中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (01): 30-34.doi: 10.3969/j.issn.1671-4091.2024.01.007

• 临床研究 • 上一篇    下一篇

三酰甘油-葡萄糖指数、脑源性神经营养因子对非糖尿病维持性血液透析患者的肌肉减少症的诊断价值分析

施晴波   樊 璠   

  1. 210003 南京，1南京中医药大学附属南京医院肾内科
  • 收稿日期:2023-08-15 修回日期:2023-10-30 出版日期:2024-01-12 发布日期:2024-01-12
  • 通讯作者: 樊璠 E-mail:yimi20210420@163.com

Diagnostic value of triglyceride-glucose index and brain-derived neurotrophic factor for sarcopenia in non-diabetic maintenance hemodialysis patients

SHI Qing-bo,  FAN Fan   

  1. Department of Nephrology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210003, China
  • Received:2023-08-15 Revised:2023-10-30 Online:2024-01-12 Published:2024-01-12
  • Contact: 210003 南京，1南京中医药大学附属南京医院肾内科 E-mail:yimi20210420@163.com

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摘要： 目的 探讨三酰甘油-葡萄糖指数(triglyceride-glucose index，TyG)、脑源性神经营养因子(brain-derived neurotrophic factor，BDNF)对非糖尿病维持性血液透析(maintenance hemodialysis，MHD)患者的肌肉减少症的诊断价值。 方法 选择2021年1月—2023年1月南京中医药大学附属南京医院肾内科收治的MHD患者，根据2019年亚洲肌少症工作组(Asian Working Group for Sarcopenia，AWGS)修订的诊断标准统计肌肉减少症患病情况，检测血清三酰甘油、葡萄糖、BDNF水平，计算TyG。Pearson分析TyG、BDNF与骨骼肌质量指数(skeletal muscle mass index，SMI)、握力、步速的相关性。多因素Logistic回归分析影响MHD患者合并肌肉减少症的因素，受试者工作特征(ROC)曲线TyG、BDNF诊断MHD患者合并肌肉减少症的价值。 结果 126例MHD患者中39例(30.95%)患者合并肌肉减少症，与非肌肉减少症组比较，肌肉减少症组患者TyG较高、血清BDNF水平偏低(t=7.974、14.699，均P＜0.001)。肌肉减少症组患者TyG与SMI、握力、步速呈负相关(r=-0.365、-0.319、-0.452，均P＜0.001)，BDNF与SMI、握力、步速呈正相关(r=0.326、0.275、0.395，P＜0.001、0.003、P＜0.001)。年龄偏大(OR=1.861，95% CI：1.040～3.330，P=0.019)、高TyG(OR=2.050，95% CI：1.049～4.008，P=0.015)是MHD患者合并肌肉减少症的危险因素，高白蛋白(OR=0.694，95% CI：0.515～0.935，P=0.008)、高BDNF(OR=0.630，95% CI：0.430～0.923，P=0.010)是MHD患者合并肌肉减少症的保护因素。TyG、BDNF诊断MHD患者合并肌肉减少症的曲线下面积为0.740(95% CI：0.654～0.814，P＜0.001)、0.727(95% CI：0.641～0.803，P＜0.001)，联合TyG、BDNF诊断MHD患者合并肌肉减少症的曲线下面积为0.939(95% CI：0.882～0.974，P＜0.001)，高于单独诊断(Z=4.075、4.241，P均＜0.001)。 结论 MHD患者TyG值增加，血清BDNF水平降低与合并肌肉减少症有关，联合TyG和BDNF可提高对MHD患者肌肉减少症风险评估价值。

关键词: 三酰甘油-葡萄糖指数, 脑源性神经营养因子, 维持性血液透析, 肌肉减少症

Abstract: Objective To investigate the diagnostic value of triglyceride-glucose index (TyG) and brain-derived neurotrophic factor (BDNF) for sarcopenia in non-diabetic maintenance hemodialysis (MHD) patients.  Methods  A total of 126 MHD patients admitted to our hospital from January 2021 to January 2023 were recruited as the research subjects. According to the diagnostic criteria revised by the Asian Sarcopenia Working Group (AWGS) in 2019, the incidence of sarcopenia was calculated and analyzed. Serum levels of triglyceride, glucose and BDNF were assayed, and TyG was calculated. Pearson correlation was used to evaluate the correlations between the biomarkers of TyG and BDNF and the sarcopenia indexes of skeletal muscle mass index (SMI), grip strength and walking speed. Multivariate logistic regression was conducted to analyze the influencing factors for sarcopenia in MHD patients. The receiver operating characteristic (ROC) curve was established to assess the values of TyG and BDNF for the diagnosis of sarcopenia in MHD patients.  Results Thirty-nine MHD patients (30.95%) were complicated with sarcopenia. Compared with non-sarcopenia group, TyG was higher (t=7.974, P＜0.001) and BDNF was lower in sarcopenia group (t=14.699, P＜0.001). In sarcopenia group, TyG was negatively correlated with SMI, grip strength and walking speed (r=-0.365, -0.319 and -0.452 respectively; P<0.001), while BDNF was positively correlated with SMI, grip strength and walking speed (r=0.326, 0.275 and 0.395 respectively; P<0.001, =0.003, <0.001 respectively). Older age (OR=1.861, 95% CI：1.040～3.330, P=0.019) and higher TyG (OR=2.050, 95% CI：1.049～4.008, P=0.015) were the risk factors for sarcopenia in MHD patients, while higher albumin (OR=0.694, 95% CI：0.515～0.935, P=0.008) and higher BDNF (OR=0.630, 95% CI：0.430～0.923, P=0.010) were the protective factors for sarcopenia in MHD patients. The areas under the curve using TyG or BDNF for the diagnosis of sarcopenia were 0.740 (95% CI：0.654～0.814, P<0.001) and 0.727 (95% CI：0.641～0.803, P<0.001) respectively; the area under the curve using both TyG and BDNF for the diagnosis of sarcopenia was 0.939 (95% CI：0.882～0.974, P<0.001), higher than those using TyG and BDNF individually for the diagnosis (Z=4.075 and 4.241, P<0.001).  Conclusion  The increase of TyG and the decrease of serum BDNF are associated with sarcopenia in MHD patients. The combination of TyG and BDNF can improve the risk assessment of sarcopenia in MHD patients.

Key words: Triglyceride-glucose index, Brain-derived neurotrophic factor, Maintenance hemodialysis, Sarcopenia

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