[an error occurred while processing this directive]
临床研究

相角与维持性血液透析患者肌少症的关系及其预测价值分析

  • 丁妍 ,
  • 常立阳
展开
  • 1浙江中医药大学附属杭州市中医院血液净化中心

收稿日期: 2021-08-26

  修回日期: 2022-01-13

  网络出版日期: 2022-03-16

基金资助

浙江省医药卫生科技计划项目(2019KY138)

The correlation of phase angle with sarcopenia and its diagnostic value in maintenance hemodialysis patients

  • DING Yan ,
  • CHANG Li-Yang
Expand
  • 1Department of Blood Purification Centre, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Traditional Chinese Medicine University, Hangzhou 310007, China

Received date: 2021-08-26

  Revised date: 2022-01-13

  Online published: 2022-03-16

摘要

【摘要】目的分析生物电阻抗法测量的相角与维持性血液透析(maintenance hemodialysis,MHD)患者肌少症的关系,并探索相角在肌少症中的作用。方法选取在浙江中医药大学附属杭州市中医院规律透析且病情稳定的MHD 患者346 例,收集相关资料,采用多元线性回归分析筛选MHD 患者相角的影响因素,并进一步采用受试者工作特征曲线图和曲线下面积评价相角对肌少症的预测价值。结果多元线性回归分析显示相角与年龄、白蛋白、瘦体质量、骨骼肌质量指数、握力、步速呈线性关系(B=-0.192、0.180、0.889、0.978、0.212、0.210,均P<0.001)。相角检测肌少症的最佳临界值是4.67° ,曲线下面积为0.823,敏感性和特异性分别为86.7%和67.4%(P<0.001)。结论本研究发现相角与MHD 患者的肌少症组分密切相关,是肌少症的重要预测因素,相角作为简便的临床指标可为MHD 人群肌少症的早期诊断提供客观参考依据。

本文引用格式

丁妍 , 常立阳 . 相角与维持性血液透析患者肌少症的关系及其预测价值分析[J]. 中国血液净化, 2022 , 21(03) : 172 -176 . DOI: 10.3969/j.issn.1671-4091.2022.03.007

Abstract

【Abstract】Objective This study aimed to analyze the correlation between phase angle measured by bioelectrical impedance method and sarcopenia in maintenance hemodialysis (MHD) patients and to explore the role of phase angle in sarcopenia. Methods We enrolled 346 MHD patients with regular dialysis in this study. Their relevant data were collected. Multivariate linear regression was used to analyze the influencing factors for phase angle in MHD patients. Receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the predictive value of phase angle for sarcopenia. Results Multivariate linear regression showed that the phase angle was linear with age, albumin, fat free mass, skeletal muscle mass index, handgrip strength, gait speed (B=- 0.192, 0.180, 0.889, 0.978, 0.212 and 0.210 respectively; P<0.05). The best cutoff value of phase angle for sarcopenia was 4.67° , with the AUC of 0.823, the sensitivity of 86.7%, and the specificity of 67.4% (P<0.001). Conclusions This study found that phase angle was closely related to sarcopenia component in MHD patients, and was an important predictor for sarcopenia. As a simple and convenient clinical index, phase angle can provide objective reference for early diagnosis of sarcopenia in MHD patients.

