基于CT图像的肌肉质量与维持性透析患者便秘的相关性研究

Association between CT image-based muscle mass and constipation in maintenance dialysis patients

目的便秘是一种常见的胃肠道症状,在透析患者中发病率很高。众所周知,影响透析患者便秘的因素很多,但肌肉质量是否影响便秘尚不清楚。本研究的目的是探讨透析患者肌肉质量与便秘之间的关系。方法纳入东南大学附属中大医院3个院区的透析中心,428名透析患者参加横断面研究。便秘通过便秘评估量表(constipation assessment scale,CAS)进行评估;肌肉质量使用计算机断层扫描(computed tomography,CT)测定L1椎体水平。采用多因素Logistic回归分析肌肉质量对便秘的影响。结果共有428名透析患者参加本研究。透析患者平均年龄(56.09±15.17)岁,便秘患病率为62.38%。在CAS评分结果中,多元Logistic回归结果显示:透析龄(OR=0.942,95%CI:0.910~0.976,P<0.001)和低肌肉脂肪浸润(low attenuation muscle,LAM)密度(OR=0.825,95%CI:0.771~0.961,P=0.008)是影响便秘的保护因素,糖尿病史(OR=2.331,95%CI:1.290~4.212,P<0.001)是便秘的危险因素。在性别亚组分析中,男性透析患者,较短的透析龄(OR=0.946,95%CI:0.903~0.990,P=0.017)和较低的LAM密度(OR=0.868,95%CI:0.777~0.970,P=0.014)是便秘的危险因素;女性透析患者,较短的透析龄(OR=0.934,95%CI:0.884~0.987,P=0.015)和较低的LAM密度(OR=0.784,95%CI:0.675~0.911,P=0.002)是便秘的危险因素。结论本研究表明透析患者便秘的发生率较高,LAM密度是透析患者便秘的独立危险因素,本研究为了解透析患者便秘易感性的原因提供了新的视角。

Objective Constipation is a common gastrointestinal symptom that is prevalent in dialysis patients.It is well known that many factors affect constipation in dialysis patients,but whether muscle mass affects constipation is unknown.The aim of this study was to explore the relationship between muscle mass and constipation in dialysis patients.Methods A total of 428 dialysis patients from three dialysis centers were enrolled in this cross-sectional study.Constipation was assessed by the constipation assessment scale(CAS).Muscle mass was determined using computed tomography(CT)at the L1 vertebral level.Multivariate logistic regression was used to assess the effect of muscle mass on constipation.Results A total of 428 dialysis patients were enrolled in the study.The mean age was 56.09±15.17 years,and the prevalence of constipation was 62.38%in dialysis patients.Multivariate logistic regression results showed that dialysis years(OR=0.942,95%CI:0.910~0.976,P<0.001)and low attenuation muscle(LAM)density(OR=0.825,95%CI:0.771~0.961,P=0.008)were the protective factors influencing constipation,while diabetes history(OR=2.331,95%CI:1.290~4.212,P<0.001)was a risk factor for constipation.We also performed sex subgroup analyses.In male dialysis patients,a younger dialysis age(OR=0.946,95%CI:0.903~0.990,P=0.017)and a lower LAM density(OR=0.868,95%CI:0.777~0.970,P=0.014)were the risk factors for constipation based on CAS score.In female dialysis patients,a younger dialysis age(OR=0.934,95%CI:0.884~0.987,P=0.015)and a lower LAM density(OR=0.784,95%CI:0.675~0.911,P=0.002)were the risk factors for constipation based on CAS scores.Conclusions The present study shows that dialysis patients have a higher incidence of constipation and that LAM density is an independent risk factor for constipation in dialysis patients.Our study provides a new perspective to understand the cause of susceptibility to constipation in dialysis patients.