维持性血液透析的2型糖尿病肾病患者并发肌少症的相关因素分析

摘要/Abstract

摘要：

目的：分析维持性血液透析(maintenance hemodialysis, MHD)的2型糖尿病肾病患者并发肌少症的相关因素，以减少肌少症的发生率。方法：回顾性收集2021年9月至2023年4月在新乡医学院附属人民医院血液净化中心行MHD合并肌少症的237例患者的临床资料。将患者分为2型糖尿病肾病组(100例)和非糖尿病肾病组(137例)，比较2组患者的临床资料及生物电阻抗法(bioelectrical impedance analysis, BIA)结果。以多因素Logistic回归模型分析影响MHD糖尿病肾病患者并发肌少症的相关因素。结果：2组间性别、空腹血糖、血清肌酐、白蛋白、前白蛋白、25-羟维生素D、体质量指数(body mass index，BMI)、体脂肪量(fat mass,FM)、上臂围(arm circumference, AC)、内脏脂肪面积(visceral fat area, VFA)、50 kHz相位角差异均有统计学意义（均P<0.05）。多因素Logistic 回归分析结果显示，性别、空腹血糖、白蛋白、BMI为MHD糖尿病肾病患者并发肌少症的影响因素(OR=0.372、1.350、0.925、1.451,均P<0.05)。结论：MHD的糖尿病肾病患者中男性、低白蛋白血症、高血糖和高BMI者更易并发肌少症。

关键词:维持性血液透析,2型糖尿病肾病,肌少症

Abstract:

ObjectiveTo analyze related factors of sarcopenia in type 2 diabetic nephropathy patients on maintenance hemodialysis (MHD), in order to reduce the incidence of sarcopenia.MethodsThe clinical data of 237 patients with MHD complicated with sarcopenia were collected from the Blood Purification Center of the Affiliated People’s Hospital of Xinxiang Medical College from September 2021 to April 2023 retrospectively and analyzed. The patients were divided into type 2 diabetic nephropathy group (100 cases) and non-diabetic nephropathy group (137 cases), and the clinical data and the result of bioelectrical impedance analysis (BIA) were compared between the two groups. Multivariate Logistic regression model was used to analyze the related factors affecting sarcopenia in MHD patients with diabetic nephropathy.ResultsThere were significant differences in gender, fasting blood glucose, serum creatinine, albumin, prealbumin, 25-hydroxyvitamin D, body mass index (BMI), fat mass (FM), arm circumference (AC), visceral fat area (VFA) and 50 kHz phase angle between the two groups(allP<0.05). Multivariate Logistic regression analysis showed that gender, fasting blood glucose, albumin and BMI were independent influencing factors of sarcopenia in MHD diabetic nephropathy patients (odds ratio =0.372, 1.350, 0.925, 1.451, allP<0.05).ConclusionsMale, hypoalbuminemia, hyperglycemia and high BMI patients with MHD are more likely to have sarcopenia among diabetic nephropathy patients with MHD.

Key words:Maintenance hemodialysis,Type 2 diabetic nephropathy,Sarcopenia

中图分类号:

R587
R459.5

武梦梦, 杨福燕, 刘雨辰, 鲁旭柯, 高静歌, 叶紫灵. 维持性血液透析的2型糖尿病肾病患者并发肌少症的相关因素分析[J]. 内科理论与实践, 2024, 19(02): 102-106.

WU Mengmeng, YANG Fuyan, LIU Yuchen, LU Xuke, GAO Jingge, YE Ziling. Analysis of related factors of sarcopenia in type 2 diabetic nephropathy patients on maintenance hemodialysis[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(02): 102-106.

图/表4

表1

2组患者临床特征比较[n(%)/M(Q1, Q3)]

项目	非糖尿病肾病组(n=137)	糖尿病肾病组(n=100)	χ²/Z	P
男性[n(%)]	63(46.0)	62(62.0)	5.948	0.015
年龄(岁)	63(51,75)	64(56,72)	-0.563	0.573
透析方式[n(%)]			2.811	0.245
血液透析	110(80.3)	85(85.0)
血液滤过	10(7.3)	9(9.0)
血液透析联合血液灌流	17(12.4)	6(6.0)
透析龄(月)	48(18,90)	45(24,85)	-0.238	0.812
抗凝剂类型[n(%)]			0.693	0.707
低分子肝素钠	109(79.6)	75(75.0)
普通肝素	9(6.6)	8(8.0)
无肝素	19(13.8)	17(17.0)
血管通路[n(%)]			6.591	0.010
动静脉内瘘	51(37.2)	54(54.0)
深静脉置管	86(62.8)	46(46.0)
BMI(kg/m²)	20.2(18.4,22.5)	21.6(20.2,23.1)	-3.868	<0.001
Kt/V	1.3(1.2,1.4)	1.3(1.1,1.4)	-1.515	0.130

