中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (06): 469-473.doi: 10.3969/j.issn.1671-4091.2026.06.006

• 临床研究 • 上一篇    下一篇

血浆C末端聚集蛋白片段、肌肉生长抑制素与老年糖尿病肾脏疾病维持性血液透析患者并发肌少症的关系分析

曹文琼   马 潇   杨金慧   朱学新   

  1. 730000 兰州，1兰州市第一人民医院肾病内科
  • 收稿日期:2025-09-11 修回日期:2025-12-19 出版日期:2026-06-12 发布日期:2026-06-12
  • 通讯作者: 曹文琼 E-mail:cwq135452@163.com
  • 基金资助:
    甘肃省卫生健康行业科研项目(GSWSKY2020-24)

Analysis of the relationship between plasma C-terminal agrin fragment, myostatin and sarcopenia in elderly patients with diabetic kidney disease on maintenance hemodialysis

 CAO Wen-qiong, MA Xiao, YANG Jin-hui, ZHU Xue-xin   

  1. Department of Nephrology, Lanzhou First People's Hospital, Lanzhou 730000, China
  • Received:2025-09-11 Revised:2025-12-19 Online:2026-06-12 Published:2026-06-12
  • Contact: 730000 兰州，1兰州市第一人民医院肾病内科 E-mail:cwq135452@163.com

摘要： 探讨血浆C末端聚集蛋白片段(C-terminal agrin fragment，CAF)、肌肉生长抑制素(myostatin，MSTN)与老年糖尿病肾脏疾病(diabetic kidney disease，DKD)维持性血液透析(maintenance hemodialysis，MHD)患者并发肌少症的关系。 方法 选取2021年1月—2025年3月在兰州市第一人民医院肾病内科接受MHD的老年(年龄≥60岁)DKD患者(DKD-MHD组)，另选取同期收治的老年非透析DKD患者为对照组，分析DKD-MHD患者并发肌少症的因素及血浆CAF、MSTN水平的预测效能。 结果  共纳入410例患者，其中DKD-MHD组210例，对照组200例。与对照组[42.57(22.34,52.16)pg/ml、60.03(29.77,83.79)ng/ml]比较，DKD-MHD组血浆CAF[96.37(58.99,135.08)pg/ml]、MSTN[145.43(100.19,259.30)ng/ml]水平升高(Z＝-13.039、-13.224，均P＜0.001)。年龄增加(OR=1.412，95%CI：1.171～1.703，P＜0.001)、CAF升高(OR=1.059，95% CI：1.034～1.084，P＜0.001)、MSTN升高(OR=1.027，95% CI：1.017～1.038，P＜0.001)为老年DKD-MHD患者并发肌少症的独立危险因素，体质量指数增加(OR=0.736，95% CI：0.567～0.954，P=0.021)为独立保护因素。血浆CAF、MSTN水平及二者联合预测老年DKD-MHD患者并发肌少症的曲线下面积分别为0.839、0.843、0.930，二者联合检测优于单独预测效能(Z=3.692、3.434，均P＜0.001)。 结论  血浆CAF、MSTN水平升高为老年DKD-MHD患者并发肌少症的独立危险因素，与肌少症参数相关，且血浆CAF、MSTN水平联合预测并发肌少症的效能较高。

关键词: 老年, 糖尿病肾脏疾病, C末端聚集蛋白片段, 肌肉生长抑制素, 维持性血液透析, 肌少症

Abstract: Objective To investigate the relationship between plasma C-terminal agrin fragment (CAF), myostatin (MSTN), and sarcopenia in elderly patients with diabetic kidney disease (DKD) undergoing maintenance hemodialysis (MHD). Methods  Elderly DKD patients (≥60 years) receiving MHD at the Department of Nephrology, Lanzhou First People's Hospital from January 2021 to March 2025 were selected as the DKD-MHD group. Elderly non-dialysis DKD patients admitted during the same period served as the control group (n=200). Factors associated with sarcopenia in DKD-MHD patients and the predictive performance of plasma CAF and MSTN levels were analyzed.  Results  Compared with the control group [CAF: 42.57(22.34, 52.16) pg/ml, MSTN: 60.03(29.77, 83.79) ng/ml], the DKD-MHD group had significantly higher plasma levels of CAF [96.37(58.99, 135.08) pg/ml] and MSTN [145.43(100.19, 259.30) ng/ml] (Z=-13.039, -13.224, both P＜0.001). Increased age (OR=1.412, 95%CI: 1.171～1.703, P＜0.001), elevated CAF (OR=1.059, 95%CI:1.034～1.084, P＜0.001), and elevated MSTN (OR=1.027, 95%CI:1.017～1.038, P＜0.001) were independent risk factors for sarcopenia in elderly DKD-MHD patients, while increased body mass index (OR=0.736, 95% CI:0.567～0.954, P=0.021) was an independent protective factor. The area under the curve (AUC) for predicting sarcopenia in elderly DKD-MHD patients was 0.839 for plasma CAF, 0.843 for MSTN, and 0.930 for the combination of both, with the combined detection being superior to either alone (Z=3.692, 3.434, both P＜0.001).  Conclusion  Elevated plasma CAF and MSTN levels are independent risk factors for sarcopenia in elderly DKD-MHD patients and are correlated with sarcopenia parameters. The combination of plasma CAF and MSTN levels has high predictive efficacy for sarcopenia.

Key words: Elderly, Diabetic kidney disease, C-terminal agrin fragment, Myostatin, Maintenance ,  ,  , hemodialysis, Sarcopenia

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