维持性血液透析患者肌少症的预测诊断及抗阻力运动联合益生菌对其生存质量的影响  

Predictive diagnosis of sarcopenia in maintenance hemodialysis patients and the effect of anti-resistance exercise combined with probiotics on their quality of life

作　　者：赵娟 赵晓倩 章诗琦 邹春波 ZHAO Juan;ZHAO Xiao-qian;ZHANG Shiqi;ZOU Chun-bo(Department of Nephrology Nantong Tongzhou People's Hospital,Nantong 226300 China;Graduate School of Dalian Medical University,Dalian 116000 China;Graduate School of Nantong University,Nantong 226300 China;Department of Nephrology Taizhou People's Hospital Affiliated to Nanjing Medical University,225300 China)

机构地区：[1]南通市通州区人民医院肾内科,南通226300 [2]大连医科大学研究生院,大连116000 [3]南通大学研究生院,南通226000 [4]南京医科大学附属泰州市人民医院肾内科,泰州225300

出　　处：《中国血液净化》2025年第3期208-213,共6页Chinese Journal of Blood Purification

基　　金：南京医科大学附属泰州人民医院临床研究项目(TZKY20230101,TZKY20220209)。

摘　　要：目的探索维持性血液透析患者发生肌少症的预测诊断因子,抗阻力运动联合益生菌对合并肌少症的维持性血液透析(maintenance hemodialysis,MHD)患者生存质量是否具有改善作用。方法纳入2023年7月─12月在南通市通州区人民医院就诊的MHD患者,根据肌少症诊断标准分为肌少症组(n=44)和非肌少症组(n=89),比较2组患者基线资料,分析MHD患者合并肌少症的危险因素,测定患者血清肌肉生长抑制素(myostain,MSTN)及白细胞介素-6(interleukin-6,IL-6)含量,ROC曲线分析两者单独及联合预测肌少症的诊断效能。将肌少症患者随机分为对照组和试验组,对照组予抗阻力运动、优质蛋白饮食,调节血压,维持水电解质平衡等常规治疗,试验组在对照组基础上予抗阻力运动联合益生菌治疗3个月,根据随访结果分析2组间患者生存质量的差异性。结果本研究纳入患者133例,MSTN(OR=1.243,95%CI:1.105~1.399,P<0.001)、IL-6(OR=1.214,95%CI:1.107~1.331,P<0.001)为MHD患者合并肌少症的危险因素。MSTN和IL-6两者联合诊断MHD合并肌少症的AUC最高为0.741,灵敏度:0.659,特异度:0.708,95%CI:0.651~0.831。肌少症试验组患者与对照组治疗后相比,试验组生理功能、精神健康均较高于对照组(t/Z=2.080、-3.752,P=-0.044、<0.001)。结论MSTN联合IL-6可有效预测MHD患者发生肌少症,抗阻力运动联合益生菌可有效改善MHD合并肌少症患者的生存质量,有一定安全性。Objective To explore the factors enable us to predict the diagnosis of sarcopenia,and the effects of anti-resistance exercise combined with probiotics on quality of life in the maintenance hemodialysis(MHD)patients with sarcopenia.Methods The MHD patients admitted to Tongzhou District People's Hospital of Nantong City from July 2023 to December 2023 were enrolled in this study.They were divided into sarcopenia group(n=44)and non-sarcopenia group(n=89)according to the diagnostic criteria of sarcopenia.The baseline data were compared between the two groups,serum myostain(MSTN)and interleukin-6(IL-6)were measured,and the risk factors for sarcopenia were analyzed.ROC curve was used to analyze the efficacy of myostain(MSTN),interleukin-6(IL-6)and MSTN combined with IL-6 on the diagnosis of sarcopenia.The patients in sarcopenia group were further and randomly divided into control group and experimental group.The patients in control group were treated with anti-resistance exercise,high quality protein diet,control of blood pressure,maintenance of water and electrolyte balance,and other routine methods;the patients in experimental group were treated with anti-resistance exercise and probiotics for 3 months in addition to the measures given to the control group.The quality of life during follow-up study was compared between the two groups.Results A total of 133 patients were included in this study.Serum MSTN(OR=1.243,95%CI:1.105~1.399,P<0.001)and IL-6(OR=1.214,95%CI:1.107~1.331,P<0.001)were the risk factors for sarcopenia in MHD patients.The AUC of MSTN combined with IL-6 for the diagnosis of sarcopenia was 0.741,with the sensitivity of 65.9%,the specificity of 70.8%,and 95%CI:0.651~0.831.After the intervention,physiological functions and mental health were better in experiment group than in control group.Conclusion Serum MSTN combined with IL-6 can effectively predict the presence of sarcopenia in MHD patients.Anti-resistance exercise combined with probiotics can successfully and safely improve the quality of life in MHD

关 键 词：维持性血液透析 肌少症 益生菌 肌肉生长抑制素 生存质量 

分 类 号：R459.5[医药卫生—治疗学]