中老年腹膜透析患者肌少症发生率及其相关因素分析

Incidence and related factors of myopenia in middle-aged and elderly peritoneal dialysis patients

目的探讨中老年腹膜透析患者肌少症发生率及其相关因素分析。方法采用问卷调查法及病例查阅法,收集2019年8月至2020年12月承德医学院附属医院肾脏内科的104例腹膜透析患者一般人口学资料,使用国产Canary EH101电子握力计评估肌肉力量,德国费森尤斯牌人体成分分析仪测定肌肉质量和脂肪组织指数,采用主观全面营养评定法评估腹膜透析患者营养状况,检测患者血清生物化学指标。比较肌少症组和无肌少症组患者一般资料、营养状态以及血清生物化学指标等,采用二元Logistic回归分析中老年腹膜透析患者肌少症相关影响因素。结果104例中老年腹膜透析患者中,肌少症发生率24.0%。与无肌少症组比较,肌少症组瘦肉组织指数7.1 kg/m^(2),低于无肌少症组的10.6 kg/m^(2)。肌少症组握力15.3 kg,低于无肌少症组的23.2 kg。肌少症组脂肪组织指数12.8 kg/m^(2),高于无肌少症组的10.2 kg/m^(2)(P<0.05)。多因素回归分析结果显示:高敏C反应蛋白为肌少症独立危险因素(OR=1.482,95%CI:1.134~1.937),体重指数(OR=0.797,95%CI:0.638~0.994)、残余肾功能(OR=0.599,95%CI:0.368~0.972)为肌少症独立保护性因素。结论中老年腹膜透析治疗的患者并发症较多,肌少症发生率较高,改善患者的营养水平,降低微炎症状态,保护残余肾功能可降低肌少症的发生。

Objective To explore the incidence of myopenia and examine its related factors in middle-aged and elderly peritoneal dialysis(PD)patients.Methods Questionnaire survey and case review were employed for collecting 104 PD patients of department of nephrology,affiliated hospital of Chengde Medical College between August 2019 to December 2020 general demographic data.Muscle strength was evaluated with a domestic Canary EH101 electronic grip strength meter.Muscle mass and adi-pose tissue index were measured with a German Fresenius body composition analyzer.Nutritional status was evaluated by comprehensive subjective nutrition assessments and serum biochemical parameters were detected.The inter-group differences of general profiles,nutritional status and serum biochemical parameters were compared.And the relevant factors of myopenia were analyzed by binary logistic regression.Results Among 104 middle-aged and elderly PD patients,the incidence of myopenia was 24.0%.Lean tissue index was lower in myopenia group than that in non-myopenia group(7.1 kg/m^(2) vs 10.6 kg/m^(2));Grip strength lower in myopenia group than that in non-myopenia group(15.3 kg vs 23.2 kg);Fat tissue index higher in myopenia group than in non-myopenia group(12.8 kg/m^(2) vs 10.2 kg/m^(2),P<0.05).The results of multivariate regression analysis indicated that serum level of hs-C-reactive protein(OR=1.482,95%CI:134-1.937)was an independent risk factor for sarcopenia.And body mass index(OR=0.797,95%CI:0.638-0.994)and residual renal function(OR=0.599,95%CI:0.368-0.972)were independent protective factors for sarcopenia.Conclusion Middle-aged and elderly PD patients are more prone to complications with a higher incidence of sarcopenia.Improving nutritional status,lowering microinflammatory status and protecting residual renal function can reduce the occurrence of sarcopenia.