维持性血液透析患者肌少症患病的风险因素分析  

Analysis of risk factors of sarcopenia in maintenance hemodialysis patients

作　　者：李洪[1] 陈汝满 曾欣[1] 白亚飞[1] 徐明芝[1] 黎吉锋 文功雄 王超群[2] Li Hong;Chen Ruman;Zeng Xin;Bai Yafei;Xu Mingzhi;Li Jifeng;Wen Gongxiong;Wang Chaoqun(Blood Purification Center,Hainan General Hospital,Haikou 570311,China;Department of Nuclear Medicine,Hainan General Hospital,Haikou 570311,China)

机构地区：[1]海南省人民医院,海南医学院附属海南医院血液净化中心,海口570311 [2]海南省人民医院,海南医学院附属海南医院核医学科,海口570311

出　　处：《中华肾脏病杂志》2023年第11期815-821,共7页Chinese Journal of Nephrology

基　　金：海南省医药卫生科研项目(22A200187);海南省社会发展科技专项基金(SF201307);海南省临床医学中心建设项目。

摘　　要：目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者肌少症患病率及其风险因素。方法该研究为横断面研究。纳入2019年10月在海南省人民医院血液净化中心接受治疗的MHD患者为研究对象,根据是否患有肌少症将其分为肌少症组和非肌少症组,收集患者胸部CT影像学和实验室检查资料。采用双能X线法测量四肢骨骼肌总量。用 χ^(2)检验或Mantel-Haenszel趋势 χ^(2)检验比较肌少症组和非肌少症组患者临床资料的差异,多因素Logistic回归模型分析MHD患者肌少症患病的风险因素。结果共182例MHD患者入选该研究,肌少症患病率为33.5%(61/182)。肌少症组年龄≥60岁、糖尿病肾病、带隧道涤纶套导管、体重指数<18 kg/m^(2)、血白蛋白<40 g/L、低密度脂蛋白胆固醇≥3.37 mmol/L、左室射血分数<50%、胸部CT疑似肺结核和肺结核比例均高于非肌少症组(均P<0.05)。多因素Logistic回归分析结果显示,左室射血分数<50%(是/否,OR=3.250,95%CI 1.035~10.206,P=0.044)、血低密度脂蛋白胆固醇≥3.37 mmol/L(是/否,OR=6.354,95%CI 1.675~24.108,P=0.007)、胸部CT疑似肺结核(正常为参照,OR=7.433,95%CI 1.531~36.083,P=0.013)及肺结核(正常为参照,OR=28.871,95%CI 3.208~259.872,P=0.030)为MHD患者肌少症患病的独立影响因素。结论 MHD患者肌少症患病率较高,血低密度脂蛋白胆固醇≥3.37 mmol/L、左室射血分数<50%、胸部CT肺结核和疑似肺结核是MHD患者肌少症患病的独立风险因素。临床上尽早纠正左心收缩功能、调节血脂及防治肺结核可能降低MHD患者肌少症的患病风险。Objective To explore the prevalence and risk factors of sarcopenia in patients with maintenance dialysis(MHD).Methods It was a cross-sectional study.Patients who received MHD treatment in the Blood Purification Center of Hainan Provincial People's Hospital in October 2019 were included as study subjects.The patients were divided into sarcopenia group and non-sarcopenia group according to whether they had sarcopenia or not.Chest CT imaging and laboratory examination data were collected.Dual-energy X-ray absorptiometry was used to measure the skeletal muscle mass.Chi-square test or Mantel-Haenszel trend chi-square test was used to compare the clinical data of patients with and without sarcopenia.Multivariate logistic regression equation was used to analyze the risk factors of sarcopenia.Results A total of 182 MHD patients were enrolled in the study,and the prevalence of sarcopenia was 33.5%(61/182).The proportions of age≥60 years old,diabetic nephropathy,tunneled-cuffed catheter,body mass index<18 kg/m^(2),serum albumin<40 g/L,low density lipoprotein cholesterol≥3.37 mmol/L,left ventricular ejection fraction<50%,chest CT-suspected pulmonary tuberculosis(PTB)and PTB in sarcopenia group were higher than those in non-sarcopenia group(all P<0.05).Multivariate logistic regression analysis results showed that left ventricular ejection fraction<50%(≥50%as a reference,OR=3.250,95%CI 1.035-10.206,P=0.044),low-density lipoprotein cholesterol≥3.37 mmol/L(<3.37 mmol/L as a reference,OR=6.354,95%CI 1.675-24.108,P=0.007),chest CT-suspected PTB(normal as a reference,OR=7.433,95%CI 1.531-36.083,P=0.013),and PTB(normal as a reference,OR=28.871,95%CI 3.208-259.872,P=0.030)were independent influencing factors of sarcopenia in MHD patients.Conclusions The prevalence of sarcopenia is higher in MHD patients.Blood low-density lipoprotein cholesterol≥3.37 mmol/L,ejection fraction<50%,chest CT-PTB and suspected PTB are independent risk factors of sarcopenia in MHD patients.Correcting left ventricular systolic function,regulating

关 键 词：肾透析 肌减少症 危险因素 肺结核 

分 类 号：R692.5[医药卫生—泌尿科学] R685[医药卫生—外科学]