老年维持性血液透析病人社会衰弱预测模型的构建与验证OA
Construction and validation of a prediction model for social frailty in elderly patients undergoing maintenance hemodialysis
目的:构建老年维持性血液透析病人社会衰弱风险预测模型,探讨透析症状负担、家庭功能、抑郁、体力活动等可干预因素对模型的预测价值.方法:采用便利抽样法,选取2024年11月—2025年4月在承德市某三级甲等医院血液透析室进行透析的451例老年维持性血液透析病人作为构建组研究对象,选取2025年5月—7月另外2所三级甲等医院血液透析室进行透析的181例老年维持性血液透析病人作为外部验证组研究对象.采用一般资料调查表、简版老年抑郁量表、透析症状评估量表、自我感知老化量表、家庭关怀度量表、中文版国际体力活动问卷评分、社会衰弱量表进行横断面调查.采用Logistic回归分析筛选社会衰弱的影响因素,R语言绘制列线图并进行内外部验证,评价模型的区分度、校准度和临床实用性.基于预测因子的可干预性构建基础模型与全模型,量化可干预因素的预测价值.结果:构建组与验证组老年维持性血液透析病人社会衰弱发生率分别为33.7%、35.9%.Logistic回归分析结果显示,透析龄、透析症状负担、家庭功能、体力活动和抑郁是老年维持性血液透析病人社会衰弱的影响因素.根据上述5个因素绘制的列线图内外部验证受试者工作特征曲线下面积分别为 0.888,0.876;Hosmer-Lemeshow 拟合优度检验结果显示 P>0.05;内外部验证的校准曲线与决策曲线均显示模型的校准度较好、临床实用性较高,可干预因素对模型预测价值贡献显著.结论:构建的老年维持性血液透析病人社会衰弱预测模型具有良好的预测效能和临床适用性,可为老年维持性血液透析病人社会衰弱的早期识别提供依据.医护人员可针对透析症状负担、家庭功能、抑郁及体力活动等可干预因素制定相应干预措施,延缓老年维持性血液透析病人社会衰弱的发生发展.
Objective:To construct a prediction model for social frailty in elderly patients undergoing maintenance hemodialysis.To explore the predictive value of modifiable factors such as dialysis symptom burden,family function,depression,and physical activity for the model.Methods:By using the convenience sampling method,451 elderly patients undergoing maintenance hemodialysis in the hemodialysis room of a tertiary grade A hospital in Chengde City from November 2024 to April 2025 were selected as the research subjects for the construction group.Another 181 elderly patients undergoing maintenance hemodialysis in the hemodialysis rooms of two tertiary grade A hospitals from May to July 2025 were selected as the external validation group for the research.A cross-sectional survey was conducted using general information questionnaires,5-Item Geriatric Depression Scale(GDS-5),Dialysis Symptom Index(DSI),Brief Aging Perceptions Questionnaire(B-APQ),Family APGAR Index(APGAR),and the Score of the Chinese Version of the International Physical Activity Questionnaire-Short Form.Logistic regression analysis was used to screen the influencing factors of social frailty.The ROC curve was drawn using R language and internal and external validations were conducted.The distinguishability,calibration,and clinical practicability of the model were evaluated.Based on the predictive factors,the basic model and the full model were constructed.The predictive value of the modifiable factors was quantified.Results:The incidence rates of social frailty among elderly maintenance hemodialysis patients in the construction group and the validation group were 33.7%and 35.9%respectively.Logistic results showed that dialysis duration,burden of dialysis symptoms,family function,physical activity,and depression were the influencing factors of social frailty in elderly maintenance hemodialysis patients.Based on the above five factors,the area under the receiver operating characteristic curve of the Nomogram for internal and external validation was 0.888 and 0.876 respectively.The Hosmer-Lemeshow test results showed that both P>0.05.The calibration curves and decision curves of internal and external validation both showed that the model had good calibration and high clinical practicability.The modifiable factors significantly contributed to the predictive value of the model.Conclusions:The constructed prediction model for social frailty in elderly patients undergoing maintenance hemodialysis has good predictive efficacy and clinical applicability.It could provide a tool for the early identification of social frailty in elderly maintenance hemodialysis patients.Medical staff could formulate corresponding intervention measures based on factors that can be intervened,such as the burden of dialysis symptoms,family function,depression,and physical activity,so as to delay the occurrence and development of social frailty in elderly patients undergoing maintenance hemodialysis.
范辰瑞;刘俊英
承德医学院护理学院,河北 067000承德医学院附属医院
老年人维持性血液透析社会衰弱预测模型危险因素
elderly peoplemaintenance hemodialysissocial frailtyprediction modelrisk factors
《护理研究》 2026 (12)
2013-2021,9
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