目的 探索初始透析诱导期患者预后营养指数变化轨迹,分析不同轨迹的影响因素,并探讨不同轨迹与透析质量的 相关关系。 方法 便利抽样法选取 2023 年 6 月至 2024 年 10 月南京医科大学第四附属医院收治的 152 例初始透析诱导期患者 作为研究对象,采用基本信息调查问卷、预后营养指数分别在首次透析(T1 )、透析 1 周后(T2 )、透析 2 周后(T3 )、透析 1 个月 (T4 )进行问卷调查,透析质量指标采取 T4 时的数据。 采用潜类别增长模型识别预后营养指数变化轨迹,单因素及多因素 Logistic 回归分析不同轨迹的影响因素,方差分析两两比较探讨不同轨迹与透析质量的关系。 结果 回收有效问卷 148 份,男性 95 例(64. 19%),女性 53 例(35. 81%)。 初始透析诱导期患者预后营养指数存在 3 条不同轨迹,平均概率分别为 0. 962、0. 958 和 0. 968。 3 条轨迹类别分别为营养不良改善组(48. 7%)、营养平稳组(27. 4%)、营养不良加剧组(23. 9%)。 不同轨迹类别在 年龄(P= 0. 022)、婚姻(χ 2 = 11. 983,P= 0. 017)、体质指数(χ 2 = 9. 856,P= 0. 043)及共病情况( χ 2 = 10. 107,P = 0. 006)方面差异 显著。 初始透析 1 个月患者透析质量结果显示:尿素下降率在 55. 35% ~ 80. 24%,平均(68. 25±6. 11)%,尿素清除指数(1. 26± 0. 25)、β2-微球蛋白(45. 27±3. 64)g / L。 两两比较结果显示:营养平稳组患者的尿素下降率、尿素清除指数高于营养不良改 善组(P<0. 01)、高于营养不良加剧组(P<0. 01),营养平稳组患者的 β2-微球蛋白水平低于营养不良改善组(P<0. 01)、低于 营养不良加剧组(P<0. 01)。 结论 不同轨迹受到患者自身年龄、婚姻、体质指数及共病情况等因素的综合影响,关注营养不良 加剧的初始透析诱导期患者,制订个性化的营养干预方案,对改善透析质量、延长生存周期有积极意义。

Objective To explore the trajectory of prognostic nutritional index changes in patients during the initial dialysis induction period analyze the influencing factors of different trajectories and explore the correlation between different trajectories and dialysis quality. Method 152 patients in the initial dialysis induction period admitted to the Fourth Affiliated Hospital of Nanjing Medical University from June 2023 to October 2024 were selected as the study objects by convenient sampling method. Basic information questionnaire and prognostic nutrition index were used to conduct questionnaire surveys at the first dialysis T1 1 week after dialysis T2 2 weeks after dialysis T3 and 1 month after dialysis T4 and specific dialysis quality indicators were used as data from one month of dialysis at T4 stage. The latent class growth model was used to identify the trajectories of prognostic nutritional index changes. Univariate and multivariate logistic regression analyses were conducted to analyze the influencing factors of different trajectories. Analysis of variance was used for pairwise comparisons to explore the relationship between different trajectories and dialysis quality. Result 148 valid questionnaires were recovered 95 men 64. 19% and 53 women 35. 81% . There were three different trajectories of nutritional indices in patients during the initial dialysis induction period with mean probabilities of 0. 962 0. 958 and 0. 968 respectively. The three trajectory categories were malnutrition improvement group 48. 7% nutritional plateauing group 27. 4% and malnutrition exacerbation group 23. 9% respectively. The different trajectory categories differed significantly in age P= 0. 022 marriage χ 2 = 11. 983 P= 0. 017 BMI χ 2 = 9. 856 P = 0. 043 and co-morbidities χ 2 = 10. 107 P = 0. 006 . The results of the quality of dialysis in patients in 1 month of initial dialysis showed that the rate of decrease in urea ranged from 55. 35% to 80. 24% with a mean 68. 25±6. 11 % urea clearance index 1. 26±0. 25 and β2-microglobulin 45. 27±3. 64 g / L. The results of two-by-two comparison showed that the rate of urea decrease and urea clearance index of patients in the nutritional smooth group were higher than that of the malnutrition improvement group P < 0. 01 and higher than that of the malnutrition exacerbation group P < 0. 01 and the β2 - microglobulin of the patients in the nutritional smooth group was lower than that of the malnutrition improvement group P < 0. 01 and lower than that of the malnutrition exacerbation group P < 0. 01 . Conclusion Different trajectories are affected by the combination of patients' own age marriage BMI and co-morbidities etc. Paying attention to patients in the initial dialysis induction period in the malnutrition exacerbation group and formulating a personalized nutritional intervention plan has positive significance in improving the quality of dialysis and prolonging the survival cycle.