中老年腹膜透析患者肌少症发生率及其相关因素分析

孙秀娜; 李雪梦; 王景福; 贾兰芳; 马滢; 李凤旋

doi:10.3969/j.issn.1671-2390.2023.09.004

中老年腹膜透析患者肌少症发生率及其相关因素分析

1.
承德医学院护理学院, 承德 067000
2.
承德医学院附属医院急诊科, 承德 067000
3.
承德医学院附属医院肾脏内科, 承德 067000

基金项目: 河北省医学科学研究课题（20200374）

详细信息

通讯作者:
贾兰芳，Email：jialanfangde@163.com

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出版历程
- 收稿日期: 2022-10-11
- 网络出版日期: 2023-10-06
- 刊出日期: 2023-10-06

Incidence and related factors of myopenia in middle-aged and elderly peritoneal dialysis patients

1.
School of Nursing, Chengde Medical College, Chengde 067000, China
2.
Department of Emergency Medicine, Affiliated Hospital, Chengde Medical College, Chengde 067000, China
3.
Department of Nephrology, Affiliated Hospital, Chengde Medical College, Chengde 067000, China

Funds: Medical Science Research Project of Hebei Province (20200374)

More Information

Corresponding author:
Jia Lan-fang, Email: jialanfangde@163.com

摘要

摘要:
目的
探讨中老年腹膜透析患者肌少症发生率及其相关因素分析。
方法
采用问卷调查法及病例查阅法，收集2019年8月至2020年12月承德医学院附属医院肾脏内科的104例腹膜透析患者一般人口学资料，使用国产Canary EH101电子握力计评估肌肉力量，德国费森尤斯牌人体成分分析仪测定肌肉质量和脂肪组织指数，采用主观全面营养评定法评估腹膜透析患者营养状况，检测患者血清生物化学指标。比较肌少症组和无肌少症组患者一般资料、营养状态以及血清生物化学指标等，采用二元Logistic回归分析中老年腹膜透析患者肌少症相关影响因素。
结果
104例中老年腹膜透析患者中，肌少症发生率24.0%。与无肌少症组比较，肌少症组瘦肉组织指数7.1 kg/m²，低于无肌少症组的10.6 kg/m²。肌少症组握力15.3 kg，低于无肌少症组的23.2 kg。肌少症组脂肪组织指数12.8 kg/m²，高于无肌少症组的10.2 kg/m²（P＜0.05）。多因素回归分析结果显示：高敏C反应蛋白为肌少症独立危险因素（OR=1.482，95%CI：1.134～1.937），体重指数（OR=0.797，95%CI：0.638～0.994）、残余肾功能（OR=0.599，95%CI：0.368～0.972）为肌少症独立保护性因素。
结论
中老年腹膜透析治疗的患者并发症较多，肌少症发生率较高，改善患者的营养水平，降低微炎症状态，保护残余肾功能可降低肌少症的发生。
- 腹膜透析 /
- 肌少症 /
- C反应蛋白 /
- 残余肾功能
Abstract:
Objective
To explore the incidence of myopenia and examine its related factors in middle-aged and elderly peritoneal dialysis （PD） patients.
Methods
Questionnaire survey and case review were employed for collecting 104 PD patients of department of nephrology, affiliated hospital of Chengde Medical College between August 2019 to December 2020 general demographic data. Muscle strength was evaluated with a domestic Canary EH101 electronic grip strength meter. Muscle mass and adipose tissue index were measured with a German Fresenius body composition analyzer. Nutritional status was evaluated by comprehensive subjective nutrition assessments and serum biochemical parameters were detected. The inter-group differences of general profiles, nutritional status and serum biochemical parameters were compared. And the relevant factors of myopenia were analyzed by binary logistic regression.
Results
Among 104 middle-aged and elderly PD patients, the incidence of myopenia was 24.0%. Lean tissue index was lower in myopenia group than that in non-myopenia group （7.1 kg/m² vs 10.6 kg/m²）; Grip strength lower in myopenia group than that in non-myopenia group （15.3 kg vs 23.2 kg）; Fat tissue index higher in myopenia group than in non-myopenia group （12.8 kg/m² vs 10.2 kg/m², P＜0.05）. The results of multivariate regression analysis indicated that serum level of hs-C-reactive protein （OR=1.482, 95%CI:134-1.937） was an independent risk factor for sarcopenia. And body mass index （OR=0.797, 95%CI:0.638-0.994） and residual renal function （OR=0.599, 95%CI:0.368-0.972） were independent protective factors for sarcopenia.
Conclusion
Middle-aged and elderly PD patients are more prone to complications with a higher incidence of sarcopenia. Improving nutritional status, lowering microinflammatory status and protecting residual renal function can reduce the occurrence of sarcopenia.
- Peritoneal dialysis /
- Sarcopenia /
- C-reactive protein /
- Residual renal function

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表 1 肌少症组和无肌少症组患者骨骼肌质量与肌肉力量的比较[M（Q₁，Q₃）]

