多频生物电阻抗与双能X线法在进展期老年慢性肾脏病患者中肌肉量评定一致性比较  

Consistency between muitifrequency bioelectrical impedance analysis and dual-energy x-ray absorptiometry for muscle mass assessment in elderly patients with advanced chronic kidney disease

作　　者：程东生[1] 张琦 简桂花[1] 汪年松[1] 王之 李军辉[1] Cheng Dongsheng;Zhang Qi;jian Guihua;Wang Niansong;Wang Zhi;Li Junhui(Department of Nephrology,the Affiliated Sixth People's Hospital,Shanghai 200233,China;TianLin Community Health Center,Xuhui District Shanghai 200233,China)

机构地区：[1]上海市第六人民医院肾内科,上海20023 [2]上海市田林街道社区卫生服务中心,上海200233

出　　处：《中华老年医学杂志》2022年第4期393-396,共4页Chinese Journal of Geriatrics

基　　金：上海市卫生健康委员会临床课题青年专项(20194Y0347);上海市第六人民医院临床课题(ynlc201806)。

摘　　要：目的比较多频生物电阻抗(BIA)与双能X线吸收检测法(DXA)方法测定进展期老年慢性肾脏病(CKD)患者骨骼肌量的一致性,进而为临床准确评估肌少症提供依据.方法上海市第六人民医院肾内科门诊就诊的进展期老年CKD患者接受手握力及步行速度等运动能力评定,以及DXA和多频BIA法测量身体肌肉量.采用组内相关系数、Bland-Altman分析及Kappa一致性检验评定两种肌肉测定方法的一致性.结果本研究共纳入67例老年CKD患者,年龄(70.7±6.1)岁,体质指数为(24.6±3.5)kg/m^(2),男性41例(61.2%),平均估算肾小球滤过率为(27.7±12.7)ml·min^(-1)·1.73m^(-2).BIA和DXA测定各节段肌肉量及骨骼肌质量指数(ASMI)的组内相关系数0.81~0.90.Bland-Altman分析得出BIA较DXA方法高估患者肌肉量,ASMI平均差值为(0.44±0.13)kg/m^(2).此外,两种测定方法对于肌肉量减少判断呈现中度一致性(Kappa=0.47).结论多频BIA和DXA两种测定方法对于进展期老年CKD患者肌肉量评估具有较良好的一致性,但多频BIA较DXA方法高估老年CKD患者肌肉量.Objective To compare the consistency between bioelectrical impedance analysis(BIA)and dual-energy X-ray absorptiometry(DXA)in skeletal muscle mass assessment in elderly patients with advanced chronic kidney disease(CKD),and to provide a basis for accurate clinical diagnosis of sarcopenia.Methods Elderly patients with advanced CKD at the Department of Nephrology of Shanghai Sixth People's Hospital were included.Parameters for physical performance included handgrip strength and gait speed,and body muscle mass was measured by DXA and multifrequency BIA.The consistency between the two methods was assessed by the intraclass correlation coefficient,Bland-Altman analysis and kappa coefficient test.Results This study included 67 elderly patients with advanced CKD with a mean age of(70.7±6.1)years and an average BMI of(24.6±3.5)kg/m^(2).The proportion of enrolled male patients was 61.2%and the mean estimated glomerular filtration rate was(27.7±12.7)mlmin.1.73m.The intraclass correlation coefficients of muscle mass and appendicular skeletal muscle mass index(ASMI)measured by BIA and DXA ranged from 0.81 to 0.90.Bland-Altman analysis showed that BIA overestimated musele mass against DXA,and the mean difference in ASMI was(0.44±0.13)kg/m^(2).In addition.there was a moderate agreement between the two measurement methods for determining muscle loss(Kappa=0.47).Conclusions BIA and DXA offer a fair level of consistency in the assessment of musele mass in elderly patients with advanced CKD.However,compared with DXA,BIA overestimates muscle mass in elderly patients with CKD.

关 键 词：慢性肾脏病 双能X线吸收检测法 多频生物电阻抗分析 肌肉减少 

分 类 号：R692[医药卫生—泌尿科学]