEL N M,KROSCH M,et al.Frailty and chronic kidney disease:A systemic review[J].Arch Gerontol Geriatr,2017(68):135-142.
[4]MCPHEE J S,FRENCH D P,JACKSON D,et al.Physical activity in older age:perspectives for healthy ageing and frailty[J].Biogerontology,2016,17(3):567-580.
[5]MARENGONI A,ANGLEMAN S,MELIS R,et al.Aging with multimorbidity:a systematic review of the literature[J].Ageing Res Rev,2011,10(4):430-439.
[6]National Kidney Foundation.K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease[J].Am J Kidney Dis,2003,42(4Suppl3):S1-201.
[7]WILHELM-LEEN E R,HALL Y N,TAMURA M,et al.Frailty and chronic kidney disease:the Third National Health and Nutrition Evaluation Survey[J].Am J Med,2009,122(7):664-671.
[8]JOHANSEN K L,CHERTOW G M,JIN C,et al.Significance of frailty among dialysis patients[J].J Am Soc Nephrol,2007,18(10):2960-2967.
[9]MCADAMS D A,LAW A.Frailty as a novel predictor of mortality and hospitalization in individuals of all ages undergoing hemodialysis[J].J Am Geriatr Soc,2013,61(6):896-901.
[10]FRIED L P,TANGEN C M,WALTSON J,et al.Frailty in older adults:evidence for a phenotype[J].J Gerontol ABiol Sci Med Sci,2001,56(3):146-156.
[11]MASSY N M,GILL T K,TAYLOR A W,et al.Hand Grip Strength:age and gender stratified normative data in apopulation-based study[J].BMC Res Not,2011(4):127.
[12]BOHANNON R W.Comfortable and maximum walking speed of adults aged 20-79years:reference values and determinants[J].Age Ageing,1997,26(1):15-19.
[13]SAGLAM M,ARIKAN H,SAVCI S,et al.International physical activity questionnaire:reliability and validity of the Turkish version[J].Percept Mot Skills,2010,111(1):278-284.
[14]VAN MUNSTER B C,DROST D,KALF A,et al.Discriminative value of frailty screening instruments in endstage renal disease[J].Clin Kidney J,2016,9(4):606-610.
[15]BIASIOLI S,FORONI R,PETROSINO L,et al.Effect of aging on the body composition of dialyzed subjects.Comparison with normal subjects[J].ASAIO J,1993,39(3):596-601.
[16]MEHROTRA R,KOPPLE J D.Nutritional management of maintenance dialysis patients:why aren′t we doing better[J].Annu Rev Nutr,2001(21):343-379.
[17]HOLICK M F.Vitamin D deficiency[J].N Engl J Med,2007,357(3):266-281.
[18]THEOU O,STATHOKOSTAS L,ROLAND K P,et al.The effectiveness of exercise interventions for the management of frailty:a systemic review[J].J Aging Res,2011:569194.
[19]DRECHSLER C,VERDUIJN M,PILZ S,et al.Vitamin D status and clinical outcomes in incident dialysis patients:results from the NECOSAD study[J].Nephrol Dial Transplant,2011,26(3):1024-1032.
[20]PATERSON D H,JONES G R,RICE C L.Aging and physical activity data on which to base recommendations for exercise in older adults[J].Appl Physiol Nutr Metab,2007,32(Suppl 2F):75-171.
[21]GRECO A,PARONI G,SERIPA D,et al.Frailty,disability and physical exercise in the aging process and in chronic kidney disease[J].Kidney Blood Press Res,2014,39(2/3):164-168.
[22]CLEGG A,YOUNG J,ILIFFE S,et al.Frailty in elderly people[J].Lancet,2013,381(9868):752-762.
[2]GALE C R,COOPER C,SAYER AA.Prevalence of frailty and disability:findings from the English Longitudinal Study of Ageing[J].Age Ageing,2015,44(1):162-165.
[3]CHOWDHURY R,PEEL N M,KROSCH M,et al.Frailty and chronic kidney disease:A systemic review[J].Arch Gerontol Geriatr,2017(68):135-142.
[4]MCPHEE J S,FRENCH D P,JACKSON D,et al.Physical activity in older age:perspectives for healthy ageing and frailty[J].Biogerontology,2016,17(3):567-580.
[5]MARENGONI A,ANGLEMAN S,MELIS R,et al.Aging with multimorbidity:a systematic review of the literature[J].Ageing Res Rev,2011,10(4):430-439.
[6]National Kidney Foundation.K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease[J].Am J Kidney Dis,2003,42(4Suppl3):S1-201.
[7]WILHELM-LEEN E R,HALL Y N,TAMURA M,et al.Frailty and chronic kidney disease:the Third National Health and Nutrition Evaluation Survey[J].Am J Med,2009,122(7):664-671.
[8]JOHANSEN K L,CHERTOW G M,JIN C,et al.Significance of frailty among dialysis patients[J].J Am Soc Nephrol,2007,18(10):2960-2967.
[9]MCADAMS D A,LAW A.Frailty as a novel predictor of mortality and hospitalization in individuals of all ages undergoing hemodialysis[J].J Am Geriatr Soc,2013,61(6):896-901.
[10]FRIED L P,TANGEN C M,WALTSON J,et al.Frailty in older adults:evidence for a phenotype[J].J Gerontol ABiol Sci Med Sci,2001,56(3):146-156.
[11]MASSY N M,GILL T K,TAYLOR A W,et al.Hand Grip Strength:age and gender stratified normative data in apopulation-based study[J].BMC Res Not,2011(4):127.
[12]BOHANNON R W.Comfortable and maximum walking speed of adults aged 20-79years:reference values and determinants[J].Age Ageing,1997,26(1):15-19.
[13]SAGLAM M,ARIKAN H,SAVCI S,et al.International physical activity questionnaire:reliability and validity of the Turkish version[J].Percept Mot Skills,2010,111(1):278-284.
[14]VAN MUNSTER B C,DROST D,KALF A,et al.Discriminative value of frailty screening instruments in endstage renal disease[J].Clin Kidney J,2016,9(4):606-610.
[15]BIASIOLI S,FORONI R,PETROSINO L,et al.Effect of aging on the body composition of dialyzed subjects.Comparison with normal subjects[J].ASAIO J,1993,39(3):596-601.
[16]MEHROTRA R,KOPPLE J D.Nutritional management of maintenance dialysis patients:why aren′t we doing better[J].Annu Rev Nutr,2001(21):343-379.
[17]HOLICK M F.Vitamin D deficiency[J].N Engl J Med,2007,357(3):266-281.
[18]THEOU O,STATHOKOSTAS L,ROLAND K P,et al.The effectiveness of exercise interventions for the management of frailty:a systemic review[J].J Aging Res,2011:569194.
[19]DRECHSLER C,VERDUIJN M,PILZ S,et al.Vitamin D status and clinical outcomes in incident dialysis patients:results from the NECOSAD study[J].Nephrol Dial Transplant,2011,26(3):1024-1032.
[20]PATERSON D H,JONES G R,RICE C L.Aging and physical activity data on which to base recommendations for exercise in older adults[J].Appl Physiol Nutr Metab,2007,32(Suppl 2F):75-171.
[21]GRECO A,PARONI G,SERIPA D,et al.Frailty,disability and physical exercise in the aging process and in chronic kidney disease[J].Kidney Blood Press Res,2014,39(2/3):164-168.
[22]CLEGG A,YOUNG J,ILIFFE S,et al.Frailty in elderly people[J].Lancet,2013,381(9868):752-762.