握力和肌肉质量与腹膜透析患者全因死亡的相关性

Association of grip strength and muscle mass with all-cause mortality in patients receiving peritoneal dialysis

目的验证握力和肌肉质量是否都与腹膜透析患者的全因死亡相关。方法回顾性分析2019年2月至7月于首都医科大学附属北京潞河医院腹膜透析中心随访的腹膜透析患者,收集患者的临床资料,测量握力,并应用人体成分分析仪测量计算四肢骨骼肌质量指数(ASMI)。所有患者随访至2022年5月,以死亡为观察终点,分为生存组和死亡组。应用多因素Cox回归分析筛选患者全因死亡的危险因素,评价握力及ASMI与全因死亡的相关性。采用SPSS 26.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、Mann-Whitney U检验及χ^(2)检验。结果最终纳入腹膜透析患者76例,平均年龄(57.43±13.01)岁,平均随访(941.49±312.32)d,其中死亡患者27例(35.52%)。全因死亡的单因素Kaplan-Meier检验结果显示:与生存组相比,死亡组患者年龄更大,糖尿病患病率较高、握力下降患者占比较多,血清肌酐、血清白蛋白较低(P<0.05)。将年龄、透析龄、是否合并糖尿病、ASMI、握力、血肌酐、白蛋白及C-反应蛋白纳入多因素Cox回归分析,提示低握力(HR=3.182,95%CI 1.114~9.089,P=0.031)、合并糖尿病(HR=4.053,95%CI 1.320~12.446,P=0.014)和年龄(HR=4.191,95%CI 1.281~13.711,P=0.018)是腹膜透析患者全因死亡的独立预测因素,而ASMI无统计学意义。结论低握力,而非低肌肉质量,是腹膜透析患者全因死亡的独立危险因素。

Objective To verify whether grip strength and muscle mass are both associated with all-cause mortality in the patients receiving peritoneal dialysis(PD).Methods A retrospective analysis was made of all followed-up patients at the PD Center of Beijing Luhe Hospital Affiliated to Capital Medical University from February to July 2019.Their clinical data were collected,hand grip strength were measured,and appendicular skeletal muscle mass index(ASMI)was measured using the body composition analyzer.All the patients were followed up until May 2022.With death as the endpoint,the patients were divided into the survival group and death group.Multivariate Cox regression was used to screen the risk factors for all-cause mortality and evaluate the association of grip strength and ASMI with all-cause mortality in PD patients.SPSS 26.0 was used for data analysis.Comparison between two groups was performed using t-test,Mann-Whitney U test orχ^(2) test,depending on data type.Results A total of 76 PD patients were enrolled,with an average age of(57.43±13.01)years and an average follow-up period of(941.49±312.32)d.Among them,27(35.52%)died.The results of univariate analysis for all-cause mortality using Kaplan-Meier test showed that the patients in death group were older,had a higher incidence of diabetes mellitus,a higher proportion of those with decreased grip strength,and lower levels of serum creatinine and serum albumin than those in the survival group(P<0.05).Uultivariate Cox regression analysis with age,years of dialysis,diabetes mellitus,ASMI,grip strength,serum creatinine,albumin and C-reactive protein showed that lower hand grip strength(HR=3.182,95%CI 1.114-9.089;P=0.031),diabetes mellitus(HR=4.053,95%CI 1.320-12.446;P=0.014)and age(HR=4.191,95%CI 1.281-13.711;P=0.018)were independent predictors of all-cause mortality in PD patients and that ASMI had no statistical difference.Conclusion Grip strength instead of muscle mass is associated with all-cause mortality of PD patients.