参考文献

参考文献
[1] Watanabe H, Enoki Y, Maruyama T. Sarcopenia in chronic kidney disease: Factors, mechanisms, and therapeutic interventions[J]. Biol Pharm Bull, 2019, 42(9): 1437-1445.
[2] Rosenberg I H. Sarcopenia: Origins and clinical relevance[J]. J Nutr, 1997, 127(5 Suppl): 990s-991s.
[3] Ren H, Gong D, Jia F, Xu B, Liu Z. Sarcopenia in patients undergoing maintenance hemodialysis: Incidence rate, risk factors and its effect on survival risk[J]. Ren Fail, 2016, 38(3): 364-371.
[4] Lamarca F, Carrero J J, Rodrigues J C, Bigogno F G, Fetter R L, Avesani C M. Prevalence of sarcopenia in elderly maintenance hemodialysis patients: The impact of different diagnostic criteria[J]. J Nutr Health Aging, 2014, 18(7): 710-717.
[5] 董志娟, 张海林. 维持性血液透析患者肌少症发生的危险因素分析[J]. 护理学杂志, 2018, 33(09): 20-24.
[6] Marini A C, Motobu R D, Freitas A T V, Laviano A, Pimentel G D. Pre-sarcopenia in patients undergoing hemodialysis: Prevalence and association with biochemical parameters[J]. Clin Nutr ESPEN, 2018, 28: 236-238.
[7] Nishi H, Takemura K, Higashihara T, Inagi R. Uremic sarcopenia: Clinical evidence and basic experimental approach[J]. Nutrients, 2020, 12(6).
[8] Lin Y L, Liou H H, Wang C H, Lai Y H, Kuo C H, Chen S Y, et al. Impact of sarcopenia and its diagnostic criteria on hospitalization and mortality in chronic hemodialysis patients: A 3-year longitudinal study[J]. J Formos Med Assoc, 2020, 119(7): 1219-1229.
[9] Ma?ecka-Massalska T, Popio?ek J, Teter M, Homa-Mlak I, Dec M, Makarewicz A, et al. Application of phase angle for evaluation of the nutrition status of patients with anorexia nervosa[J]. Psychiatr Pol, 2017, 51(6): 1121-1131.
[10] Kosacka M, Korzeniewska A, Jankowska R. The evaluation of body composition, adiponectin, c-reactive protein and cholesterol levels in patients with obstructive sleep apnea syndrome[J]. Adv Clin Exp Med, 2013, 22(6): 817-824.
[11] Lukaski H C, Kyle U G, Kondrup J. Assessment of adult malnutrition and prognosis with bioelectrical impedance analysis: Phase angle and impedance ratio[J]. Curr Opin Clin Nutr Metab Care, 2017, 20(5): 330-339.
[12] Beberashvili I, Azar A, Sinuani I, Shapiro G, Feldman L, Stav K, et al. Bioimpedance phase angle predicts muscle function, quality of life and clinical outcome in maintenance hemodialysis patients[J]. Eur J Clin Nutr, 2014, 68(6): 683-689.
[13] Garlini L M, Alves F D, Ceretta L B, Perry I S, Souza G C, Clausell N O. Phase angle and mortality: A systematic review[J]. Eur J Clin Nutr, 2019, 73(4): 495-508.
[14] Hirose S, Nakajima T, Nozawa N, Katayanagi S, Ishizaka H, Mizushima Y, et al. Phase angle as an indicator of sarcopenia, malnutrition, and cachexia in inpatients with cardiovascular diseases[J]. J Clin Med, 2020, 9(8).
[15] Pessoa D F, de Branco F M S, Dos Reis A S, Limirio L S, Borges L P, Barbosa C D, et al. Association of phase angle with sarcopenia and its components in physically active older women[J]. Aging Clin Exp Res, 2020, 32(8): 1469-1475.
[16] Espirito Santo Silva D D, Waitzberg D L, Passos de Jesus R, Oliveira L P M, Torrinhas R S, Belarmino G. Phase angle as a marker for sarcopenia in cirrhosis[J]. Clin Nutr ESPEN, 2019, 32: 56-60.
[17] Kalantar-Zadeh K, Kleiner M, Dunne E, Lee G H, Luft F C. A modified quantitative subjective global assessment of nutrition for dialysis patients[J]. Nephrol Dial Transplant, 1999, 14(7): 1732-1738.
[18] Janardhan V, Soundararajan P, Rani N V, Kannan G, Thennarasu P, Chacko R A, et al. Prediction of malnutrition using modified subjective global assessment-dialysis malnutrition score in patients on hemodialysis[J]. Indian J Pharm Sci, 2011, 73(1): 38-45.
[19] Hou Y, Li X, Hong D, Zou H, Yang L, Chen Y, et al. Comparison of different assessments for evaluating malnutrition in chinese patients with end-stage renal disease with maintenance hemodialysis[J]. Nutr Res, 2012, 32(4): 266-271.
