维持性血液透析患者肌少症的患病率及相关影响因素

Prevalence and influencing factors of sarcopenia in maintenance hemodialysis patients

目的研究维持性血液透析(maintenance hemodialysis,MHD)患者肌少症的患病率,并探讨MHD患者发生肌少症的相关影响因素。方法回顾性纳入2019年3月至2019年11月于上海交通大学医学院附属瑞金医院血液净化中心接受治疗且治疗时间≥3个月的18岁以上的MHD患者,收集患者的一般资料。使用国际通用的Jamar握力器测定患者的握力,使用标准高度的座椅测量患者的椅子站立-坐下时间,评估骨骼肌强度;采用双能X线吸收法检测患者的四肢骨骼肌量。比较MHD肌少症患者和无肌少症患者的基线资料。采用Logistic回归分析法分析MHD患者发生肌少症的相关影响因素。结果共纳入125例MHD患者,男性68例(54.4%),年龄(59.4±14.9)岁,中位透析龄为51.0(23.5,101.0)个月,肌少症39例(31.2%)。与MHD无肌少症患者比较,MHD肌少症患者年龄、肿瘤坏死因子α、血管性血友病因子(von Willebrand factor,vWF)及使用α酮酸片的比例均更高,体重指数、血清CO_(2)结合力、前白蛋白、白蛋白和规律运动的比例均更低(均P<0.05)。多因素Logistic回归分析结果显示,低血清CO_(2)结合力(OR=0.717,95%CI 0.576~0.892,P=0.003)、高vWF(OR=1.037,95%CI 1.016~1.058,P<0.001)以及未规律运动(OR=0.309,95%CI 0.118~0.810,P=0.017)是MHD患者发生肌少症的独立影响因素。结论MHD患者肌少症的患病率高,低CO_(2)结合力、高vWF和未规律运动是MHD患者发生肌少症的独立影响因素。

Objective To determine the prevalence of sarcopenia and explore related influencing factors of sarcopenia in maintenance hemodialysis(MHD)patients.Methods MHD patients aged≥18 years old and receiving therapies of≥3 months from March 2019 to December 2019 in Blood Purification Centre of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were retrospectively enrolled in this study.General data of the patients were collected.Grip strength was measured by the Jamar dynamometer and the chair stand was measured by a chair of standard height to assess skeletal muscle strength and appendicular skeletal muscle mass was measured by dual energy X-ray absorptiometry.Baseline data between MHD patients with and without myasthenia were compared.Logistic regression analysis method was used to analyze the influencing factors for sarcopenia in MHD patients.Results A total of 125 MHD patients were enrolled,with 68 males(54.4%),age of(59.4±14.9)years and median dialysis age of 51.0(23.5,101.0)months.Sarcopenia was diagnosed in 39 cases(31.2%).Compared with MHD patients without sarcopenia,age,tumor necrosis factor-α,von Willebrand factor(vWF)and proportion of usingαketones were higher,and serum carbondioxide combining power(CO_(2)CP),prealbumin,albumin and proportion of regular exercise were lower in MHD patients with sarcopenia(all P<0.05).Multivariable logistic regression analysis results showed that low CO_(2)CP(OR=0.717,95%CI 0.576-0.892,P=0.003),high vWF(OR=1.037,95%CI 1.016-1.058,P<0.001)and no regular exercise(OR=0.309,95%CI 0.118-0.810,P=0.017)were independent influencing factors of sarcopenia in MHD patients.Conclusions The prevalence of sarcopenia in MHD patients is high.Low CO_(2)CP,high vWF and no regular exercise are independent influencing factors for sarcopenia in MHD patients.