维持性血液透析患者肌肉减少影响因素研究  

Analysis of influencing factors of muscle loss in patients undergoing maintenance hemodialysis

作　　者：戴婷婷 曾小庆[2] 柳园[2] 龚杰[1] 周莉[3] 程懿[2] 陈林[4] 胡雯[1,2] DAI Tingting;ZENG Xiaoqing;LIU Yuan;GONG Jie;ZHOU Li;CHENG Yi;CHEN Lin;HU Wen(West China School of Public Health/West China Fourth Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Clinical Nutrition,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Nephrology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Hemodialysis Center,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西公共卫生学院/四川大学华西第四医院,成都610041 [2]四川大学华西医院临床营养科,成都610041 [3]四川大学华西医院肾脏内科,成都610041 [4]四川大学华西医院血液透析中心,成都610041

出　　处：《华西医学》2020年第4期489-493,共5页West China Medical Journal

基　　金：四川省科学技术厅科技计划项目(2015SZ0144)。

摘　　要：目的采用生物电阻抗法研究肌肉量减少与肌肉量正常的维持性血液透析(maintenance hemodialysis,MHD)患者体成分差异并分析其影响因素。方法选择2018年9月-2019年5月在某三级甲等医院血液透析中心进行MHD的122例患者为研究对象,按照相对骨骼肌质量指数分为肌肉量减少组和肌肉量正常组,收集其一般情况、透析后体成分指标、血清白蛋白等,分析其组间差异并进行多因素逐步logistic回归分析。结果肌肉量正常组53例,肌肉量减少组69例。肌肉量正常组的透后体重、各项肌肉相关指标、细胞内水分、细胞外水分、总体水分、蛋白质、矿物质、身体细胞量、骨矿物质含量、体质量指数、上臂围、上臂肌围均高于肌肉量减少组(P<0.05),肌肉量正常组的细胞外水分占总体水分的百分比低于肌肉量减少组(P<0.05)。多因素逐步logistic回归分析结果显示,透后体重[比值比(odds ratio,OR)=0.679,95%置信区间(confidence interval,CI)(0.535,0.862),P=0.001]是MHD患者肌肉减少的保护因素,细胞外水分占总体水分的百分比高于正常值[OR=6.926,95%CI(1.014,47.280),P=0.048]、身体细胞量低于正常值[OR=57.707,95%CI(6.927,480.761),P<0.001]、骨矿物质含量低于正常值[OR=9.743,95%CI(1.220,77.831),P=0.032]和上臂围[OR=2.183,95%CI(1.004,4.749),P=0.049]是MHD患者肌肉减少的危险因素。结论MHD患者肌肉减少发生率高,宜密切监测其体成分变化,重点关注透后体重偏低、骨矿物质和身体细胞量缺乏、浮肿系数大、上臂围增加等高危人群,及时进行营养运动干预以预防肌肉衰减综合征的发生。Objective To study the differences in body composition between maintenance hemodialysis(MHD) patients with reduced muscle mass and the ones with normal muscle mass by bioelectrical impedance analysis,and explore the influencing factors.Methods A total of 122 patients undergoing MHD in the hemodialysis center of a general hospital between September 2018 and May 2019 were selected as the research subjects.According to the relative skeletal muscle mass index,they were divided into the muscle loss group and the normal muscle mass group.Their general conditions,post-dialysis body composition,and serum albumin were collected to analyze the differences between the two groups,and a multiple stepwise logistic regression analysis was carried out.Results Among the included subjects,53 patients had normal muscle mass and 69 patients had muscle mass loss.The post-dialysis body weight,muscle-related indexes,intracellular water,extracellular water(ECW),total body water(TBW),protein,minerals,body cell mass,bone mineral content,body mass index,arm circumference,and arm muscle circumference in the normal muscle mass group were higher than those in the muscle loss group(P<0.05);the percentage of ECW/TBW in the normal muscle mass group was lower than that in the muscle loss group(P<0.05).The multiple stepwise logistic regression analysis showed that the post-dialysis weight[odds ratio(OR)=0.679,95%confidence interval(CI)(0.535,0.862),P=0.001]was a protective factor from losing muscle in MHD patients,and the high ECW/TBW[OR=6.926,95%CI(1.014,47.280),P=0.048],low body cell mass[OR=57.707,95%CI(6.927,480.761),P<0.001],low bone mineral content[OR=9.743,95%CI(1.220,77.831),P=0.032],and arm circumference[OR=2.183,95%CI(1.004,4.749),P=0.049]were risk factors for muscle loss in MHD patients.Conclusions MHD patients have a high incidence of muscle loss.It is necessary to monitor the changes of their body composition,especially those who with low post-dialysis body weight,lack of bone minerals and body cells,excessive ECW/TBW,and increased ar

关 键 词：血液透析 肌肉减少 生物电阻抗 体成分 影响因素 

分 类 号：R692.5[医药卫生—泌尿科学]