维持性血液透析患者久坐时间与肌肉减少症的剂量-效应关系  

Dose-effect relationship between sedentary time and sarcopenia in maintenance hemodialysis patients

作　　者：丁悦凤 汪思 黄家懿[1] Ding Yuefeng;Wang Si;Huang Jiayi(Department of Hemodialysis,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院血液净化部,上海200092

出　　处：《中国实用护理杂志》2025年第4期283-289,共7页Chinese Journal of Practical Nursing

基　　金：上海交通大学医学院附属新华医院科技基金项目(xhhlcx2023-016)。

摘　　要：目的探讨维持性血液透析(MHD)患者久坐时间与肌肉减少症的剂量-效应关系,为提升MHD患者的肌肉健康状况提供决策参考。方法采用回顾性队列研究方法,以便利抽样法选择2021年1月至2023年12月在上海交通大学医学院附属新华医院进行透析的MHD患者为研究对象。收集一般资料、肌肉减少症患病率和久坐时间等数据。根据久坐时间四分位数将MHD患者分为Q1组(久坐时间<3.40 h),Q2组(3.40 h≤久坐时间<5.20 h),Q3组(5.20 h≤久坐时间<9.33 h)和Q4组(久坐时间≥9.33 h)。采用限制性立方样条图分析久坐时间与肌肉减少症风险的剂量-效应关系。采用Logistic回归分析久坐时间与肌肉减少症风险的关系且行趋势分析。按照年龄、性别、透析龄分组,采用交互检验法行亚组分析。结果共纳入MHD患者576例,男272例,女304例,年龄(59.69±11.38)岁,久坐时间5.20(3.40,9.33)h,肌肉减少症患病率为31.60%(182/576)。限制性立方样条图分析显示,久坐时间与肌肉减少症患病风险有线性关联趋势(P_(非线性)=0.226),呈正相关(P_(整体)<0.01)。Logistic分析显示,校正全部混杂因素时,与Q1组比较,Q3、Q4组的肌肉减少症风险分别增高1.557倍(OR=2.557,95%CI 1.255~5.334,P<0.01)、7.721倍(OR=8.721,95%CI 4.328~18.323,P<0.01)。且Q1、Q2、Q3、Q4组患肌肉减少症风险的OR值均呈增加趋势(P_(趋势)<0.01)。亚组分析显示,在不同年龄、性别、透析龄亚组的MHD患者中,肌肉减少症风险与久坐时间的关系基本一致(OR值为1.807~3.090,均P<0.05),且久坐时间与年龄、性别、透析龄均不存在交互作用(P交互>0.05)。结论MHD患者的久坐时间越长,患肌肉减少症的风险越高,久坐时间≥5.20 h时,患肌肉减少症的风险显著增高。医护工作者应鼓励MHD患者改善生活习惯,尤其是每日久坐时间≥5.20 h的患者,预防肌肉减少症的发生。ObjectiveTo investigate the dose-effect relationship between sedentary time and sarcopenia in maintenance hemodialysis(MHD)patients,and to inform decision-making to improve muscle health in MHD patients.MethodsA retrospective cohort study was conducted.MHD patients undergoing dialysis in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2021 to December 2023 were selected by convenience sampling method.Data on general information,prevalence of sarcopenia and sedentary time,etc.were collected.Based on the quartile of sedentary time,MHD patients were categorized into group Q1(sedentary time<3.40 h),group Q2(3.40 h≤sedentary time<5.20 h),group Q3(5.20 h≤sedentary time<9.33 h)and group Q4(sedentary time≥9.33 h).Restricted cubic spline plots were used to analyze the dose-effect relationship between sedentary time and the risk of sarcopenia.Logistic regression was used to analyze the relationship between sedentary time and the risk of sarcopenia with trend analysis.Subgroups were grouped according to age,gender,and age on dialysis,and subgroup analyses were performed using the interaction test.ResultsA total of 576 MHD patients were enrolled,272 males and 304 females,age(59.69±11.38)years,the sedentary time was 5.20(3.40,9.33)h,and the prevalence of sarcopenia was 31.60%(182/576).Restricted cubic spline plots analysis showed that there was a trend of linear association between sedentary time and the risk of sarcopenia(P_(non-linear)=0.226),with a positive correlation(P_(overall)<0.01).Logistic analysis showed that when correcting for all confounding factors,compared with group Q1,the risk of sarcopenia increased 1.557 times in group Q3(OR=2.557,95%CI 1.255-5.334,P<0.01)and 7.721 times in group Q4(OR=8.721,95%CI 4.328-18.323,P<0.01).And the OR values of sarcopenia in sedentary time of group Q1,Q2,Q3,and Q4 showed an increasing trend(P_(trend)<0.01).Subgroup analysis showed that the relationship between the risk of sarcopenia and sedentary time was basically the same in MHD

关 键 词：维持性血液透析 肌肉减少症 久坐时间 限制性立方样条图 

分 类 号：R16[医药卫生—公共卫生与预防医学]