血液透析患者肌少症影响因素及中医证型研究  

Influencing Factors of Sarcopenia in Hemodialysis Patients and a Study on TCM Symptom Type

作　　者：曹琛伟 杨柳 俞曼殊 姚敏 华建武 周子人 盛梅笑 CAO Chenwei;YANG Liu;YU Manshu(Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing,210029)

机构地区：[1]南京中医药大学附属医院,南京210029 [2]重庆市涪陵区中医院,重庆408000 [3]南京中医药大学附属医院肾内科,南京210029

出　　处：《中国中西医结合肾病杂志》2024年第6期495-500,共6页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：国家自然科学青年基金资助项目(No.82004295);江苏省中医院高峰学术人才项目(No.Y2021rc10)。

摘　　要：目的:通过单中心调查探讨血液透析患者肌少症的影响因素和中医证型。方法:维持性血液透析患者169例,根据2019年亚洲肌少症工作组制订的诊断标准,分为肌少症组和非肌少症组,比较两组患者肌肉质量、肌肉力量、躯体功能和相关临床资料的差异,分析肌少症发生的影响因素,基于119例透析肌少症及可能肌少症患者的中医四诊信息,运用因子分析及聚类分析统计中医证素,归纳中医证型及其与肌少证相关指标的关系。结果:(1)169例患者中,肌少症34例(20.1%),可能肌少症85例(50.3%),Logistic多因素回归分析结果显示,高龄(OR=1.305,95%CI:1.159~1.471,P<0.001)、男性(OR=5.473,95%CI:1.02~29.367,P=0.047)是肌少症发生的危险因素,较高的BMI(OR=0.385,95%CI:0.255~0.581,P<0.001)是肌少症发生的保护因素。(2)通过因子分析提取出11个公因子,结合聚类分析、中医证素辨证显示肌少症和可能肌少症患者的中医证型依次为肝肾亏虚兼湿瘀证50例(42.01%),脾肾气虚证49例(41.18%),气阴两虚证20例(16.81%)。(3)3组中医证型患者的步速、四肢骨骼肌质量指数比较,差异具有统计学意义(P<0.05)。其中,脾肾气虚证患者四肢骨骼肌质量指数低于气阴两虚证及肝肾亏虚兼湿瘀证(P<0.05),步速低于气阴两虚证(P<0.05)。在握力方面,3组患者差异无统计学意义(P>0.05)。结论:(1)透析相关肌少症患病率为20.1%,高龄、男性是肌少症发生的危险因素,较高的BMI是肌少症的保护性因素。(2)透析肌少症中医证型可分为肝肾亏虚兼湿瘀证、脾肾气虚证、气阴两虚证,脾肾气虚证患者的肌肉质量、躯体功能指标更低下。Objective:To evaluate the factors and traditional Chinese medicine(TCM)syndrome in hemodialysis-associated sarcopenia patients using a single center study.Methods:Underlying the criteria introduced by the Asian Working Group in Sarcopenia in 2019,169 patients were enrolled who were divided into sarcopenia group and non-sarcopenia group.We analyzed muscle mass,muscle strength,physical function within two groups,as well as that factors for sarcopenia.Based on the TCM diagnosis information in 119 patients with sarcopenia or possible sarcopenia,the relationship between TCM syndrome and related indicators of sarcopenia syndrome is summarized.Results:(1)Among 169 patients,34(20.1%)were sarcopenia and 85(50.3%)were possible sarcopenia.Logistic multivariate regression analysis showed that advanced age(OR=1.305,95%CI:1.159~1.471,P<0.001)and male(OR=5.473,95%CI:1.02~29.367,P=0.047)were risk factors for sarcopenia.Higher BMI(OR=0.385,95%CI:0.255~0.581,P<0.001)was a protective factor for sarcopenia.(2)Through factor analysis,11 common factors were extracted.Combined with cluster analysis and TCM syndrome differentiation,the TCM syndromes of patients with sarcopenia and possible sarcopenia were 50 cases(42.01%)of liver and kidney deficiency and dampness stasis syndrome,49 cases(41.18%)of spleen and kidney Qi deficiency syndrome,and 20 cases(16.81%)of Qi and Yin deficiency syndrome.(3)In a study comparing gait speed and appendicular skeletal muscle mass index among patients with different TCM syndromes,statistically significant differences were observed(P<0.05).Specifically,patients with spleen and kidney Qi deficiency syndrome had lower appendicular skeletal muscle mass index compared to those with Qi and Yin deficiency syndrome and liver and kidney deficiency and dampness stasis syndrome(P<0.05).Their gait speed was also slower than that of Qi and Yin deficiency syndrome(P<0.05).However,there were no statistically significant differences in handgrip strength among the three groups of patients(P>0.05).Conclusion:(1)The preval

关 键 词：肌少症 血液透析 影响因素 中医证型 临床研究 

分 类 号：R259[医药卫生—中西医结合] R274.9[医药卫生—中医内科学]