中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (11): 736-740.doi: 10.3969/j.issn.1671-4091.2017.011.005

• 临床研究 • 上一篇    下一篇

血液透析患者人体测量学指标与肌肉质量的相关性研究

李靓1,王颖1,檀敏1,袁梦荷1,王磊1,蔡美顺1,赵新菊1,左力1   

  1. 1. 北京大学人民医院肾内科
  • 收稿日期:2017-07-17 修回日期:2017-09-17 出版日期:2017-11-12 发布日期:2017-10-27
  • 通讯作者: 赵新菊 silverbirch-me@163.com E-mail:silverbirch-me@163.com
  • 基金资助:

    卫生公益性行业科研专项；项目名称：优化尿毒症患者管理模式的研究；批号：201502010

Correlation between anthropometric parameters and muscle mass in hemodialysis patients

  • Received:2017-07-17 Revised:2017-09-17 Online:2017-11-12 Published:2017-10-27

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摘要： 目的营养不良，更准确为蛋白质能量代谢障碍(protein energy wasting, PEW)是维持性血液透析(maintenance hemodialysis,MHD)患者死亡的独立危险因素。其中肌肉作为人体最大的蛋白质储备库，是反映PEW 的重要标志。在血液透析患者中传统的评价营养的人体测量学指标与人体肌肉组织质量(lean tissue mass, LTM)相关性研究较少，本研究旨在明确人体测量学指标与LTM 的相关性，为临床寻找简单易行的评价肌肉质量的方法。方法选择北京大学人民医院血液透析室2015 年11 月～2016 年2 月进行身体成分监测仪(body composition monitor,BCM)检查和人体测量学指标检查的MHD患者，收集患者性别、年龄、身高、干体质量、原发病、透析龄等资料，计算身体质量指数，透析前检查患者上臂围、上臂肌围、肱三头肌皮褶厚度、握力(grip strength, HGS)并进行BCM 检测，记录LTM、肌肉组织指数(lean tissue index, LTI，LTM/身高2)；检测透析前血白蛋白水平。采用独立样本t 检验比较不同性别间各项指标的差异，使用Pearson 相关分析对血清学及人体测量学指标与LTM、LTI 的相关性进行分析，使用一元线性回归得到回归方程。结果共52 例HD 患者纳入研究，其中男性28 例，女性24 例；平
均年龄(51.6±12.2)岁，中位透析时间65.5 个月。不同性别的患者间白蛋白水平、HGS、LTM、LTI 的差异有显著性(t 值分别为2.400, 6.412, 5.485, 3.330;P 值分别为0.020, ＜0.001, ＜0.001, 0.002)。Pearson 相关分析结果表明只有HGS 与LTM、LTI 相关(r 值分别为0.686, 0.486，P 值分别为＜0.001,＜0.001)。结论不同性别的MHD 患者间营养指标、身体组成存在明显差异，在进行相应评价时可能需要使用不同的标准。MHD 患者的HGS 与BCM 测量的LTM 及LTI 具有良好的相关性，或许可以用于评价患者的肌肉质量，临床上无创、简单易行，是LTM的良好替代指标。

关键词: 维持性血液透析, 人体测量, 蛋白质能量代谢障碍, 握力, 肌肉组织质量

Abstract: Objective Malnutrition which we prefer to call protein energy wasting (PEW) is an independent risk factor for mortality in maintenance hemodialysis (MHD) patients. Muscle tissue is the largest protein storage pool in human body and is also an indicator for PEW. The relationship between traditional anthropometric parameters and lean tissue mass (LTM) was rarely reported. This study aims at identifying the correlation between anthropometric indices and LTM and at finding a simple method for clinical assessment of muscle mass. Methods MHD patients were recruited in the hemodialysis unit of Peking University People’s Hospital. Patients’demographics and primary cause of ESRD were collected. Body mass index (BMI) was calculated. Upper arm circumference, arm muscle circumference, triceps skinfold thickness, grip strength (HGS) and body composition monitor (BCM) were examined pre- dialysis. LTM and lean tissue index for patients (LTI, LTM/height2) were recorded, and serum albumin was assayed. Independent t-testing was used to compare mean values between males and females. Pearson correlation was performed to correlate anthropometric and serum variables with LTM and LTI.Regression method was used to derive an estimation equation. Results A total of 52 MHD patients (28 males and 24 females) were included in this study. The average age of the patients was 51.6±12.2 years, and the median dialysis vintage was 65.5 months. There were significant differences between genders in albumin, HGS, LTM and LTI (t=2.400, 6.412, 5.485 and 3.330, respectively; P=0.020, ＜0.001, ＜0.001 and 0.002, respectively). Pearson correlation analysis showed that only HGS correlated with LTM and LTI (r=0.686 and 0.486, respectively; P＜0.001 and ＜0.001, respectively). Regression method was used to derive an estimation equation. Conclusions There were significant differences in nutritional indices and body composition between males and females. HGS had a better correlation with LTM and LTI, and may be used to evaluate muscle volume simply and noninvasively.

Key words: hemodialysis, anthropometric parameter, protein energy wasting, grip strength, lean tissue mass