腹膜透析病人四肢肌肉量变化及其与预后关系的研究  

Study of the relationship between survival and shortage of appendicular skeletal muscle in peritoneal dialysis patients

作　　者：邹立琴[1] 路潜[2] 苏春燕[3] 汪涛[3] 

机构地区：[1]肇庆医学高等专科学校护理系,广东肇庆526020 [2]北京大学护理学院,北京100191 [3]北京大学第三医院肾内科,北京100191

出　　处：《肠外与肠内营养》2015年第4期206-209,共4页Parenteral & Enteral Nutrition

摘　　要：目的:探讨腹膜透析病人四肢肌肉量变化情况,分析四肢肌肉量与病人预后的关系。方法:本研究为纵向随访研究,采用生物电阻抗法测定117例腹膜透析病人透析前和透析12个月后的体重、体脂肪量、四肢肌肉量等情况,同时收集病人资料、血生化指标、透析充分性状况等资料,之后随访本组病人的生存状况。采用亚洲肌少症工作组(AWGS)推荐的标准,判断病人是否存在四肢肌肉量不足。结果:与透析前比较,透析12个月后本组病人的四肢肌肉量明显减少(P<0.001),19例(16.2%)有四肢肌肉量不足,比例高于透析前(10例,8.5%,P=0.013)。Kaplan-Meier生存分析发现,四肢肌肉量不足病人的生存状况比正常者差(χ2=16.588,P<0.001)。多因素Cox回归分析发现,年龄、合并糖尿病、四肢肌肉量不足是影响病人预后的危险因素。结论:随着透析治疗的延续,腹膜透析病人四肢肌肉量减少,四肢肌肉量不足者比例增加。除了年龄、合并糖尿病外,四肢肌肉量不足是腹膜透析病人预后的独立危险因素。Objective ： To investigate the changes of appendicular skeletal muscle （ ASM）, and its relationship with the clinical outcome in peritoneal dialysis （PD） patients. Methods： One hundred and seventeen Chinese PD patients were enrolled. Bioelectrical impedance analysis （BIA） was used. Demographics, serum biochemistry and glomerular filtration rate were also collected. Results： Com- pared with baseline,after 12 months,the patient~ ASM decreased significantly（ 19.40 ±5.60 vs 21.85 ± 6.14, P 〈 0. 001 ）. The shortage of ASM incidence increased [ 19 （ 16.2% ） vs 10 （ 8.5 % ）, P = 0. 013 ]. The patients with the shortage of ASM had shorter overall survival （ X2 = 16. 588, P 〈 0. 001 ）. Patient survival was independently associated with age （ OR = 1. 067,95 % CI = 1. 033-1. 102 ,P 〈 0.01 ）, diabetes mellitus （DM） （ OR = 2. 253,95 % CI = 1. 280-3. 966, P = 0.005, ）, the shortage of appendicular skeletal muscle（OR ： 2. 119,95% CI = 1. 109-4. 047, P = 0. 023） in the Cox proportional hazards model analysis. Conclusion ： With the continuation of PD,ASM decreases, and the shortage of ASM incidence increased. The shortage of ASM remaines an independent predictor of mortality.

关 键 词：腹膜透析 人体成分分析 四肢肌肉量 肌少症 预后 

分 类 号：R459.5[医药卫生—治疗学]