慢性肾脏病患者衰弱的筛查/评估工具研究进展

doi:10.3877/cma.j.issn.2095-3216.2023.04.010

中华肾病研究电子杂志 ›› 2023, Vol. 12 ›› Issue (04) : 229 -233. doi: 10.3877/cma.j.issn.2095-3216.2023.04.010

综述

慢性肾脏病患者衰弱的筛查/评估工具研究进展

杨长沅, 凌曦淘, 丘伽美, 段若兰, 李琴, 林玉婕, 秦新东, 侯海晶, 卢富华^†(

), 苏国彬^†(

)

510120　广东省中医院肾内科、广州中医药大学第二临床医学院、国家慢性肾脏病中医临床研究基地
510120　广东省中医院肾内科、广州中医药大学第二临床医学院、国家慢性肾脏病中医临床研究基地；11228　瑞典斯德哥尔摩，卡罗林斯卡医学院流行病学和生物统计学系

收稿日期:2022-10-25 出版日期:2023-08-28
通信作者: 卢富华, 苏国彬
基金资助:
国家自然科学基金(82004205); 广东省中医院科学技术研究基金(YN2018QL08); 广东省中医院中医药科学技术研究专项资助(YN2020QN18); 国家中医药管理局黄春林全国名老中医传承工作室项目(2012KT1301); 广东省中医院中医药科学技术研究专项资助(YN2020QN24)

Progress of research on screening/assessment tools for frailty in patients with chronic kidney disease

Changyuan Yang, Xitao Ling, Jiamei Qiu, Ruolan Duan, Qin Li, Yujie Lin, Xindong Qin, Haijing Hou, Fuhua Lu^†(), Guobin Su^†()

Department of Nephrology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Second Clinical School of Guangzhou University of Traditional Chinese Medicine, National Clinical Research Base of Traditional Chinese Medicine for Chronic Kidney Disease, Guangzhou 510120, Guangdong Province, China
Department of Nephrology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Second Clinical School of Guangzhou University of Traditional Chinese Medicine, National Clinical Research Base of Traditional Chinese Medicine for Chronic Kidney Disease, Guangzhou 510120, Guangdong Province, China; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm 11228, Sweden

Received:2022-10-25 Published:2023-08-28
Corresponding author: Fuhua Lu, Guobin Su

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引用本文：

杨长沅, 凌曦淘, 丘伽美, 段若兰, 李琴, 林玉婕, 秦新东, 侯海晶, 卢富华, 苏国彬. 慢性肾脏病患者衰弱的筛查/评估工具研究进展[J]. 中华肾病研究电子杂志, 2023, 12(04): 229-233.

Changyuan Yang, Xitao Ling, Jiamei Qiu, Ruolan Duan, Qin Li, Yujie Lin, Xindong Qin, Haijing Hou, Fuhua Lu, Guobin Su. Progress of research on screening/assessment tools for frailty in patients with chronic kidney disease[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(04): 229-233.

衰弱是一种以机体生理储备减少为特点，个体对外在依赖性和疾病易感性增加的临床综合征。衰弱在慢性肾脏病(CKD)患者中的患病率高，且已被证实与多种不良结局相关。目前国际上已有多达67种衰弱筛查/评估工具，CKD患者衰弱的最佳筛查/评估方法尚无共识。本综述对当前CKD患者衰弱的筛查/评估工具进行了对比分析。

关键词: 慢性肾脏病, 衰弱, 评估工具, 衰弱表型, 衰弱量表

Frailty is a clinical syndrome characterized by a decrease in the physical reserve of the body, and increases in individual external dependence and susceptibility to disease. Frailty has a high prevalence in patients with chronic kidney disease (CKD) and has been proven to be associated with a variety of adverse outcomes. Currently, there are up to 67 types of screening/assessment tools for frailty in the world, while there is no consensus on the best screening/assessment method for frailty in CKD patients. This review provided a comparative analysis of current screening/assessment tools for frailty in CKD patients.

Key words: Chronic kidney disease, Frailty, Assessment tool, Frailty phenotype, Frailty scale

表1 不同阶段慢性肾脏病患者衰弱的患病率及其与不良结局的关系

衰弱患病率及其与不良结局的关系	非透析患者	透析患者	肾移植患者
衰弱患病率	7%~42.6%^[5]	14%~73%^[5]	13.3%~25.1%^[7]
衰弱与不良结局的关系	肾功能↓^[8]	生活质量↓^[12]	移植成功率↓^[16]
	生活质量↓^[9]	跌倒风险↑^[13]	住院事件↑^[17]
	住院事件↑^[10]	住院风险↑^[14]	死亡风险↑^[18]
	死亡风险↑^[11]	死亡风险↑^[14,15]	心血管事件↑^[17]

表1 不同阶段慢性肾脏病患者衰弱的患病率及其与不良结局的关系

衰弱患病率及其与不良结局的关系	非透析患者	透析患者	肾移植患者
衰弱患病率	7%~42.6%^[5]	14%~73%^[5]	13.3%~25.1%^[7]
衰弱与不良结局的关系	肾功能↓^[8]	生活质量↓^[12]	移植成功率↓^[16]
	生活质量↓^[9]	跌倒风险↑^[13]	住院事件↑^[17]
	住院事件↑^[10]	住院风险↑^[14]	死亡风险↑^[18]
	死亡风险↑^[11]	死亡风险↑^[14,15]	心血管事件↑^[17]