[20] Chen J, Peng H, Yuan Z, Zhang K, Xiao L, Huang J, et al. Combination with anthropometric measurements and mqsga to assess nutritional status in chinese hemodialysis population[J]. Int J Med Sci, 2013, 10(8): 974-980.
[21] Jiang J, Ni L, Ren W, Zhou X, Su K, Wang L, et al. Nutritional status in short daily hemodialysis versus conventional hemodialysis patients in china[J]. Int Urol Nephrol, 2018, 50(4): 755-762.
[22] Craig C L, Marshall A L, Sj?str?m M, Bauman A E, Booth M L, Ainsworth B E, et al. International physical activity questionnaire: 12-country reliability and validity[J]. Med Sci Sports Exerc, 2003, 35(8): 1381-1395.
[23] Lou X, He Q. Validity and reliability of the international physical activity questionnaire in chinese hemodialysis patients: A multicenter study in china[J]. Med Sci Monit, 2019, 25: 9402-9408.
[24] Kyle U G, Bosaeus I, De Lorenzo A D, Deurenberg P, Elia M, Gómez J M, et al. Bioelectrical impedance analysis--part i: Review of principles and methods[J]. Clin Nutr, 2004, 23(5): 1226-1243.
[25] Dent E, Morley J E, Cruz-Jentoft A J, Arai H, Kritchevsky S B, Guralnik J, et al. International clinical practice guidelines for sarcopenia (icfsr): Screening, diagnosis and management[J]. J Nutr Health Aging, 2018, 22(10): 1148-1161.
[26] Norman K, Stob?us N, Pirlich M, Bosy-Westphal A. Bioelectrical phase angle and impedance vector analysis--clinical relevance and applicability of impedance parameters[J]. Clin Nutr, 2012, 31(6): 854-861.
[27] Janssen I, Baumgartner R N, Ross R, Rosenberg I H, Roubenoff R. Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women[J]. Am J Epidemiol, 2004, 159(4): 413-421.
[28] Chen L K, Woo J, Assantachai P, Auyeung T W, Chou M Y, Iijima K, et al. Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment[J]. J Am Med Dir Assoc, 2020, 21(3): 300-307.e302.
[29] Di Vincenzo O, Marra M, Scalfi L. Bioelectrical impedance phase angle in sport: A systematic review[J]. J Int Soc Sports Nutr, 2019, 16(1): 49.
[30] Bansal N, Zelnick L R, Himmelfarb J, Chertow G M. Bioelectrical impedance analysis measures and clinical outcomes in ckd[J]. Am J Kidney Dis, 2018, 72(5): 662-672.
[31] 李颖颖, 余亚英. 开封地区健康成人相位角及其影响因素[J]. 河南医学研究, 2020, 29(27): 5005-5008.
[32] 曾小庆, 柳园, 程懿, 石运莹, 周莉, 胡雯. 不同年龄、性别血液透析患者体成分及营养状况分析[J]. 现代预防医学, 2018, 45(06): 1141-1144.
[33] Sieber C C. Malnutrition and sarcopenia[J]. Aging Clin Exp Res, 2019, 31(6): 793-798.
[34] Basile C, Della-Morte D, Cacciatore F, Gargiulo G, Galizia G, Roselli M, et al. Phase angle as bioelectrical marker to identify elderly patients at risk of sarcopenia[J]. Exp Gerontol, 2014, 58: 43-46.
[35] Ji W, Liu X, Zheng K, Yang H, Cui J, Li W. Correlation of phase angle with sarcopenia and its diagnostic value in elderly men with cancer[J]. Nutrition, 2020, 84: 111110.
[36] 曹梦宇, 祁晓磊, 周明, 林希圣, 刘陪沛, 刘金炜, et al. 不同诊断标准下相位角对肌少症的诊断价值分析[J]. 解放军医学院学报: 1-7.
[37] Santana N M, Pinho C P S, da Silva C P, Dos Santos N F, Mendes R M L. Phase angle as a sarcopenia marker in hospitalized elderly patients[J]. Nutr Clin Pract, 2018, 33(2): 232-237.
[38] Janssen I, Heymsfield S B, Baumgartner R N, Ross R. Estimation of skeletal muscle mass by bioelectrical impedance analysis[J]. J Appl Physiol (1985), 2000, 89(2): 465-471.
[39] Kilic M K, Kizilarslanoglu M C, Arik G, Bolayir B, Kara O, Dogan Varan H, et al. Association of bioelectrical impedance analysis-derived phase angle and sarcopenia in older adults[J]. Nutr Clin Pract, 2017, 32(1): 103-109.
[40] Kosoku A, Uchida J, Nishide S, Kabei K, Shimada H, Iwai T, et al. Association of sarcopenia with phase angle and body mass index in kidney transplant recipients[J]. Sci Rep, 2020, 10(1): 266.
[41] Jensen B, Moritoyo T, Kaufer-Horwitz M, Peine S, Norman K, Maisch M J, et al. Ethnic differences in fat and muscle mass and their implication for interpretation of bioelectrical impedance vector analysis[J]. Appl Physiol Nutr Metab, 2019, 44(6): 619-626.
文章导航

/

[an error occurred while processing this directive]