Abstract: Background　As one of the most important geriatric syndromes，frailty seriously affects the quality of life and the survival time of the elderly patients undergoing chronic hemodialysis.Infection is also considered to be an important factor affecting the prognosis of elderly dialysis patients．Objective　To investigate the incidence of infection and its relationship with frailty in elderly patients on maintenance hemodialysis （MHD）．Methods　A total of 115 elderly patients on MHD admitted in the Blood Purification Center of the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University were recruited into our study from January 2015 and January 2016.Infection was recorded and clinical data and blood biochemical data of enrolled patients were collected in the one-year follow-up.Frailty was assessed by Fried's Frailty Phenotype，and the correlation of infection and frailty was analyzed by Spearman's rank correlation coefficient analysis and multivariate Logistic regression analysis. Results　After one-year follow-up，41 cases （35.7%） had infection．There were significant differences between the infection group and the non- infection group in C-reactive protein （CRP），plasma albumin，pre albumin，monocyte chemoattractant protein 1 （MCP-1） and frailty （P<0.05）．Spearman's rank correlation coefficient analysis showed that infection was positively correlated with CRP，MCP-1 and frailty （rs=0.187，0.269，0.239，P=0.045，0.004，0.010，respectively），while it was negatively correlated with plasma albumin，pre albumin levels （rs=-0.216，-0.192，P=0.021，0.041）.Multivariate Logistic regression analysis showed that CRP 〔OR=1.008，95%CI（1.007，1.095）〕，MCP-1 〔OR=1.008，95%CI（1.001，1.014）〕 and frailty 〔OR=1.997，95%CI（1.156，3.450）〕 were the independent risk factors for the progression of infection in elderly patients on MHD.Conclusion　A high prevalence of infection occurred in elderly patients on MHD. CRP，MCP-1 levels and frailty are the risk factors for aggravation of infection in such population.

Key words: Hemodialysis, Infection, Frailty, Aged, Relationship, Root cause analysis

摘要： 背景　衰弱是一种重要的老年综合征，严重影响着老年透析患者的生活质量和生存时间。感染也被认为是影响老年透析患者预后的重要因素。目的　探讨老年维持性血液透析（MHD）患者感染发生情况及其与衰弱的相关性。方法　选取2015年1月—2016年1月在温州医科大学附属第二医院血液净化中心行MHD治疗的老年患者115例，随访1年，记录感染发生情况。收集入选患者的临床资料和实验室检查指标，采用衰弱症状学量表评定衰弱评分，分析感染与衰弱的相关性采用Spearman秩相关分析及多因素Logistic回归分析。结果　随访1年，发生感染41例（35.7%），感染组与无感染组患者C反应蛋白（CRP）、清蛋白、前清蛋白、单核细胞趋化蛋白1（MCP-1）水平、衰弱情况比较，差异均有统计学意义（P<0.05）。Spearman秩相关分析显示：老年MHD患者发生感染与CRP、MCP-1水平、衰弱评分均呈正相关（rs=0.187，P=0.045；rs=0.269，P=0.004；rs=0.239，P=0.010）；与清蛋白、前清蛋白水平均呈负相关（rs=-0.216，P=0.021；rs=-0.192，P=0.041）。多因素Logistic回归分析结果显示，CRP〔OR=1.008，95%CI（1.007，1.095）〕、MCP-1水平〔OR=1.008，95%CI（1.001，1.014）〕、衰弱评分〔OR=1.997，95%CI（1.156，3.450）〕与感染发生独立相关（P<0.05）。结论　老年MHD患者感染发生率较高，感染的发生与CRP、MCP-1水平、衰弱评分相关。

关键词: 血液透析, 感染, 衰弱, 老年人, 相关性, 影响因素分析