目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者血清25羟维生素D[25(OH)D]水平与握力(handgrip strength, HGS)和捏力(pinch strength,PS)的关系。方法 采用单中心横断面研究，纳入2021年3月暨南大学附属广州红十字会医院血液净化中心行规律MHD的患者，收集受试者的一般资料，透析前测定血常规、血清生化指标和25(OH)D水平(电化学发光免疫法)，使用测力计测量HGS和PS水平。根据25(OH)D水平将受试者分为25(OH)D正常组[25(OH)D＞30 ng/ml]、25(OH)D不足组[20 ng/ml≤25(OH)D≤30 ng/ml]、25(OH)D缺乏组[25(OH)D＜20 ng/ml]，比较3组间各指标的差异。应用Spearman相关分析和线性回归评价25(OH)D水平与HGS和PS的相关性。 结果 共纳入126例MHD患者，25(OH)D正常组28例(22.22%)、不足组42例(33.33%)、缺乏组56例(44.44%)。Spearman相关性分析提示血清25(OH)D水平与HGS(r=0.289，P=0.001)、PS(r=0.289，P=0.001)呈正相关。在调整相关混杂因素后，多元线性回归显示血清25(OH)D水平降低与较低的HGS(β=0.199,95% CI:0.058～0.341,P=0.006)和PS(β=0.052,95% CI:0.017～0.087,P=0.004)独立相关。结论 MHD患者血清25(OH)D水平降低是HGS和PS降低的独立相关因素。
Objectives To investigate the correlation between serum 25 hydroxyvitamin D [25(OH)D] level and handgrip strength (HGS) and pinch strength (PS) in maintenance hemodialysis (MHD) patients. Method This was a single-center and cross-sectional study. Patients undergoing MHD in the month of March 2021 in our Hemodialysis Center were enrolled in this study. Demographic data of the patients were collected. Routine blood counts, serum biochemical parameters and 25(OH)D levels (by electrochemiluminescence immunoassay) were determined before dialysis. HGS and PS were measured using a dynamometer. Patients were categorized into 25(OH)D normal, 25(OH)D insufficient, and 25(OH)D deficient groups based on 25(OH)D levels. Differences in these indexes were compared among the 3 groups. Spearman correlation analysis and linear regression were applied to evaluate the correlation between 25(OH)D level and HGS and PS. Results A total of 126 MHD patients were included in this study; 28 patients (22.22%) in the normal 25(OH)D group, 42 patients (33.33%) in the insufficient group, and 56 patients (44.44%) in the deficient group. Spearman correlation analysis suggested that serum 25(OH)D level was positively correlated with HGS (r=0.289, P=0.001) and PS (r=0.289, P=0.001). After adjusting for relevant confounders, multivariate linear regression showed that lower serum 25(OH)D level was independently associated with lower HGS (β=0.199, 95% CI:0.058～0.341, P=0.006) and PS (β=0.052, 95% CI：0.017～0.087, P=0.004). Conclusion Reduced serum 25(OH)D level was an independent factor for reduced HGS and PS in MHD patients.
1. Bello AK, Okpechi IG, Osman MA, Cho Y, Htay H, Jha V, et al. Epidemiology of haemodialysis outcomes. Nat Rev Nephrol. 2022;18(6):378-95.
2. Lai S, Muscaritoli M, Andreozzi P, Sgreccia A, De Leo S, Mazzaferro S, et al. Sarcopenia and cardiovascular risk indices in patients with chronic kidney disease on conservative and replacement therapy. Nutrition. 2019;62:108-14.
3. Ikizler TA. Optimal nutrition in hemodialysis patients. Adv Chronic Kidney Dis. 2013;20(2):181-9.
4. Wen J, Fang Y, Su Z, Cai J, Chen Z. Mental health and its influencing factors of maintenance hemodialysis patients: a semi-structured interview study. BMC Psychol. 2023;11(1):84.
5. Jiang K, Slee A, Davenport A. Body composition and weakness of hand grip strength and pinch strength in patients with chronic kidney disease from different ethnic backgrounds. J Hum Nutr Diet. 2021;34(2):450-5.
6. El-Katab S, Omichi Y, Srivareerat M, Davenport A. Pinch grip strength as an alternative assessment to hand grip strength for assessing muscle strength in patients with chronic kidney disease treated by haemodialysis: a prospective audit. J Hum Nutr Diet. 2016;29(1):48-51.