组别	例数	脂肪组织指数（kg/m²）	瘦肉组织指数（kg/m²）	握力（kg）
无肌少症组	79	10.2（7.4，12.3）	10.6（9.1，12.6）	23.2（17.6，30.1）
肌少症组	25	12.8（8.9，14.5）	7.1（6.8，8.6）	15.3（12.3，21.5）
Z值	-	2.952	6.547	4.253
P值	-	0.003	＜0.001	＜0.001

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表 2 肌少症组和无肌少症组患者一般资料的比较

组别	例数	年龄（岁）	男性[例（%）]	透析龄（月）	BMI（kg/m²）	SGA[例（%）]
无肌少症组	79	58.0（54.0，63.0）	38（48.1）	30.1（12.5，58.2）	23.9（22.5，26.4）	30（38.0）
肌少症组	25	64.0（61.0，66.0）	11（44.0）	47.7（31.7，74.2）	20.7（17.9，22.8）	17（68.0）
${\chi ^2} $/Z值	-	6.306	0.128	2.803	4.980	6.912
P值	-	＜0.001	0.720	0.005	＜0.001	0.009
注：BMI为体重指数；SGA为主观全面营养评分；数据形式除标注外，均为M（Q₁，Q₃）。

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表 3 肌少症组和无肌少症组患者临床资料的比较

组别	例数	Alb[g/L， M（Q₁，Q₃）]	GLU[mmol/L， M（Q₁，Q₃）]	hs-CRP[mg/L， M（Q₁，Q₃）]	25（OH）D[mmol/L， M（Q₁，Q₃）]	Hb（g/L，${\bar{\euclidfontbi\text{{x}}}} \pm s $）	TC（mmol/L， ${\bar{\euclidfontbi\text{{x}}}} \pm s $）	血Ca（mmol/L， ${\bar{\euclidfontbi\text{{x}}}} \pm s $）
无肌少症组	79	39.7（36.7，43.5）	5.5（5.0，6.7）	1.2（0.6，3.8）	34.7（22.9，49.0）	107.4 ± 16.4	4.6 ± 1.1	2.2 ± 0.2
肌少症组	25	39.0（33.9，42.9）	6.1（5.3，9.5）	3.7（1.5，7.9）	28.1（20.3，33.5）	108.9 ± 12.2	4.8 ± 1.1	2.1 ± 0.1
Z值	-	1.468	2.111	3.990	1.993	0.430	0.723	0.136
P值	-	0.142	0.035	＜0.001	0.046	0.668	0.472	0.892

组别	例数	血P（mmol/L， ${\bar{\euclidfontbi\text{{x}}}} \pm s $）	TG[mmol/L， M（Q₁，Q₃）]	PTH[ng/L， M（Q₁，Q₃）]	总肌酐清除率[L·周⁻¹·（1.73 m²）⁻¹， M（Q₁，Q₃）]		总尿素清除指数 [M（Q₁，Q₃）]	RRF[mL/min， M（Q₁，Q₃）]
无肌少症组	79	1.6 ± 0.4	1.7（1.2，2.1）	330.0（214.7，563.7）	62.6（44.6，81.4）		1.8（1.3，2.3）	2.1（0，3.7）
肌少症组	25	1.6 ± 0.2	1.3（1.0，1.9）	242.0（179.0，413.2）	46.2（41.9，89.4）		1.7（1.4，2.0）	0（0，0.8）
Z值	-	0.012	1.404	1.305	1.076		0.631	3.866
P值	-	0.990	0.160	0.192	0.282		0.528	＜0.001
注：Alb为血清白蛋白；GLU为葡萄糖；hs-CRP为高敏C-反应蛋白；25（OH）D为25羟维生素D；Hb为血红蛋白；TC为总胆固醇；Ca为钙；P为磷；TG为三酰甘油；PTH为甲状旁腺激素；RRF为残余肾功能。

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表 4 中老年腹膜透析患者发生肌少症的多因素Logistic回归分析

自变量	B值	SE值	Wals值	P值	OR值	95%CI
透析龄	0.008	0.013	0.391	0.532	1.008	0.983～1.034
BMI	−0.227	0.113	4.043	0.044	0.797	0.638～0.994
SGA	1.077	0.730	2.179	0.140	2.937	0.702～12.277
GLU	0.269	0.147	3.368	0.066	1.309	0.982～1.744
hs-CRP	0.393	0.137	8.277	0.004	1.482	1.134～1.937
25（OH）D	−0.039	0.025	2.404	0.121	0.961	0.915～1.010
RRF	−0.513	0.248	4.299	0.038	0.599	0.368～0.972
常量	1.979	3.082	0.412	0.521	7.233	-
注：BMI为体重指数；SGA为主观营养评分；GLU为葡萄糖；hs-CRP为高敏C反应蛋白；25（OH）D为25羟维生素D；RRF为残余肾功能。

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