非透析慢性肾脏病患者相位角的影响因素及临床结局预测

Influencing factors of phase angle and prediction of clinical outcome in patients with non-dialysis chronic kidney disease

目的 探讨非透析慢性肾脏病(chronic kidney disease,CKD)患者相位角(phase angle,PhA)的影响因素及临床结局预测能力。方法 收集2019年1-11月于华中科技大学同济医学院附属同济医院肾病内科住院的60例非透析CKD患者,进行血尿生化检验、营养风险筛查与评估、SF-36生活质量调查、人体测量、握力测试及人体成分检测。根据相位角将患者分为A组(PhA>4.5°)及B组(PhA≤4.5°),各30例。分析相位角与营养、炎症、疾病、水分等相关指标的相关性,逐步多元线性回归分析找到相位角的主要影响因素。随访3~4年,比较两组患者生存情况。结果 A组的血总蛋白(TP)、白蛋白(ALB)、前白蛋白(PAB)、生活质量评分、握力均明显高于B组(P<0.05)。A组的超敏C反应蛋白(CRP)、总胆固醇(TC)、低密度脂蛋白(LDL)、24 h尿蛋白总量(UTP)、24 h尿白蛋白总量(UMA)、尿白蛋白肌酐比值(ACR)、改良SGA评分、细胞外水分比率(ECW/TBW)均明显低于B组(P<0.05)。相关性分析显示,TP、ALB、PAB与PhA成正相关(P<0.05)。CRP、TC、LDL、UMA、改良SGA评分、ECW/TBW与PhA成负相关(P<0.05)。逐步多元线性回归分析显示,ECW/TBW是PhA的独立影响因素。随访发现B组的死亡率(20.00%,6/30)高于A组(6.67%,2/30),Cox回归生存分析结果显示,年龄和PhA是影响非透析CKD患者生存率的主要因素,年龄越大,死亡风险越大,相位角每减少1°,死亡风险增加至2.605倍。结论 在非透析CKD患者中,ECW/TBW是PhA的独立影响因素,两者呈负相关;相位角能有效预测非透析CKD患者的生存率,PhA越小,死亡风险越大。

Objective To investigate the influencing factors of phase angle(PhA) and its predictive ability of clinical outcome in patients with non-dialysis chronic kidney disease(CKD).Methods Sixty patients with non-dialysis CKD admitted to Department of Nephrology of Tongji Hospital from January to November 2019 were recruited in this study.All of them received hematuria biochemical test,nutritional risk screening and assessment,SF-36 quality of life survey,anthropometry,grip strength test and body composition detection.According to their PhA,they were divided into group A(PhA4.5°) and group B(PhA≤4.5°),with 30 cases in each group.The correlation of phase angle with nutrition,inflammation,disease,moisture and other related indicators was analyzed,and the main influencing factors of PhA were analyzed with stepwise multiple linear regression analysis.Follow-up was conducted for 3 to 4 years to compare the survival of patients between the 2 groups.Results The blood total protein(TP),albumin(ALB),prealbumin(PAB),life quality score and grip strength were significantly better in group A than group B(P<0.05).The high-sensitive C-reactive protein(CRP),total cholesterol(TC),low density lipoprotein(LDL),total 24h urinary protein(UTP),total 24h urinary albumin(UMA),urinary albumin creatinine ratio(ACR),modified SGA score and extracellular water(ECW/TBW) ratio were obviously lower in group A than group B(P<0.05).Correlation analysis showed that TP,ALB and PAB were positively correlated with PhA(P<0.05),and CRP,TC,LDL,UMA,modified SGA score and ECW/TBW ratio were negatively correlated with PhA(P<0.05).Stepwise multiple linear regression analysis indicated that that ECW/TBW ratio was an independent factor affecting PhA.The mortality rate was high in group B(20.00%,6/30) than group A(6.67%,2/30) during follow-up.Cox regression survival analysis suggested that age and PhA were the main factors affecting the survival of non-dialysis CKD patients.The older the age,the higher the risk of death,with the risk of death being increased to 2.605 times for every 1° reduction of PhA.Conclusion In non-dialysis CKD patients,ECW/TBW ratio is an independent factor affecting PhA,and PhA is negatively correlated to ECW/TBW ratio.PhA can well predict the survival of these patients.And the smaller the phase angle is,the higher the mortality rate.