相对骨骼肌质量指数对老年维持性血液透析病人骨折的预测价值

Value of relative skeletal muscle mass index in predicting bone fracture of elderly patients undergoing maintenance hemodialysis

目的探究相对骨骼肌质量指数(RSMI)对老年维持性血液透析病人骨折的预测价值。方法选取我院2018年4月至2021年1月收治的163例老年维持性血液透析病人作为研究对象,于病人入院24 h内收集病人的临床资料,检测病人血清全段甲状旁腺激素(iPTH)、白蛋白(ALB)水平及四肢骨骼肌质量(ASMM),并根据ASMM计算RSMI。随访12个月,观察病人是否发生非外力创伤性骨折,并将其分为骨折组及非骨折组,采用多因素Logistic回归分析影响老年维持性血液透析病人骨折的相关因素,绘制ROC曲线分析RSMI对老年维持性血液透析病人骨折的预测价值。结果入组的163例老年维持性血液透析病人均未失访,随访期内发生骨折21例(12.88%)。2组性别、年龄、BMI、吸烟史、饮酒史、透析龄、骨密度T值、高血压病人比例差异均无统计学意义(P>0.05);2组糖尿病病人比例、血清ALB水平、iPTH水平、RSMI差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,糖尿病、低水平的RSMI、低血清ALB及iPTH<150 ng/L均为老年维持性血液透析病人骨折的独立危险因素。ROC曲线分析结果显示,RSMI预测老年维持性血液透析病人发生骨折的灵敏度为71.43%,特异度为78.87%,AUC为0.802(95%CI0.697~0.907),最佳截断值为6.44。结论RSMI可有效预测老年维持性血液透析病人骨折的风险,临床治疗中应定期密切监测病人的RSMI。

Objective To investigate the predictive value of relative skeletal muscle mass index(RSMI)for bone fracture in the elderly patients undergoing maintenance hemodialysis.Methods A total of 163 elderly patients with maintenance hemodialysis treated in our hospital from April 2018 to January 2021 were selected as the subjects.The clinical data of the patients were collected within 24 hours after admission.The levels of serum parathyroid hormone(iPTH),albumin(ALB)and appendicular skeletal muscle mass(ASMM)were measured,and RSMI was calculated according to ASMM.All the patients were followed up for 12 months,and they were divided into fracture group and non-fracture group according to whether they suffered from non-external traumatic bone fracture.The influencing factors of bone fracture in the elderly patients undergoing maintenance hemodialysis were analyzed by multivariate Logistic regression.The receiver operating characteristic(ROC)curve was drawn to analyze the value of RSMI in predicting the bone fracture of the patients.Results No patient was lost to follow-up.During the follow-up period,21 patients(12.88%)presented with bone fracture.There were no significant differences in gender,age,body mass index,smoking history,drinking history,duration of hemodialysis,T score of bone mineral density,and the proportion of the patients with hypertension between the two groups(P>0.05).There were significant differences in the proportion of patients with diabetes,the levels of RSMI,serum ALB and iPTH between the two groups(P<0.05).Multivariate Logistic regression analysis showed that diabetes,low levels of RSMI and serum ALB,iPTH<150 ng/L were the independent risk factors of bone fracture in the elderly patients undergoing maintenance hemodialysis.ROC curve analysis showed that the sensitivity of RSMI in predicting the bone fracture of the elderly patients undergoing maintenance hemodialysis was 71.43%,the specificity was 78.87%,the area under the curve was 0.802(95%CI 0.697-0.907),and the cut-off value was 6.44.Conclusions RSMI can effectively predict the risk of bone fracture in the elderly patients undergoing maintenance hemodialysis.RSMI should be closely monitored regularly in clinical treatment.