肌少症对血液透析终末期糖尿病肾病患者远期生存率的影响  

Effect of sarcopenia on long-term survival of patients with end-stage diabetes nephropathy after hemodialysis

作　　者：陈乔 王莉 黄玉兰 钟华芳 Chen Qiao;Wang Li;Huang Yulan;Zhong Huafang(DepartmentⅡ,Cadre Ward,Central Theater Command General Hospital of the People's Liberation Army,Wuhan 430000,China;Department of Outpatient,Hubei Provincial Military Region Wuhan 16th Cadre Rest,Wuhan 430000,China)

机构地区：[1]中国人民解放军中部战区总医院干部病房二科,武汉430000 [2]湖北省军区武汉第十六干休所门诊部,武汉430000

出　　处：《国际泌尿系统杂志》2025年第1期116-120,共5页International Journal of Urology and Nephrology

基　　金：湖北省卫生健康委科研项目(WJ2019Q059)。

摘　　要：目的探讨肌少症对血液透析终末期糖尿病肾病患者远期生存率的影响。方法选取2015年1月至2017年6月在中国人民解放军中部战区总医院就诊的139例终末期糖尿病肾病患者,按照是否合并肌少症将患者分为肌少症组(52例)和无肌少症组(87例),采用1∶1倾向性评分匹配法将两组中倾向性评分最相近的患者进行配对,比较匹配后各临床因素在两组分布的均衡性,绘制Kaplan-Meier生存曲线,采用log-tank检验比较匹配后两组患者随访5年的总生存率,采用Cox回归分析肌少症对终末期糖尿病肾病患者总生存率的影响。结果匹配前两组患者的体质量指数、查尔森合并症指数(CCL)、血肌酐、尿素、白蛋白、空腹血糖、三酰甘油(TG)、总胆固醇(TC)以及低密度脂蛋白胆固醇(LDL)比较,差异均有统计学意义(均P<0.05)。无肌少症组患者随访1、3、5年的累积总生存率明显高于肌少症组(100.0%、73.4%、57.5%vs.82.5%、48.1%、38.7%,均P<0.05)。多因素Cox回归分析结果显示,肌少症、白蛋白和CCL是影响终末期糖尿病肾病患者随访5年的总生存率的独立预测因素(均P<0.05),其中合并肌少症患者随访5年内死亡的风险为不合并肌少症患者的3.732倍(P<0.001)。结论肌少症、白蛋白和CCL是影响终末期糖尿病肾病患者随访5年总生存率的独立预测因素。Objective To explore the effect of sarcopenia on the long-term survival rate of patients with end-stage diabetes nephropathy after hemodialysis.Methods From January 2015 to June 2017,139 patients with end-stage diabetes nephropathy who were hospitalized in Central Theater Command General Hospital of the People's Liberation Army were included as the study subject.Patients were divided into sarcopenia group(52 cases)and non-sarcopenia group(87 cases)according to whether they had sarcopenia or not.Patients with the most similar sarcopenia in the two groups were matched by 1∶1 propensity score matching method.After matching,the equilibrium distribution of various clinical factors in the two groups was compared,and Kaplan-Meier survival curve was drawn.log-tank test was used to compare the 5-year overall survival rate of the two groups after matching,and Cox regression was used to analyze the effect of sarcopenia on the overall survival rate of patients with end-stage diabetic nephropathy.Results There were significant differences in body mass index,CCL value,blood creatinine,urea,albumin,fasting blood glucose,triglyceride(TG),total cholesterol(TC)and low density lipoprotein cholesterol(LDL)between the two groups before matching(all P<0.05).The cumulative overall survival rate of patients without sarcopenia was significantly higher than that of patients with sarcopenia(100.0%,73.4%,57.5%vs 82.5%,48.1%,38.7%,all P<0.05).Multivariate Cox regression analysis showed that sarcopenia,albumin and CCL were independent predictors of the 5-year overall survival rate of patients with end-stage diabetes nephropathy(P<0.05).The risk of death in patients with sarcopenia was 3.732 times higher than that in patients without sarcopenia(P<0.001).Conclusions Sarcopenia,albumin and CCL are independent predictors of 5-year overall survival rate in patients with end-stage diabetes nephropathy.

关 键 词：糖尿病肾病 肾透析 肌少症 

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