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终末期肾脏病行维持性血液透析患者发生肌少症的相关影响因素分析

Analysis in related influencing factors of sarcopenia in patients with maintenance hemodialysis for end-stage renal disease

    摘要
  • 摘要:
    目的 探讨终末期肾脏病(ESRD)行维持性血液透析(MHD)患者发生肌少症的相关影响因素。
    方法 选取197例规律行MHD治疗的ESRD患者为研究对象。应用生物电阻抗法测量骨骼肌质量指数(SMI)及其他人体成分，采用电子握力器测量握力，并收集一般资料、人体测量学指标、血液检测指标等数据。分析ESRD行MHD患者发生肌少症的相关影响因素。
    结果 197例ESRD行MHD患者中，肌少症发生率为36.55%(72/197)。肌少症组(n=72)与非肌少症组(n=125)患者在年龄、透析龄、性别、合并高血压、体质量指数(BMI)、肱三头肌皮褶厚度、握力、肌肉组织指数(LTI)、体内水分总量(TWB)、细胞内水分(ICW)、肌肉组织量(LTM)、脂质量(FAT)、身体细胞质量(BCM)、去脂体质量(FFM)、肌酐、β2微球蛋白、甘油三酯、高密度脂蛋白等方面比较，差异有统计学意义(P < 0.05)。单因素二元Logistic回归分析结果显示，高龄(OR=1.048, P=0.040, 95%CI: 1.021~1.078)、男性(OR=0.371, P=0.001, 95%CI: 0.204~0.673)、握力(OR=0.838, P < 0.001, 95%CI: 0.764~0.920)、FFM(OR=0.634, P < 0.001, 95%CI: 0.527~0.761)是ESRD行MHD患者肌少症发生的影响因素。Spearman相关分析显示，年龄与握力呈负相关(r=-0.283, P < 0.001), 握力与SMI呈正相关(r=0.455, P < 0.001), FFM与SMI、握力呈正相关(r=0.904、0.499, P < 0.001), FFM与6 m步行速度呈负相关(r=-0.245, P=0.001)。性别、高龄、握力及FFM联合诊断ESRD行MHD患者肌少症的曲线下面积(AUC)为0.817(95%CI: 0.759~0.875), 灵敏度为100.00%, 特异度为64.00%。
    结论 肌少症在ESRD行MHD患者中发病率较高，高龄、男性、握力、FFM是ESRD行MHD患者发生肌少症的影响因素。FFM可预测ESRD行MHD患者肌少症的发生概率，联合性别、年龄、握力的预测效能更高。

     

    Abstract:
    Objective To explore the related influencing factors of sarcopenia in patients with maintenance hemodialysis (MHD) for end-stage renal disease (ESRD).
    Methods A total of 197 ESRD patients with regular MHD treatment were selected as research objects. Skeletal muscle mass index (SMI) and other body components were measured by bioelectrical impedance method, the grip strength was measured by electronic grip tester, and the general material, anthropometry indicators and blood test indicators were collected. The related influencing factors of sarcopenia in ESRD patients with MHD were analyzed.
    Results The incidence of sarcopenia in 197 ESRD patients with MHD was 36.55% (72/197). There were significant differences in age, dialysis duration, gender, combined with hypertension, body mass index (BMI), thickness of triceps skinfold, grip strength, lean tissue index (LTI), total water of body (TWB), intracellular water (ICW), lean tissue mass (LTM), fat mass (FAT), body cell mass (BCM), fat free mass (FFM), creatinine, β2 microglobulin, triglyceride and high-density lipoprotein between sarcopenia group (n=72) and non-sarcopenia group (n=125) (P < 0.05). The results of univariate binary Logistic regression analysis showed that advanced age (OR=1.048, P=0.040, 95%CI, 1.021 to 1.078), male (OR=0.371, P=0.001, 95%CI, 0.204 to 0.673), grip strength (OR=0.838, P < 0.001, 95%CI, 0.764 to 0.920) and FFM (OR=0.634, P < 0.001, 95%CI, 0.527 to 0.761) were the influencing factors of sarcopenia in ESRD patients with MHD. Spearman correlation analysis showed that age was negatively correlated with grip strength (r=-0.283, P < 0.001), grip strength was positively correlated with SMI (r=0.455, P < 0.001), FFM was positively correlated with SMI and grip strength (r=0.904, 0.499, P < 0.001), and FFM was negatively correlated with 6-meter walking speed (r=-0.245, P=0.001). The area under the curve (AUC) for diagnosis of sarcopenia in combination of gender, advanced age, grip strength and FFM in ESRD patients with MHD was 0.817 (95%CI, 0.759 to 0.875), with a sensitivity of 100.00% and a specificity of 64.00%.
    Conclusion The incidence of sarcopenia is higher in ESRD patients with MHD, and advanced age, male, grip strength and FFM are the influencing factors of sarcopenia in ESRD patients with MHD. FFM can predict the probability of sarcopenia in ESRD patients with MHD, and its predictive efficacy will be higher when combined with gender, age and grip strength.

     

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