目的 探讨肌少症对维持性血液透析(maintenance hemodialysis，MHD)患者主要不良心血管事件(major adverse cardiovascular events，MACE)的影响。 方法 采用便利抽样法选取广州中医药大学第二附属医院血液透析科2021年12月─2025年7月的MHD患者作为研究对象，根据是否合并肌少症分为肌少症组和非肌少症组，随访36个月，记录MACE发生及生存情况。采用Kaplan-Meier分析法、COX回归模型及Fine-Gray竞争风险模型分析肌少症与MHD患者MACE发生、全因死亡、心血管疾病死亡的关系。 结果 纳入177例MHD患者，肌少症组(n=65)MACE发生率为74.89%，非肌少症组(n=112)MACE发生率为41.69%。肌少症组死亡率为53.36%，非肌少症组死亡率为22.26%。Kaplan-Meier分析显示，肌少症组MACE发生率(χ2=17.596，P＜0.001)、死亡率(χ2=18.977，P＜0.001)高于非肌少症组。多因素COX回归分析显示，肌少症(HR=2.011，95% CI：1.214～3.333，P=0.008)及低肌肉力量(HR=1.818，95% CI：1.075～3.074，P=0.026)是MHD患者MACE发生的独立影响因素。肌少症是MHD患者全因死亡的独立影响因素(HR=2.133，95% CI：1.015～4.486，P=0.046)。Fine-Gray竞争风险模型分析显示，肌少症组发生心血管疾病死亡风险是非肌少症组7.696倍(SHR=7.696，95% CI：2.077～28.524，P=0.002)。 结论 MHD患者肌少症及MACE发生率高，肌少症及低肌肉力量增加其MACE发生风险。
Abstract
Objective To investigate the impact of sarcopenia on major adverse cardiovascular events (MACE) in patients undergoing maintenance hemodialysis (MHD). Methods A convenience sampling method was used to select MHD patients as the research subjects from Department of Dialysis, The Second Hospital Affiliated to Guangzhou University of Chinese Medicine between December 2021 to July 2025. These patients were divided into the sarcopenia group and the non-sarcopenia group based on the presence or absence of sarcopenia. The follow-up period was 36 months, and the occurrence of MACE and survival status were recorded. Kaplan-Meier curve, Cox regression model, and Fine-Gray competing risk model were used to analyze the relationship between sarcopenia and the occurrence of MACE, all-cause death, and cardiovascular disease death in these MHD patients. Results A total of 177 MHD patients were included. The MACE rate was 74.89% in the sarcopenia group (n=65), and was 41.69% in the non-sarcopenia group (n=112). The mortality rate was 53.36% in the sarcopenia group, and was 22.26% in the non-sarcopenia group. Kaplan-Meier analysis showed that the rates of MACE and mortality in the sarcopenia group were higher than those in the non-sarcopenia group (log-rank χ2=17.596 and 18.977, P＜0.001). Multivariate Cox regression revealed that sarcopenia (HR=2.011, 95% CI:1.214～3.333, P=0.008) and low muscle strength (HR=1.818, 95% CI:1.075～3.074, P=0.026) were the independent influencing factors for the occurrence of MACE in MHD patients, and sarcopenia was the independent influencing factor for all-cause death in MHD patients (HR=2.133, 95% CI:1.015～4.486, P=0.046). Fine-Gray competing risk model analysis found that the risk of cardiovascular disease death in the sarcopenia group was 7.696 times higher than that in the non-sarcopenia group (HR=7.696, 95% CI:2.077～28.524, P=0.002). Conclusion The rates of sarcopenia and MACE are higher in MHD patients. Sarcopenia and low muscle strength increase the risk of MACE.
关键词
血液透析 /
肌少症 /
主要不良心血管事件 /
MACE /
生存率
Key words
Hemodialysis /
Sarcopenia /
Major adverse cardiovascular events /
Survival rate
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基金
广东省哲学社会科学规划2024年度学科共建项目(GD24XSH08)；老年长期照护教育部重点实验室开放基金(LNYBPY-2023-08)；2025年广州中医药大学“固本”工程一级学科能力提升项目（GZY2025GB0901）
