身体成分与慢性肾脏病患者心血管疾病的相关因素分析

Related factors analysis of body composition and cardiovascular disease in patients with chronic kidney disease

目的探讨慢性肾脏病(chronic kidney disease,CKD)患者身体成分与心血管疾病(cardiovascular disease,CVD)的相关关系。方法纳入2017年1月至2019年12月于重庆市人民医院肾脏内科住院治疗且临床生化资料完整的CKD患者,根据病史及相应辅助检查分为CKD伴CVD组、CKD不伴CVD组。收集临床资料,进行人体学测量,以双能X线吸收法测定骨骼肌指数(skeletal muscle index,SMI)、肌肉指数、总体脂(total body fat,TBF)、内脏脂肪面积(visceral adipose tissue,VAT)、全身骨矿含量、全身骨密度等。采用t检验、U检验、卡方检验进行统计学分析。采用Logistic回归法分析身体成分与CVD的关系。结果本研究共纳入604例CKD患者,其中CKD 3期患者560例(92.7%),CKD 4期患者44例(7.3%);CKD伴CVD患者180例(29.8%),CKD不伴CVD患者424例(70.2%)。与CKD不伴CVD组相比,CKD伴有CVD组患者的男性比例、高血压病史比例、糖尿病病史比例、年龄、CKD病程、收缩压、血尿酸、腰臀比及腰围均较高(均P<0.05),而低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇、估算肾小球滤过率(eGFR)水平较低(均P<0.05)。身体成分方面,与CKD不伴CVD组相比,CKD伴CVD组中SMI(t=-11.964,P<0.001)和体重指数(t=-4.462,P<0.001)较低,VAT(t=3.089,P=0.002)和TBF(t=5.177,P<0.001)均较高。使用多元Logistic回归分析校正年龄、CKD病程、高血压病史、糖尿病病史、LDL-C、体重指数、eGFR、TBF等混杂因素后发现,随着SMI降低,CKD患者伴发CVD风险升高[以SMI高分位(36.37%~50.80%)为参照,SMI中分位(28.23%~36.31%):OR=1.49,95%CI 1.24~1.71,P=0.003;SMI低分位(15.28%~28.19%):OR=2.17,95%CI 1.79~2.62,P<0.001],未发现VAT与CKD患者伴发CVD的风险相关(P>0.05)。结论SMI降低与CKD患者伴发CVD独立相关。

Objective To investigate the correlation between body composition and cardiovascular disease(CVD)in patients with chronic kidney disease(CKD).Methods CKD patients who were hospitalized in the Department of Nephrology of Chongqing General Hospital from January 2017 to December 2019 and had complete clinical biochemical data were divided into CKD patients with CVD and CKD patients without CVD according to their medical history and corresponding auxiliary examinations.Clinical data were collected and anthropometric measurements were conducted.Skeletal muscle index(SMI),appendage lean mass/height2,total body fat(TBF),visceral adipose tissue(VAT),bone mineral capacity,bone mineral density and et al,were measured by dual-energy X-ray absorptiometry.T test,U test and Chi-square test were used for statistical analysis.Logistic regression was used to analyze the relationship between body composition and CVD.Results A total of 604 CKD patients were included in this study,including 560 patients(92.7%)with CKD stage 3,44 patients(7.3%)with CKD stage 4,and 180 CKD patients with CVD(29.8%),424 CKD patients without CVD(70.2%).Compared with CKD patients without CVD,the proportion of men,the proportion of hypertension,the proportion of diabetes,age,duration of CKD,systolic blood pressure,blood uric acid,waist to hip ratio and waist circumference were higher(all P<0.05),while low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol,and estimated glomerular filtration rate(eGFR)were lower in CKD patients with CVD(all P<0.05).In terms of body composition,SMI(t=-11.964,P<0.001)and body mass index(t=-4.462,P<0.001)in CKD patients with CVD were significantly lower than those in CKD patients without CVD,but VAT(t=3.089,P=0.002)and TBF(t=5.177,P<0.001)in CKD patients with CVD were significantly higher.After adjusting for confounders such as age,CKD duration,hypertension history,diabetes history,LDL-C,body mass index,eGFR,TBF,etc.by multivariate logistic regression analysis,the risk of CKD patients suffering from CVD increased significantly with the decrease of SMI[with SMI high tertile(36.37%-50.80%)as reference,SMI middle tertile(28.23%-36.31%):OR=1.49,95%CI 1.24-1.71,P=0.003;SMI low tertile(15.28%-28.19%):OR=2.17,95%CI 1.79-2.62,P<0.001],and VAT was not found to be associated with the risk of CVD in CKD patients(P>0.05).Conclusion Reduction of SMI is independently associated with CVD in CKD patients.