维持性血液透析患者肌肉量调查及相关因素分析

Muscle mass evaluation and influential factors of sarcopenia in maintenance hemodialysis patients

目的系统评估本中心维持性血液透析（MHD）患者肌肉量，并分析可能导致肌肉量下降的影响因素。方法入选97例患者及34例同社区年龄性别匹配的健康人，通过生物电阻抗法（BIA）评估肌肉量，同时收集MHD患者年龄、透析龄、运动、饮食、改良定量主观评分（MQSGA评分）、握力、人体测量学指标等，并测定营养、矿物质代谢、炎症、酸中毒、维生素水平等影响肌肉量的指标，以矫正肌肉量[ASM／H2：四肢肌肉量（kg）／身高的平方（m2）1作为因变量，行多因素回归分析。结果MHD患者体脂率及ASM／H2均低于健康人群（均P〈0．05）。以男性ASM／H2〈7．0kg／m2，女性ASM／H2〈5．8kg／m2为肌肉量偏低的标准，男性低肌肉量者的比例为21．4％，女性为24．4％。ASM／H。低组握力、肌酐、1，25（OH）：D、上臂肌围低于正常组，差异有统计学意义（均P〈0．05）。多因素回归分析表明，男性（β=0．534，P=0．003）、1，25（OH）。D（β=0．582，P=0．024）、肌酐（卢=0．421，P=0．037）、握力（β=0．681，P=O．001）、lg[NT．proBNP]（β=-1．760，P=0．042）是MHD患者ASM／H2水平的主要影响因素。结论1,25（OH）：D、NT-proBNP、肌酐、握力水平可能是MHD患者肌肉量的主要影响因素。

Objective To evaluate the muscle mass in maintenance hemodialysis （MHD） patients and analyze the influential factors. Methods Ninetyseven patients on MHD and 34 healthy people were recruited. Muscle mass was measured by bioelectrical impedance analysis and compared. Patients＇age, sex, height, body weight, walking activity, modified quantitative subjective global assessment （MQSGA） score and laboratory tests were recorded. The relationship of appendicular skeletal muscle mass/height2 （ASM/H2） and other factors were analyzed using multivariate linear regression. Results Compared with normal cohort, the MHD patients showed lower body fat rate and lower ASM/H2 （both P 〈 0.05）. In 97 MHD patients, 21.4% of male patients suffered from sarcopenia, and 24.4% of female patients suffered from sarcopenia. Patients were divided into two groups according to the level of ASM/H2 （male 〈 7.0 kg/m2, female 〈 5.8 kg/m2）. The grip strength, serum creatinine, 1,25（OH）2D and mid-arm muscle circumference in low ASM/H2 group were lower than those in normal ASM/H2 group, and the differences were significant （all P 〈 0.05）. In multivariable regression model, male （8=0.534, P=0.003）, 1,25（OH）2D （8=0.582, P=0.024）, creatinine （β=0.421, P=0.037）, grip strength（β=0.681, P=0.001）, and lg[NT-proBNP] （β=-1.760, P=0.042） were independently associated with ASM/H2 in MHD patients. Conclusion The prevalence of sarcopenia is much higher in MHD patients than in healthy people. The levels of grip strength, NT-proBNP, ereatinine and 1, 25（OH）2D are the important influential factors for muscle mass in MHD patients.