肌少症在维持性血液透析患者中的发生率及其相关危险因素分析

Prevalence and risk factors of sarcopenia in maintenance hemodialysis patients

目的:观察肌少症在维持性血液透析患者中的发生情况,并分析其危险因素。方法:选择2020年7月1日~12月31日在弋矶山医院血液净化中心门诊行维持性血液透析治疗的100例患者为研究对象。根据2019年亚洲肌少症工作组所制定的诊断标准,观察肌少症在维持性血液透析患者中的发生率,并据此将研究对象分为肌少症组(24例)及非肌少症组(76例)。比较两组患者的相关检测指标,同时运用二分类Logistic回归分析肌少症发生的相关危险因素。结果:100例维持性血液透析患者肌少症发生率为24.00%。≥60岁的透析患者中,肌少症发生率为35.48%;<60岁的透析患者中,肌少症发生率为18.84%。肌少症组的MQSGA评分、年龄、透析时间、超敏C反应蛋白(hs-CRP)较非肌少症组高(P<0.05),而体质量指数、人体蛋白质含量、去脂体质量、血清白蛋白、血磷较非肌少症组低(P<0.05)。二分类多因素Logistic回归分析显示,MQSGA评分高(OR=1.422,95%CI:1.154~1.751)、透析时间长(OR=1.028,95%CI:1.007~1.050)、hs-CRP水平高(OR=1.361,95%CI:1.115~1.662)是肌少症发生的独立危险因素(P<0.05)。结论:肌少症在维持性血液透析患者中有较高的发生率,老年透析患者的发生率可能更高。营养状况、透析时间、炎症状态均是其独立危险因素。

Objective:To investigate the incidence of sarcopenia and the related risk factor in patients undergoing maintenance hemodialysis(MHD).Methods:One hundred patients undergoing MHD on outpatient basis in our hospital were included from July 1 to December 31 of 2020,and divided into sarcopenia group(n=24)and non-sarcopenia group(n=76)by the diagnostic criteria established by the Asian Working Group for Sarcopenia(2019 Consensus Update on Sarcopenia Diagnosis and Treatment)to observe the incidence of sarcopenia.Relevant detected indexes were compared between the two groups,and binary logistic regression model was used to analyze the risk factors for incidence of sarcopenia.Results:The total incidence of sarcopenia was 24.00%in the 100 MHD patients.The incidence of sarcopenia was 35.48%in MHD patients aged 60 years and over,and 18.84%in those under 60 years.MHD patients in scaropenia group had lower scoring on Modified Quantitative Subjective Global Assessment(MQSGA)scale,younger ages,shorter dialysis duration and lower level of high-sensitivity C-reactive protein(hs-CRP)than those in the non-sarcopenia group(all P<0.05),whereas the BMI,protein mass,free fat mass,levels of serum albumin and phosphorus were lower in sarcopenia group than in non-sarcopenia group(all P<0.05).Binary logistic regression analysis showed that MQSGA scores(OR=1.345,95%CI:1.047-1.728),dialysis duration(OR=1.030,95%CI:1.006-1.053)and hs-CRP(OR=1.374,95%CI:1.111-1.698)were independent risk factors for incidence of sarcopenia.Conclusion:The incidence of sarcopenia remains relatively higher in patients undergoing MHD,and can be much higher in elderly MHD patients.Malnutrition,longer dialysis duration and inflammatory state may predispose the MHD patients to sarcopenia.