表1

表2

2组患者实验室指标比较[（$\bar{x} \pm s$）/M(Q1, Q3)]

项目	非糖尿病肾病组(n=137)	糖尿病肾病组(n=100)	t/Z	P
血红蛋白(g/L)	110(90,123)	102±23	-1.310	0.190
空腹血糖(mmol/L)	5.10(4.32,6.08)	7.28(5.32,12.14)	-6.292	<0.001
ALP(U/L)	93(68,120)	96(75,120)	-1.237	0.216
血清肌酐(μmol/L)	653(458,859)	540(394,752)	-2.235	0.025
血清尿素氮(mmol/L)	21.11(14.45,27.90)	19.43(14.64,27.97)	-0.326	0.744
血清磷(mmol/L)	1.72(1.37,2.21)	1.66(1.24,1.98)	-1.525	0.127
IPTH(ng/L)	22.21(11.17,41.55)	21.19(11.88,43.28)	-0.125	0.901
白蛋白(g/L)	38.3±5.3	36.0(32.3,39.7)	-3.688	<0.001
前白蛋白(g/L)	243±87	194(132,261)	-3.545	<0.001
25-羟维生素D(μg/L)	18.13(10.44,27.94)	13.89(8.27,21.72)	-2.160	0.031
TC(mmol/L)	3.56(2.94,4.44)	3.38(2.70,4.15)	-1.495	0.135
TG(mmol/L)	1.28(0.85,1.94)	1.28(0.99,1.94)	-0.756	0.450
HDL(mmol/L)	1.11(0.80,1.49)	1.03(0.75,1.49)	-0.764	0.445
LDL(mmol/L)	0.99(0.59,1.71)	1.13(0.70,1.49)	-0.759	0.448
CRP(mg/L)	13.73(3.41,50.11)	12.26(4.08,51.52)	-0.582	0.560
hs-CRP(mg/L)	6.69(2.57,15.83)	7.32(2.65,15.08)	-0.488	0.625

表2

表3

2组患者BIA结果比较[（$\bar{x} \pm s$）/M(Q1, Q3)]

项目	非糖尿病肾病组(n=137)	糖尿病肾病组(n=100)	t/Z	P
蛋白质(kg)	7.4±1.2	7.9(6.7,8.5)	-1.550	0.121
无机盐(kg)	2.81±0.40	2.86(2.64,3.16)	-1.481	0.139
FM(kg)	14.4(10.9,19.2)	17.7(13.4,20.9)	-2.926	0.003
FFM(kg)	39.0±6.3	40.4±6.5	-1.715	0.088
PBF(%)	28.0±9.6	30.2±9.1	-1.845	0.066
SMM(kg)	20.4±3.7	21.8(18.2,23.8)	-1.467	0.142
BMR[kJ/(m²·h) ]	1 213.2±135.9	1 245.3±141.1	-1.768	0.078
VFA(cm²)	80.3(61.0,116.4)	96.8(75.1,128.2)	-3.036	0.002
AC(cm)	26.8(24,7,28.6)	27.5±2.1	-2.091	0.036
AMC(cm)	23.6±1.9	24.0±1.7	-1.485	0.139
SMI(%)	5.7(5.0,6.4)	6.0(5.2,6.5)	-1.847	0.065
50 kHz相位角(rad)	4.3±1.2	3.9±1.1	2.684	0.008

表3

表4

MHD糖尿病肾病患者并发肌少症的相关因素分析

因素	β	SE	Wald χ²	P	OR	95% CI
性别	-0.990	0.448	4.877	0.027	0.372	0.154~0.895
空腹血糖	0.300	0.063	22.933	<0.001	1.350	1.194~1.527
血清肌酐	0.000	0.001	0.023	0.880	1.000	0.999~1.001
白蛋白	-0.078	0.036	4.606	0.032	0.925	0.861~0.993
前白蛋白	0.000	0.002	0.032	0.858	1.000	0.995~1.004
25-羟维生素D	-0.016	0.014	1.245	0.265	0.984	0.957~1.012
FM	0.133	0.116	1.333	0.248	1.143	0.911~1.433
BMI	0.373	0.186	4.011	0.045	1.451	1.008~2.090
VFA	-0.015	0.015	1.049	0.306	0.985	0.957~1.014
AC	-0.272	0.192	2.017	0.156	0.762	0.523~1.109
50 kHz相位角	-0.223	0.190	1.384	0.239	0.800	0.552~1.160

表4

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