肌少症对维持性血液透析患者生存预后的影响

Impact of sarcopenia on mortality in patients undergoing maintenance hemodialysis

目的探讨肌少症对维持性血液透析(maintenance hemodialysis,MHD)患者生存预后的影响。方法回顾性队列研究,纳入2021年3月广州红十字会医院血液净化中心的MHD患者。收集患者的人口学资料、生化指标、握力及人体成分指标。根据患者是否合并肌少症将其分为肌少症组和非肌少症组,随访18个月,记录患者的生存状况。采用Kaplan-Meier法、多因素Cox回归模型及Fine-Gray竞争风险模型分析肌少症与MHD患者全因死亡、心脑血管疾病死亡及感染相关疾病死亡的关系。结果共纳入143例MHD患者,年龄65(58,74)岁,男性89例(62.24%)。肌少症患病率为25.17%(36/143)。与非肌少症组相比,肌少症组患者有较高的年龄(Z=3.486,P<0.001)、单室尿素清除指数(Z=3.634,P<0.001)、白细胞介素6(Z=3.434,P<0.001)和细胞外液/细胞内液比值(Z=2.477,P=0.013),有较低的体重指数(Z=-3.210,P=0.001)、血磷(t=2.475,P=0.015)、血肌酐(t=3.319,P=0.001)、血清白蛋白(t=2.851,P=0.005)、前白蛋白(t=3.384,P<0.001)、细胞外液(Z=-5.124,P<0.001)、细胞内液(Z=-5.417,P<0.001)、握力(Z=-3.796,P<0.001)及四肢骨骼肌质量指数(t=3.862,P<0.001)。Kaplan-Meier生存分析结果显示,肌少症组患者的总体生存率明显低于非肌少症组(Log-rankχ2=15.99,P<0.001)。多因素Cox回归分析结果显示,校正混杂因素后,肌少症是MHD患者全因死亡的独立影响因素(HR=2.75,95%CI 1.07~7.10,P=0.036)。Fine-Gray竞争风险模型分析结果显示,两组患者发生心脑血管疾病死亡风险的差异无统计学意义(SHR=4.99,95%CI 0.94~26.85,P=0.069),而肌少症组患者的感染相关疾病死亡风险是非肌少症组的5.76倍(SHR=5.76,95%CI 1.15~28.96,P=0.034)。结论肌少症在MHD患者中发生率较高,是MHD患者全因死亡和感染相关疾病死亡的独立危险因素。

Objective To investigate the impact of sarcopenia on mortality in maintenance hemodialysis(MHD)patients.Methods It was a retrospective cohort study.MHD patients admitted to the blood purification center of Guangzhou Red Cross Hospital in March 2021 were recruited.Demographic data and laboratory indicators,grip strength,and bioelectrical impedance analysis indexes were collected.The patients were divided into sarcopenia group and non-sarcopenia group based on whether they had sarcopenia or not.By following up for 18 months,the survival status of the patients was documented.Kaplan-Meier method,multivariate Cox regression model,and Fine-Gray competing risk model were used to assess the relationship between sarcopenia and all-cause mortality,cardio-cerebrovascular disease mortality,and infection-related disease mortality.Results A total of 143 MHD patients were enrolled in this study,with age of 65(58,74)years old and 89 males(62.24%).The prevalence of sarcopenia was 25.17%(36/143).The sarcopenia group had older age(Z=3.486,P<0.001),higher single-pool Kt/V(Z=3.634,P<0.001),interleukin-6(Z=3.434,P<0.001)and extracellular water/intracellular water ratio(Z=2.477,P=0.013),and lower body mass index(Z=-3.210,P=0.001),serum phosphorus(t=2.475,P=0.015),serum creatinine(t=3.319,P=0.001),serum albumin(t=2.851,P=0.005),serum prealbumin(t=3.384,P<0.001),extracellular water(Z=-5.124,P<0.001),intracellular water(Z=-5.417,P<0.001),grip strength(Z=-3.796,P<0.001)and appendicular skeletal muscle mass index(t=3.862,P<0.001)than those in the non-sarcopenia group.Kaplan-Meier survival curves showed that the overall survival rate in the sarcopenia group was lower than that in the non-sarcopenia group(Log-rank testχ2=15.99,P<0.001).Multivariable Cox regression analysis demonstrated that sarcopenia was independently correlated with all-cause mortality in MHD patients after adjusting for confounding factors(HR=2.75,95%CI 1.07-7.10,P=0.036).Fine-Gray competing risk model result showed that there was no statistically significant difference in cardio-cerebrovascular disease mortality between sarcopenia group and non-sarcopenia group(SHR=4.99,95%CI 0.94-26.85,P=0.069);the risk of infection-related disease mortality in sarcopenia group was 5.76 folds than that in non-sarcopenia group(SHR=5.76,95%CI 1.15-28.96,P=0.034).Conclusions There is prevalent sarcopenia in MHD patients.Moreover,sarcopenia is an independent risk factor of all-cause mortality and infection-related disease mortality in MHD patients.