表2 慢性肾脏病人群中常用的衰弱评估工具及各自特点

评估工具	构成	优势	局限	评分与分级	研究人群
衰弱表型	5项条目：低体力活动水平、行走缓慢、握力下降、疲惫感和非自主体重下降。	客观+主观评估高敏感性 CKD中应用最为广泛	部分条目不易收集包含残疾的评估，但未包含合并症	0~5分；0＝强健，1~2＝衰弱前期，≥3＝衰弱	非透析CKD^[8,25] HD^[26] 肾移植^[16,17]
MFP量表	4项条目：低体力活动水平、疲惫感、身体机能和精力分量表	数据易于收集，所有条目均可从SF-36量表中获取	主观评估特异性较低未包含合并症和残疾的评估	同衰弱表型	HD和腹透^[27] HD^[28,29]
衰弱指数	基于缺陷累积理论，通常包括40-70项缺陷。涵盖合并症、疾病症状和自我报告的残疾等方面	半定量工具高特异性评估全面，对不良结局的预测优于衰弱表型包含合并症和残疾的评估	较为繁琐、耗时	0~1分；≤0.12＝无衰弱，0.12~0.25＝衰弱前期，≥0.2＝衰弱	非透析CKD^[30,31,32]
临床衰弱量表	9级量表：涵盖行动能力、能量消耗、体力活动和功能等方面	图文并茂，易于理解对衰弱程度进行递进式分层	主观评估包含残疾的评估，但未包含合并症	1~9分；非常健康~非常严重的衰弱	非透析CKD^[33] HD^[15,32]
FRAIL量表	5项条目：疲乏、耐力下降、自由活动下降、合并症和体重下降	简便易行，一般可在1分钟内完成评估包含合并症与残疾的评估	主观评估	0~5分；0＝健康状态，1~2＝衰弱前期，≥3＝衰弱	HD^[34] 非透析CKD和 HD^[35] 肾移植^[17]
埃德蒙顿衰弱量表	9项条目：认知水平、健康状况、功能依赖、社会支持、用药情况、营养状况、情绪、自控力和活动能力	客观+主观评估包含认知和营养的评估包含合并症与残疾的评估	部分条目不易收集	0~17分；≥7＝衰弱	HD^[34,36,37]
Groningen衰弱量表	15项条目：涵盖行动能力、身体健康、视力、听力、营养、认知功能、合并症和社会心理等八个方面	客观+主观评估包含认知和营养的评估包含合并症与残疾的评估	较为繁琐、耗时低敏感性	0~15分；≥4＝衰弱	非透析CKD^[38] 紧急透析^[39] HD^[34]

表2 慢性肾脏病人群中常用的衰弱评估工具及各自特点

评估工具	构成	优势	局限	评分与分级	研究人群
衰弱表型	5项条目：低体力活动水平、行走缓慢、握力下降、疲惫感和非自主体重下降。	客观+主观评估高敏感性 CKD中应用最为广泛	部分条目不易收集包含残疾的评估，但未包含合并症	0~5分；0＝强健，1~2＝衰弱前期，≥3＝衰弱	非透析CKD^[8,25] HD^[26] 肾移植^[16,17]
MFP量表	4项条目：低体力活动水平、疲惫感、身体机能和精力分量表	数据易于收集，所有条目均可从SF-36量表中获取	主观评估特异性较低未包含合并症和残疾的评估	同衰弱表型	HD和腹透^[27] HD^[28,29]
衰弱指数	基于缺陷累积理论，通常包括40-70项缺陷。涵盖合并症、疾病症状和自我报告的残疾等方面	半定量工具高特异性评估全面，对不良结局的预测优于衰弱表型包含合并症和残疾的评估	较为繁琐、耗时	0~1分；≤0.12＝无衰弱，0.12~0.25＝衰弱前期，≥0.2＝衰弱	非透析CKD^[30,31,32]
临床衰弱量表	9级量表：涵盖行动能力、能量消耗、体力活动和功能等方面	图文并茂，易于理解对衰弱程度进行递进式分层	主观评估包含残疾的评估，但未包含合并症	1~9分；非常健康~非常严重的衰弱	非透析CKD^[33] HD^[15,32]
FRAIL量表	5项条目：疲乏、耐力下降、自由活动下降、合并症和体重下降	简便易行，一般可在1分钟内完成评估包含合并症与残疾的评估	主观评估	0~5分；0＝健康状态，1~2＝衰弱前期，≥3＝衰弱	HD^[34] 非透析CKD和 HD^[35] 肾移植^[17]
埃德蒙顿衰弱量表	9项条目：认知水平、健康状况、功能依赖、社会支持、用药情况、营养状况、情绪、自控力和活动能力	客观+主观评估包含认知和营养的评估包含合并症与残疾的评估	部分条目不易收集	0~17分；≥7＝衰弱	HD^[34,36,37]
Groningen衰弱量表	15项条目：涵盖行动能力、身体健康、视力、听力、营养、认知功能、合并症和社会心理等八个方面	客观+主观评估包含认知和营养的评估包含合并症与残疾的评估	较为繁琐、耗时低敏感性	0~15分；≥4＝衰弱	非透析CKD^[38] 紧急透析^[39] HD^[34]

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Progress of research on screening/assessment tools for frailty in patients with chronic kidney disease

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Progress of research on screening/assessment tools for frailty in patients with chronic kidney disease