维持性血液透析患者肌肉减少症调查及影响因素分析
摘要
目的:通过对维持性血液透析(MHD)患者肌肉减少症发生情况的调查,分析其影响因素。方法:选取规律透析且病情稳定的218例非住院MHD患者,使用多频生物电阻抗法(BIA)测量患者的四肢骨骼肌质量(ASM),使用握力计测握力评估肌肉力量,以4 m步速评估活动能力,并收集相关资料,采用logistic回归分析危险因素。结果:218例MHD患者中肌肉减少症的发生率是33%(72/218),肌肉减少症组与非肌肉减少症组在年龄、尿素氮、肌酐、白蛋白、胆固醇、空腹血糖、血磷、改良全面主观营养评估量表评分、体力活动代谢当量差异有统计学意义(P<0.05)。logistic回归分析显示,随着年龄的增长、营养不良加重、空腹血糖的升高,肌肉减少症风险增加。结论:MHD患者肌肉减少症发生率较高,其发生与多种因素相关,提示尤其需要关注高龄、营养不良及高空腹血糖的患者。
引文
1.Rosenberg I H.Sarcopenia:origins and clinical relevance.Clinics in Geriatric Medicine,2011,27(3):337-339.
2.Battaglia Y,Galeano D,Cojocaru E,et al.[Muscle-wasting in end stage renal disease in dialysis treatment:a review].Giornale Italiano Di Nefrologia Organo Ufficiale Della Societa Italiana Di Nefrologia,2016,33(2).
3.黄丽娅,李少华,翁敏.维持性血液透析病人骨骼肌减少症发生率和危险因素研究.肠外与肠内营养,2017,24(2):78-81.
4.Ren H,Gong D,Jia F,et al.Sarcopenia in patients undergoing maintenance hemodialysis:incidence rate,risk factors and its effect on survival risk.Renal Failure,2016,38(3):1.
5.Hotta C,Hiraki K,Wakamiya A,et al.Relation of physical function and physical activity to sarcopenia in hemodialysis patients:A preliminary study.International Journal of Cardiology,2015,191(3):198.
6.Bataille S,Serveaux M,Carreno E,et al.The diagnosis of sarcopenia is mainly driven by muscle mass in hemodialysis patients.Clinical Nutrition,2016.
7.Matsuzawa R,Matsunaga A,Wang G,et al.Relationship between lower extremity muscle strength and all-cause mortality in Japanese patients undergoing dialysis.Physical Therapy,2014,94(7):947-956.
8.Craig CL,Marshall AL,Sj9str9m M,et al.International physical activity questionnaire:12-country reliability and validity.Medicine&Science in Sports&Exercise,2003,35(8):1381.
9.屈宁宁,李可基.国际体力活动问卷中文版的信度和效度研究.中华流行病学杂志,2004,25(3):265-268.
10.Yamada M,Nishiguchi S,Fukutani N,et al.Prevalence of sarcopenia in community-dwelling Japanese older adults.Journal of the American Medical Directors Association,2013,14(12):911-915.
11.Domański M,Ciechanowski K.Sarcopenia:A Major Challenge in Elderly Patients with End-Stage Renal Disease.Journal of aging research,2012,2012(10):754739.
12.Janardhan V,Soundararajan P,Rani NV,et al.Prediction of Malnutrition Using Modified Subjective Global Assessment-dialysis Malnutrition Score in Patients on Hemodialysis.Indian Journal of Pharmaceutical Sciences,2011,73(1):38-45.
13.Chen J,Peng H,Yuan Z,et al.Combination with anthropometric measurements and MQSGA to assess nutritional status in Chinese hemodialysis population.International Journal of Medical Sciences,2013,10(8):974.
14.施凌云,何华平,倪松,等.维持性血液透析患者营养状况及营养不良的影响因素分析.现代生物医学进展,2016,16(6):1135-1138.
15.Carrero JJ.Identification of patients with eating disorders:clinical and biochemical signs of appetite loss in dialysis patients.Journal of Renal Nutrition,2009,19(1):10-15.
16.丁婷婷,王会玲,陆石,等.血液透析患者微炎症状态与骨骼肌消耗性营养不良的临床研究.中国中西医结合肾病杂志,2013,14(7):582-585,660.
17.孙建琴,张坚,常翠青,等.肌肉衰减综合征营养与运动干预中国专家共识(节录).营养学报,2015(4):320-324.
