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慢性肾脏病5期非透析患者肌少症的发生率及影响因素分析

Incidence and risk factors of sarcopenia in non-dialysis patients with stage 5 chronic kidney disease

    摘要
  • 摘要:
    目的 探讨慢性肾脏病（chronic kidney disease, CKD）5期非透析患者肌少症的发生率及相关危险因素。
    方法 选择2023年10月至2024年10月在上海健康医学院附属嘉定区中心医院住院治疗的CKD 5期非透析患者作为研究对象。根据瘦组织指数（lean tissue index, LTI）和握力（handgrip strength, HGS），将患者分为非肌少症组和肌少症组。采集人口统计学资料，检测生化指标，采用竞争性ELISA法检测血清晚期糖基化终末产物（advanced glycation end products, AGEs），分析CKD 5期非透析患者肌少症的发生率。采用多因素logistic回归分析该类患者发生肌少症的危险因素，受试者工作特征（receiver operating characteristic, ROC）曲线评价各因素预测肌少症发生的临床价值。
    结果 共入选102例患者，其中男性61例（59.8%），年龄（68.52±7.39）岁，肌少症24例（23.5%）。与非肌少症组患者相比，肌少症组患者年龄更大，白细胞介素6（interleukin-6, IL-6）、AGEs更高，体质量指数（body mass index, BMI）、血清白蛋白（serum albumin, sAlb）降低（P＜0.05）。多因素logistic回归分析显示，年龄增长（OR=1.153，95%CI 1.045～1.273，P＝0.005）、血清IL-6升高（OR＝1.165，95%CI 1.042～1.302，P＝0.007）、sAlb降低（OR＝0.675, 95%CI 0.542～0.840，P＝0.001）和AGEs升高（OR＝1.105, 95%CI 1.013～1.206，P＝0.024）是CKD 5期非透析患者肌少症发生的独立危险因素。ROC曲线显示，年龄、IL-6、sAlb、AGEs预测肌少症发生的AUC分别为0.896、0.643、0.658、0.724。
    结论 CKD 5期非透析患者合并肌少症较常见，高龄、IL-6升高、低sAlb、AGEs升高的CKD 5期非透析患者发生肌少症的风险较高。

     

    Abstract:
    Objective To explore the incidence and risk factors of sarcopenia in non-dialysis patients with stage 5 chronic kidney disease (CKD).
    Methods Non-dialysis stage 5 CKD patients in Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences from October 2023 to October 2024 were enrolled and divided into the non-sarcopenia group and the sarcopenia group according to lean tissue index (LTI) and handgrip strength (HGS). Demographic data of patients were collected and biochemical indicators were detected. Serum advanced glycation end products (AGEs) were detected by competitive ELISA. Multivariate logistic regression analysis was conducted to analyze the risk factors of sarcopenia in these patients. The diagnostic efficacy of the risk factors was evaluated by the receiver operating characteristic (ROC) curve.
    Results A total of 102 non-dialysis stage 5 CKD patients with (68.52±7.39) years, were enrolled, including 61 male (59.8%). Among them, 24 were diagnosed with sarcopenia (23.5%). Compared with patients in non-sarcopenia group, patients in sarcopenia group were older and had higher interleukin-6 (IL-6) and AGEs, lower body mass index (BMI) and lower serum albumin (sAlb; P＜0.05). Multivariate logistic regression showed that advanced age (OR＝1.153, 95%CI 1.045–1.273, P＝0.005), higher IL-6 (OR＝1.165, 95%CI 1.042–1.302, P＝0.007)、lower sAlb (OR＝0.675, 95%CI 0.542–0.840, P＝0.001), and higher serum AGEs (OR＝1.105, 95%CI 1.013–1.206, P＝0.024) were independent risk factors of sarcopenia in non-dialysis CKD 5 patients. The areas under the curve (AUC) for the age, IL-6, sAlb, and serum AGEs were 0.896, 0.643, 0.658, and 0.724, respectively.
    Conclusions Sarcopenia is common in non-dialysis stage 5 CKD patients, and the risk of sarcopenia is higher in non-dialysis stage 5 CKD patients with advanced age, higher IL-6, lower sAlb, and higher serum AGEs.

     

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