中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (06): 382-385.doi: 10.3969/j.issn.1671-4091.2019.06.002

• 临床研究 • 上一篇    下一篇

维持性血液透析患者瘦体质量与死亡风险相关性研究

王家林1,张敏1,王少艳1,龙刚1   

  1. 1. 天津市人民医院肾脏科
  • 收稿日期:2018-07-13 修回日期:2019-04-04 出版日期:2019-06-12 发布日期:2019-06-12
  • 通讯作者: 龙刚 longgang@hotmail.com E-mail:jialin-w@163.com
  • 基金资助:

    天津市卫生计生委面上课题项目(2013KY30)

The relationship between lean body mass and risk of mortality in maintenance hemodialysis patients

  • Received:2018-07-13 Revised:2019-04-04 Online:2019-06-12 Published:2019-06-12

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摘要： 【摘要】目的探讨维持性血液透析患者瘦体质量(lean body mass, LBM)与死亡风险的相关性。方法回顾性分析天津市人民医院血液透析中心符合研究标准的维持性血液透析患者，统计患者瘦体质量及其他资料。使用公式计算LBM=0.34×血清肌酐(mg/dl，1mg/dl=88.4μmol/L)+5.58×性别(女性为1，男性为0)+0.30×体质量(kg)+0.67×身高(inch)-0.23×尿素清除率-5.75,1inch=0.1254m。分析患者LBM 与死亡风险的相关性。结果最终入组维持性血液透析患者187 名。分析结果显示较高的LBM与年轻(H=3.273，P=0.049)、男性(χ2=4.174，P=0.041)、较高的体质量(F=6.438，P=0.027)、体质量指数(F=5.997，P=0.029)、血浆白蛋白(F=3.811, P=0.043)、血清肌酐(F=4.778，P=0.031)、血清磷(F=3.766，P=0.044)、血清甲状旁腺激素水平(F=3.498，P=0.047)相关。根据每20%患者人数将LBM 平均分为5 组(＜36.3, 36.3～40.7, 40.7～44.9, 44.9～49.4, ＞49.4kg)，将中间水平LBM 组(40.7～44.9 kg)作为对照组。进行多因素矫正分析发现较高的LBM与较好的生存率相关。与对照组比较，最低LBM组患者死亡风险增加31%(HR=1.31, 95% CI:1.11～1.53，P=0.043)，而最高LBM 组患者死亡风险下降15%(HR =0.85,95% CI: 0.72 ～0.95, P=0.038)。结论在维持性血液透析患者中，较高的LBM 与较低的死亡风险相关，我们可以谨慎的使用LBM来预测这类患者的死亡风险。

关键词: 血液透析, 瘦体质量, 体质量指数, 死亡率, 营养

Abstract: 【Abstract】Objective To investigate the relationship between lean body mass (LBM) and risk of mortality in maintenance hemodialysis (MHD) patients. Methods We retrospectively analyzed the MHD patients treated in the Dialysis Center, Tianjin Union Medical Center and matched the research criteria. Their
LBM and others parameters were collected. A validated creatinine-based formula, LBM(kg)=0.34×serum creatinine (mg/dl)+5.58×gender (1 for female and 0 for male)+0.30×body weight(kg)+0.67×body height (inch)-0.23×URR (urea reduction ratio)-5.75(linch=0.1254m), was used to estimate LBM. The relationship between LBM and risk of mortality was then assessed. Results This cohort enrolled 187 MHD patients. Higher LBM was related to younger age (H=3.273, P=0.049), male (χ2=4.174, P=0.041), higher body weight (F=6.438, P=0.027) and body mass index(BMI)(F=5.997,P=0.029), higher serum albumin (F=3.811, P=0.043), creatinine(F=4.778,P=0.031), phosphorus(F=3.766,P=0.044) and intact parathyroid hormone(iPTH) (F=3.498, P=0.047). We divided the patients into 5 groups based on the 20th percentile of LBM values (＜36.3, 36.3～40.7,40.7～44.9,44.9～49. 4and＞49.4 kg). Patients in the 40.7～44.9 kg group was used as the reference group. After adjustment by multiple factors, we found that higher LBM was associated with lower mortality. Compared to the reference group, the risk of mortality increased by 31% in the lowest LBM group (HR: 1.31, 95% CI 1.11-1.53, P=0.043), while the risk decreased by 15% in the highest LBM group (HR: 0.85, 95% CI 0.72-0.95, P=0.038). Conclusions In MHD patients, higher LBM was associated with lower risk of mortality. We therefore have the possibility to predict risk of mortality by LBM in MHD patients.

Key words: hemodialysis, lean body mass, body mass index, mortality, nutrition