7. Omichi Y, Srivareerat M, Panorchan K, Greenhall GH, Gupta S, Davenport A. Measurement of Muscle Strength in Haemodialysis Patients by Pinch and Hand Grip Strength and Comparison to Lean Body Mass Measured by Multifrequency Bio-Electrical Impedance. Ann Nutr Metab. 2016;68(4):268-75.
8. Norman K, Stob?us N, Gonzalez MC, Schulzke JD, Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr. 2011;30(2):135-42.
9. Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A, Jr., Orlandini A, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet. 2015;386(9990):266-73.
10. Ishihara K, Izawa KP, Kitamura M, Shimogai T, Kanejima Y, Morisawa T, et al. Pinch strength is associated with the prevalence of mild cognitive impairment in patients with cardiovascular disease. J Cardiol. 2020;75(6):594-9.
11. Tripathi A, Ansari M, Dandekar P, Jain R. Analytical methods for 25-hydroxyvitamin D: advantages and limitations of the existing assays. J Nutr Biochem. 2022;109:109123.
12. Crescioli C. Vitamin D Restores Skeletal Muscle Cell Remodeling and Myogenic Program: Potential Impact on Human Health. Int J Mol Sci. 2021;22(4).
13. Wolf M, Shah A, Gutierrez O, Ankers E, Monroy M, Tamez H, et al. Vitamin D levels and early mortality among incident hemodialysis patients. Kidney Int. 2007;72(8):1004-13.
14. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42(4 Suppl 3):S1-201.
15. Matsuzawa R, Roshanravan B, Shimoda T, Mamorita N, Yoneki K, Harada M, et al. Physical Activity Dose for Hemodialysis Patients: Where to Begin? Results from a Prospective Cohort Study. J Ren Nutr. 2018;28(1):45-53.
16. Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am. 1984;9(2):222-6.
17. Gunton JE, Girgis CM. Vitamin D and muscle. Bone Rep. 2018;8:163-7.
18. Bauer JM, Verlaan S, Bautmans I, Brandt K, Donini LM, Maggio M, et al. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2015;16(9):740-7.
19. Song Y, Zhang Q, Ni L, Zhang M, Wang M, Zhang W, et al. Risk Factors Affecting Muscle Mass Decline in Maintenance Hemodialysis Patients. Biomed Res Int. 2022;2022:2925216.
20. Lin YL, Liou HH, Wang CH, Lai YH, Kuo CH, Chen SY, et al. Impact of sarcopenia and its diagnostic criteria on hospitalization and mortality in chronic hemodialysis patients: A 3-year longitudinal study. J Formos Med Assoc. 2020;119(7):1219-29.
21. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(4):601.
22. Silva LF, Matos CM, Lopes GB, Martins MT, Martins MS, Arias LU, et al. Handgrip strength as a simple indicator of possible malnutrition and inflammation in men and women on maintenance hemodialysis. J Ren Nutr. 2011;21(3):235-45.
23. Matos CM, Silva LF, Santana LD, Santos LS, Protásio BM, Rocha MT, et al. Handgrip strength at baseline and mortality risk in a cohort of women and men on hemodialysis: a 4-year study. J Ren Nutr. 2014;24(3):157-62.
24. Silveira L, Silva JMD, Tanaka C, Fu C. Decline in functional status after intensive care unit discharge is associated with ICU readmission: a prospective cohort study. Physiotherapy. 2019;105(3):321-7.
25. Bae JH, Kang SH, Seo KM, Kim DK, Shin HI, Shin HE. Relationship Between Grip and Pinch Strength and Activities of Daily Living in Stroke Patients. Ann Rehabil Med. 2015;39(5):752-62.
26. Bollen SE, Bass JJ, Fujita S, Wilkinson D, Hewison M, Atherton PJ. The Vitamin D/Vitamin D receptor (VDR) axis in muscle atrophy and sarcopenia. Cell Signal. 2022;96:110355.
27. Wimalawansa SJ. Vitamin D Deficiency: Effects on Oxidative Stress, Epigenetics, Gene Regulation, and Aging. Biology (Basel). 2019;8(2).
28. Costamagna D, Costelli P, Sampaolesi M, Penna F. Role of Inflammation in Muscle Homeostasis and Myogenesis. Mediators Inflamm. 2015;2015:805172.
29. Wang XH, Mitch WE. Mechanisms of muscle wasting in chronic kidney disease. Nat Rev Nephrol. 2014;10(9):504-16.
30. Jones G. Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr. 2008;88(2):582s-6s.
