中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (10): 744-748.doi: 10.3969/j.issn.1671-4091.2022.10.009

• 临床研究 • 上一篇    下一篇

维持性血液透析患者肌少症与同型半胱氨酸、鸢尾素及营养不良-炎症评分的关系

宝 群    闫 燕   丁秀和   

  1. 271126 济南，1济南市第八人民医院肾内科
  • 收稿日期:2022-05-09 修回日期:2022-07-22 出版日期:2022-10-12 发布日期:2022-10-12
  • 通讯作者: 闫燕 E-mail:yanyan94472619@126.com
  • 基金资助:
    山东省济南市卫健委科技计划项目(2021-2-64)

Relationship between sarcopenia and levels of homocysteine, irisin and malnutrition-inflammation score in maintenance hemodialysis patients 

BAO Qun, YAN Yan, DING Xiu-he   

  1. Department of Nephrology, Jinan Eighth People’s Hospital, Jinan 271126, China
  • Received:2022-05-09 Revised:2022-07-22 Online:2022-10-12 Published:2022-10-12
  • Contact: 271126 济南，1济南市第八人民医院肾内科 E-mail:yanyan94472619@126.com

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摘要： 目的 探讨维持性血液透析(maintenance hemodialysis patients，MHD)患者肌少症与同型半胱氨酸(homocysteinemia，Hcy)、鸢尾素(Irisin)及营养不良-炎症评分(malnutrition-inflammation score，MIS)的相关性。 方法  选取2019年6月～2021年10月在济南市第八人民医院血液净化中心的MHD患者206例为研究对象，通过握力、步行速度、四肢骨骼肌质量指数诊断肌少症，采用酶联免疫吸附法检测患者血清Hcy、Irisin水平，应用MIS量表进行营养不良-炎症评估。根据多因素Logistic回归结果建立列线图模型。 结果  在206例被研究对象中，56例(27.2％)患有肌少症。多因素Logstic回归分析结果显示：透析龄、合并认知功能障碍、Hcy、MIS评分是影响MHD患者发生肌少症的独立危险因素(OR值分别为1.423，1.718，1.728，2.104，95%CI：值分别为1.111～1.820，1.222～2.223，1.348～2.446，1.424～3.442，P值分别为0.038，0.021，0.026，＜0.001)，Irisin是MHD患者发生肌少症的独立保护因素(OR=0.488，95% CI：0.089～0.762，P＜0.001)。据此构建的列线图预测模型采用Bootstrap内部验证，发现该模型具有良好的精准度和区分度，C-index指数为0.822(95%CI：为0.734～0.887)。 结论  MIS评分、Hcy水平升高是MHD患者发生肌少症的独立危险因素，Irisin水平升高是MHD患者发生肌少症的独立保护因素，基于独立影响因素建立的列线图预测模型能够提高对MHD患者并发肌少症的预测效能。

关键词: 维持性血液透析, 肌少症, 同型半胱氨酸, 鸢尾素, 营养不良-炎症评分

Abstract: Objective  To explore the correlation between sarcopenia and the levels of  homocysteine (Hcy), irisin and malnutrition-inflammation score (MIS) in maintenance hemodialysis (MHD) patients.  Methods  A total of 206 MHD patients treated in the Blood Purification Center of Jinan Eighth People’s Hospital from June 2019 to October 2021 were selected as the research subjects. Sarcopenia was diagnosed by handgrip strength, walking speed, and limb skeletal muscle mass index (ASMI). Serum levels of Hcy and irisin were measured by enzyme-linked immunosorbent assay. Nutrition-inflammation was assessed using the MIS scale. A nomogram model was constructed based on the multivariate logistic regression results.  Results Among the 206 MHD patients, 56 (27.2％) were diagnosed with sarcopenia. Logistic regression showed that dialysis age, combined cognitive dysfunction, Hcy and MIS were the independent risk factors for the development of sarcopenia in MHD patients (OR=1.423, 1.718, 1.728 and 2.104 respectively; 95% CI :1.111~1.820, 1.222~2.223, 1.348~2.446 and 1.424~3.442 respectively; P=0.038, 0.021, 0.026 and＜0.001 respectively). Irisin was an independent protective factor for sarcopenia in MHD patients (OR=0.488, 95% CI :0.089~0.762, P＜0.001). The prediction nomogram model constructed based on the above analyses and using Bootstrap internal verification indicates that this model has good accuracy and discrimination, with the C-index index of 0.822 (95% CI :0.734~0.887).  Conclusion  Higher MIS and elevated serum Hcy were the independent risk factors for sarcopenia in MHD patients. Elevated serum irisin was an independent protective factor for sarcopenia in MHD patients. The prediction nomogram model based on the independent influencing factors is useful to improve the predictive ability of sarcopenia complicated in MHD patients.

Key words: Maintenance hemodialysis, Sarcopenia, Homocysteinemia, Irisin, Malnutrition-inflammation score

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