维持性血液透析患者心肺适能与肌力的相关性

Association between cardiorespiratory fitness and muscle strength in maintenance hemodialysis patients

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者心肺适能(cardiorespiratory fitness,CRF)的影响因素及CRF与肌力的相关关系。方法本研究为单中心横断面观察性研究,纳入2020年9月1日至2020年12月31日在同济大学附属同济医院血液透析中心接受规律MHD的患者为研究对象。收集患者一般资料、实验室检查资料及Charlson共病指数(CCI)等资料,测量患者的身体围度(包括非内瘘手上臂围度、三头肌皮褶厚度和受力腿小腿围度)、评估入选者的运动能力[6 min步行试验(6MWT)、计时起立-行走测试(TUGT)]及上下肢肌力(握力、伸膝力量)。采用运动心肺功能测试(CPET)测定患者峰值千克体重摄氧量(peakVO_(2)/kg)等指标。以peakVO_(2)/kg作为反映CRF的金标准,采用Pearson相关或Spearman相关法分析peakVO_(2)/kg与各项临床参数的相关关系。采用多元线性回归(步进法)分析peakVO_(2)/kg的影响因素。结果48例MHD患者入选本研究,年龄(60.31±10.44)岁,男性34例(70.8%),中位透析龄48(15,84)个月,peakVO_(2)/kg为(12.37±2.71)ml·kg^(-1)·min^(-1)(健康人群参考值30~50 ml·kg^(-1)·min^(-1))。相关分析结果显示,peakVO_(2)/kg与受力腿伸膝力量(r=0.322,P=0.026)、6MWT距离(r=0.307,P=0.034)呈正相关,与年龄(r=-0.300,P=0.038)呈负相关。多元线性回归分析结果显示,伸膝力量(β=0.241,P=0.009)及年龄(β=-0.235,P=0.022)为peakVO_(2)/kg的影响因素。结论MHD患者CRF显著低于健康人群,下肢肌力下降为CRF降低的影响因素。

Objective To investigate the association between cardiorespiratory fitness(CRF)and muscle strength,and the influencing factors of CRF in maintenance hemodialysis(MHD)patients.Methods It was a single-center cross-sectional study.Patients who were treated with regular MHD from September 1,2020 to December 31,2020 were recruited.Baseline data of MHD patients including body circumference(upper arm circumference of non-fistula,triceps skinfold thickness,and calf circumference),exercise capacity[6-min walking test(6MWT),timed up and go test(TUGT)]and upper and lower limb muscle strength(grip strength,knee extension strength)as well as clinical and biochemical data,Charlson comorbidity index were collected or measured.Cardiopulmonary exercise test(CPET)was used to test peak oxygen consumption per kg body weight(peakVO_(2)/kg)for reflecting CRF.Pearson correlation or Spearman correlation was used to analyze the correlation between peakVO_(2)/kg and clinical parameters.Multiple linear regression analysis(stepwise)was performed to analyze the influencing factors of peakVO_(2)/kg.Results A total of 48 patients were enrolled in the study,of whom 34 were males(70.8%).The age was(60.31±10.44)years old.The median dialysis duration was 48(15,84)months,and the peakVO_(2)/kg was(12.37±2.71)ml·kg^(-1)·min^(-1),which was well below the normal value of 30-50 ml·kg^(-1)·min^(-1).Furthermore,peakVO_(2)/kg was positively correlated with lower extremity muscle strength(r=0.322,P=0.026)and 6MWT(r=0.307,P=0.034),and negatively correlated with age(r=-0.300,P=0.038).Multiple linear regression analysis demonstrated that lower extremity muscle strength(β=0.241,P=0.009)and age(β=-0.235,P=0.022)were the influencing factor of peakVO_(2)/kg.Conclusions CRF of MHD patients is significantly decreased.The decrease of lower extremity muscle strength is an influencing factor of CRF reduction.