中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (11): 823-827.doi: 10.3969/j.issn.1671-4091.2024.11.005

• 临床研究 • 上一篇    下一篇

维持性血液透析患者肌少症及肌少性肥胖的相关因素

陈雅丽    丁 宁    刁宗礼   

  1. 100050 北京，1首都医科大学附属北京友谊医院肾内科
    100730 北京，2首都医科大学附属北京同仁医院肾内科
  • 收稿日期:2024-03-27 修回日期:2024-08-13 出版日期:2024-11-12 发布日期:2024-11-12
  • 通讯作者: 刁宗礼 E-mail:diaozl@ccmu.edu.cn

The influencing factors for sarcopenia and sarcopenic obesity in maintenance hemodialysis patients

CHEN Ya-li, DING Ning, DIAO Zong-li   

  1. Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China;  2Department of Nephrology, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China
  • Received:2024-03-27 Revised:2024-08-13 Online:2024-11-12 Published:2024-11-12
  • Contact: 100050 北京，1首都医科大学附属北京友谊医院肾内科 E-mail:diaozl@ccmu.edu.cn

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摘要： 目的 分析维持性血液透析(maintenance hemodialysis,MHD)患者肌少症及肌少性肥胖的患病率及相关危险因素。 方法 选取2023年1月─2024年1月于首都医科大学附属北京友谊医院肾内科行MHD患者107例，进行肌少症的单因素及多因素分析，再根据体脂比(男性：≥30%，女性：≥40%)分为肌少性肥胖组和非肌少性肥胖组，比较临床资料。  结果  MHD患者肌少症患病率为33.6%。肌少症患者与非肌少症患者相比年龄更大(t=2.426,P=0.009)、体质量指数(body mass index,BMI)更低(t=-3.541,    P=0.001)、糖尿病患病率(χ2=4.466,P=0.035)、冠心病患病率更高(χ2=4.306,P=0.038)；改良定量主观整体评估(modified quantitative subjective global assessment,MQSGA)评分更高(Z=-6.192,P＜0.001)。Logistic回归分析显示行血液透析滤过(hemodialysis with diffusion and filtration,HDF)(OR=0.167,95% CI：0.041～0.683,P=0.013)、高BMI(OR=0.234,95%CI：0.074～0.736,P=0.013)是MHD肌少症保护因素；容量负荷重(OR=4.951,95% CI：1.030～23.790,P=0.046)、MQSGA评分高(OR=10.794,95% CI：3.060～38.071,P＜0.001)高是危险因素。MHD患者肌少性肥胖患病率15.9%，与非肌少性肥胖患者相比，肌少症患者BMI低(F=2.433,P=0.007)，但体脂比高(F=-5.661,P=0.007)、HDF比例低(χ2=8.758,P =0.003)、中性粒细胞与淋巴细胞计数比值(neutrophil to lymphocyte ratio,NLR)高(F=-1.008,P=0.006)。 结论  MHD患者肌少症及肌少性肥胖患病率高，医护人员应早识别并采取针对性的干预措施。

关键词: 维持性血液透析患者, 人体成分分析, 肌少症, 肌少性肥胖

Abstract: Objective To analyze the prevalence and the risk factors for sarcopenia and sarcopenic obesity in patients undergoing maintenance hemodialysis (MHD).  Methods  A total of 107 patients undergoing MHD at the Department of Nephrology, Beijing Friendship Hospital, Capital Medical University from January 2023 to January 2024 were enrolled in this study. Univariate and multivariate regressions were conducted for the analysis of sarcopenia in MHD patients. Based on body fat percentage (≥30% for males and ≥ 40% for females), the patients were divided into sarcopenic obesity group and non-sarcopenic obesity group. Clinical data were compared between patient groups.  Results  The prevalence of sarcopenia in MHD patients was 33.6%. Compared to non-sarcopenia patients, the sarcopenia patients had older age (t=2.426, P=0.009), lower body mass index (BMI) (t=-3.541, P=0.001), higher prevalence rates of diabetes (χ²=4.466, P=0.035) and coronary artery disease (χ²=4.306, P=0.038), and higher modified quantitative subjective global assessment (MQSGA) scores (Z=-6.192, P＜0.001). Logistic regression showed that hemodialysis with diffusion and filtration (HDF) (OR=0.167, 95% CI:0.041～0.683, P=0.01) and higher BMI (OR=0.234, 95% CI: 0.074～0.736, P=0.013) were the protective factors against sarcopenia, while higher volume load (OR=4.951, 95% CI: 1.030～23.790, P=0.046) and higher MQSGA scores (OR=10.794, 95% CI: 3.060～38.071, P=0.000) were the risk factors for sarcopenia in MHD patients. The prevalence of sarcopenic obesity in MHD patients was 15.9%. Compared to non-sarcopenic obesity patients, the sarcopenia patients had a lower BMI (F=2.433, P=0.007), a higher body fat percentage (F=-5.661, P=0.007), a lower proportion of HDF (χ²=8.758, P=0.003), and a higher neutrophil to lymphocyte ratio (NLR) (F=-1.008, P=0.006).   Conclusion  The prevalence rates of sarcopenia and sarcopenic obesity are higher in MHD patients. Early identification and effective management of the abnormalities should be conducted for MHD patients with sarcopenia or sarcopenic obesity.

Key words: Maintenance hemodialysis patient, Body composition analysis, Sarcopenia, Sarcopenic obesity

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