老年慢性肾脏病3-4期患者肌少症的临床特征及危险因素分析  

Analysis of clinical characteristics and risk factors of sarcopenia in elderly patients with chronic kidney disease stage 3-4

作　　者：王倩[1] 郭静[1] 李冰[1] 董玲 赵向娅[1] 杨轶[1] 杨胜楠[1] 李淑莹 田蕊[1] Wang Qian;Guo Jing;Li Bing;Dong Ling;Zhao Xiangya;Yang Yi;Yang Shengnan;Li Shuying;Tian Rui(The Second Division of General Geriatrics,Department of Geriatrics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院老年综合二科,郑州450052

出　　处：《中华肾脏病杂志》2023年第7期485-490,共6页Chinese Journal of Nephrology

基　　金：河南省科技攻关项目(222102310435);国家科技创新2030——“新一代人工智能”重大专项(2021ZD0111001)。

摘　　要：目的探讨老年慢性肾脏病(chronic kidney disease,CKD)3~4期患者肌少症的临床特征及危险因素。方法该研究为单中心、回顾性观察研究,纳入2019年3月至2022年3月于郑州大学第一附属医院老年科住院的CKD 3~4期≥60岁患者,并收集患者的一般资料,检测实验室指标、肌肉力量、躯体功能、四肢骨骼肌量指数(appendicular muscle mass index,ASMI)。根据肌少症诊断标准,患者被分为非肌少症CKD组和肌少症CKD组,比较两组患者的基线资料;采用Logistic回归分析法分析CKD 3~4期患者发生肌少症的相关因素。结果该研究共纳入162例CKD 3~4期患者,中位年龄75(69,82)岁,男性89例(54.9%),肌少症40例,肌少症患病率为24.7%(95%CI 18.1%~31.3%)。与非肌少症CKD组相比,肌少症CKD组患者年龄、患痴呆比例、胱抑素C、尿素氮、C反应蛋白及尿蛋白/肌酐比值较高(均P<0.05),体重指数、血红蛋白、二氧化碳结合力、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、血清白蛋白、规律运动及服用α酮酸患者比例均较低(均P<0.05),同时握力、步速、简易体能测量表评分、ASMI均较低(均P<0.05)。多因素Logistic回归分析显示,低eGFR(OR=0.824,95%CI 0.687~0.987,P=0.036)、低体重指数(OR=0.463,95%CI 0.304~0.704,P<0.001)、低血清白蛋白(OR=0.459,95%CI 0.263~0.802,P=0.006)及高C反应蛋白(OR=2.754,95%CI 1.708~4.439,P<0.001)是CKD患者发生肌少症的独立相关因素。结论CKD 3~4期患者肌少症的患病率较高,低eGFR、低体重指数、低血清白蛋白及高C反应蛋白是CKD 3~4期患者发生肌少症的独立危险因素。Objective To explore the clinical characteristics and risk factors of sarcopenia in elderly patients with chronic kidney disease(CKD)stage 3-4.Methods It was a single-center,retrospective observational study.CKD stage 3-4 patients aged≥60 years old from March 2019 to March 2022 in the Geriatrics Department of the First Affiliated Hospital of Zhengzhou University were enrolled in the study.General data of the patients were collected,and laboratory indicators,muscle strength,physical function and appendicular muscle mass index(ASMI)were measured.According to the diagnostic criteria of sarcopenia,the patients were divided into no sarcopenia CKD group and sarcopenia CKD group.Baseline data between these two groups were compared.Logistic regression analysis was used to analyze the related factors of sarcopenia in elderly CKD stage 3-4 patients.Results A total of 162 CKD stage 3-4 patients were enrolled in this study,with 89 males(54.9%)and a median age of 75(69,82)years.Sarcopenia was diagnosed in 40 cases,and the prevalence was 24.7%(95%CI 18.1%-31.3%).Compared with no sarcopenia CKD group,age,proportion of dementia,cystatin C,urea nitrogen,C-reactive protein(CRP)and ratio of urine protein to creatinine were higher(all P<0.05),while body mass index(BMI),hemoglobin,carbon dioxide combining power,estimated glomerular filtration rate(eGFR),serum albumin and the proportion of regular exercise and usingα-ketones were lower in sarcopenia CKD group(all P<0.05).Meanwhile,grip strength,walking speed,short physical performance battery score and ASMI were lower in sarcopenia CKD group(all P<0.05).Multivariable logistic regression analysis results showed that low eGFR(OR=0.824,95%CI 0.687-0.987,P=0.036),low BMI(OR=0.463,95%CI 0.304-0.704,P<0.001),low serum albumin(OR=0.459,95%CI 0.263-0.802,P=0.006)and high CRP(OR=2.754,95%CI 1.708-4.439,P<0.001)were the independent related factors of sarcopenia in elderly CKD patients.Conclusions The prevalence of sarcopenia in elderly CKD stage 3-4 patients is high.Low eGFR,low BMI,low seru

关 键 词：肾功能不全 慢性 肌减少症 危险因素 老年人 

分 类 号：R692[医药卫生—泌尿科学] R685[医药卫生—外科学]