18.Leenders M,Verdijk LB,Vand HL,et al.Patients with type 2diabetes show a greater decline in muscle mass,muscle strength,and functional capacity with aging.Journal of the American Medical Directors Association,2013,14(8):585-592.
19.Wang HL,Ding TT,Lu S,et al.Muscle mass loss and intermuscular lipid accumulation were associated with insulin resistance in patients receiving hemodialysis.中华医学杂志(英文版),2013,126(24):4612.
20.余馨.抗阻运动对血液透析患者躯体功能和生活质量干预效果的研究.北京:北京协和医学院,2014.64-65.
2.Battaglia Y,Galeano D,Cojocaru E,et al.[Muscle-wasting in end stage renal disease in dialysis treatment:a review].Giornale Italiano Di Nefrologia Organo Ufficiale Della Societa Italiana Di Nefrologia,2016,33(2).
3.黄丽娅,李少华,翁敏.维持性血液透析病人骨骼肌减少症发生率和危险因素研究.肠外与肠内营养,2017,24(2):78-81.
4.Ren H,Gong D,Jia F,et al.Sarcopenia in patients undergoing maintenance hemodialysis:incidence rate,risk factors and its effect on survival risk.Renal Failure,2016,38(3):1.
5.Hotta C,Hiraki K,Wakamiya A,et al.Relation of physical function and physical activity to sarcopenia in hemodialysis patients:A preliminary study.International Journal of Cardiology,2015,191(3):198.
6.Bataille S,Serveaux M,Carreno E,et al.The diagnosis of sarcopenia is mainly driven by muscle mass in hemodialysis patients.Clinical Nutrition,2016.
7.Matsuzawa R,Matsunaga A,Wang G,et al.Relationship between lower extremity muscle strength and all-cause mortality in Japanese patients undergoing dialysis.Physical Therapy,2014,94(7):947-956.
8.Craig CL,Marshall AL,Sj9str9m M,et al.International physical activity questionnaire:12-country reliability and validity.Medicine&Science in Sports&Exercise,2003,35(8):1381.
9.屈宁宁,李可基.国际体力活动问卷中文版的信度和效度研究.中华流行病学杂志,2004,25(3):265-268.
10.Yamada M,Nishiguchi S,Fukutani N,et al.Prevalence of sarcopenia in community-dwelling Japanese older adults.Journal of the American Medical Directors Association,2013,14(12):911-915.
11.Domański M,Ciechanowski K.Sarcopenia:A Major Challenge in Elderly Patients with End-Stage Renal Disease.Journal of aging research,2012,2012(10):754739.
12.Janardhan V,Soundararajan P,Rani NV,et al.Prediction of Malnutrition Using Modified Subjective Global Assessment-dialysis Malnutrition Score in Patients on Hemodialysis.Indian Journal of Pharmaceutical Sciences,2011,73(1):38-45.
13.Chen J,Peng H,Yuan Z,et al.Combination with anthropometric measurements and MQSGA to assess nutritional status in Chinese hemodialysis population.International Journal of Medical Sciences,2013,10(8):974.
14.施凌云,何华平,倪松,等.维持性血液透析患者营养状况及营养不良的影响因素分析.现代生物医学进展,2016,16(6):1135-1138.
15.Carrero JJ.Identification of patients with eating disorders:clinical and biochemical signs of appetite loss in dialysis patients.Journal of Renal Nutrition,2009,19(1):10-15.
16.丁婷婷,王会玲,陆石,等.血液透析患者微炎症状态与骨骼肌消耗性营养不良的临床研究.中国中西医结合肾病杂志,2013,14(7):582-585,660.
17.孙建琴,张坚,常翠青,等.肌肉衰减综合征营养与运动干预中国专家共识(节录).营养学报,2015(4):320-324.
18.Leenders M,Verdijk LB,Vand HL,et al.Patients with type 2diabetes show a greater decline in muscle mass,muscle strength,and functional capacity with aging.Journal of the American Medical Directors Association,2013,14(8):585-592.
19.Wang HL,Ding TT,Lu S,et al.Muscle mass loss and intermuscular lipid accumulation were associated with insulin resistance in patients receiving hemodialysis.中华医学杂志(英文版),2013,126(24):4612.
20.余馨.抗阻运动对血液透析患者躯体功能和生活质量干预效果的研究.北京:北京协和医学院,2014.64-65.