血肌酐与胱抑素C的比值在溃疡性结肠炎合并骨骼肌质量减少中的意义

Clinical Significance of Serum Creatinine-to-Cystatin C ratio in Ulcerative Colitis with Skeletal Muscle Mass Reduction

目的评估患者的血肌酐与胱抑素C比值(CCR)作为筛查溃疡性结肠炎(UC)患者合并骨骼肌质量减少的一种血清标志物的临床价值。方法回顾性分析135例UC患者的一般临床资料、实验室检查结果、肠镜及CT检查结果。按照CCR四分位数水平分为低CCR组(Q1)和高CCR组(Q2-4)。组间比较采用t检验、χ^(2)检验,Logistic回归分析UC合并骨骼肌质量减少的影响因素,ROC曲线评价CCR对UC合并骨骼肌减少的诊断价值。结果低CCR组和高CCR组组间BMI、血肌酐、血胱抑素C、淋巴细胞计数、白蛋白、预后营养指数(PNI)、L3骼肌指数(L3SMI)、血小板与淋巴细胞比值(PLR)等表现出显著差异(P<0.05)。合并骨骼肌减少的UC患者的CCR值显著低于不合并骨骼肌减少的UC患者(P<0.01)。CCR与L3SMI、血红蛋白、白蛋白、预后营养指数(PNI)呈显著正相关,与年龄、血沉、血小板与淋巴细胞比值(PLR)呈显著负相关。单因素Logistic回归分析中,低CCR、LDL-C与UC患者合并肌少症相关,男性、BMI、血肌酐、血红蛋白为可能的保护因素。在多因素Logistic回归分析中,发现男性、BMI为保护因素,低CCR、LDL-C为危险因素,低CCR组相对于高CCR组合并骨骼肌减少的风险为9.543倍(P<0.05)。ROC曲线分析显示CCR预测UC患者合并骨骼肌减少的ROC曲线下面积为0.677(95%CI:0.587~0.767),切点为63.48。结论CCR与UC患者的营养状况、骨骼肌质量及部分临床、生化指标相关,并且可以作为一种简便的在UC患者中识别骨骼肌减少的指标。

Objective To evaluate the clinical value of serum creatinine-to-cystatin C ratio(CCR)as a serum marker for screening patients with ulcerative colitis(UC)complicated by skeletal muscle mass reduction.Methods A retrospective study was conducted to collect the general clinical data,laboratory test results,colonoscopy and CT examination results of 135 patients with UC.According to the CCR quartile level,they were divided into low CCR group(Q1)and high CCR group(Q2-4).The t test andχ^(2) test were used to compare between groups,and Logistic regression was used to analyze the influencing factors of UC complicated with skeletal muscle mass reduction,and ROC curve was used to evaluate the diagnostic value of CCR in UC complicated with skeletal muscle mass reduction.Results BMI,serum creatinine,cystatin C,lymphocyte count,albumin,prognostic nutritional index(PNI),L3 Skeletal Muscle Index(L3SMI),Platelet-to-lymphocyte ratio(PLR)showed significant differences between low CCR group(Q1)and high CCR group(Q2-4)(P<0.05).The CCR value of UC patients with skeletal muscle reduction was significantly lower than that of UC patients without skeletal muscle reduction(P<0.01).CCR was significantly positively correlated with L3SMI,hemoglobin,albumin,and prognostic nutritional index(PNI),and significantly negatively correlated with age,erythrocyte sedimentation rate,and platelet-to-lymphocyte ratio(PLR).In univariate Logistic regression analysis,low CCR and LDL-C were associated with sarcopenia in UC patients,and male gender,BMI,serum creatinine,and hemoglobin were possible protective factors.In the multivariate Logistic regression analysis,it was found that male gender and BMI were protective factors,low CCR and LDL-C were risk factors,and the lowest CCR quartile group had a 9.543-fold higher risk of combined skeletal muscle reduction compared with the upper quartile(P<0.05).ROC curve analysis showed that the area under the ROC curve of CCR for predicting UC patients with skeletal muscle reduction was 0.677(95%CI:0.587-0.767),and the cut point was 63.48.Conclusion CCR is correlated with nutritional status,skeletal muscle mass,and some clinical and biochemical indicators in UC patients,and can be used as a simple indicator to identify skeletal muscle reduction in UC patients.