目的 探索维持性血液透析患者发生肌少症的预测诊断因子，抗阻力运动联合益生菌对合并肌少症的维持性血液透析(maintenance hemodialysis,MHD)患者生存质量是否具有改善作用。 方法 纳入2023年7月─12月在南通市通州区人民医院就诊的MHD患者，根据肌少症诊断标准分为肌少症组(n=44)和非肌少症组(n=89)，比较2组患者基线资料，分析MHD患者合并肌少症的危险因素，测定患者血清肌肉生长抑制素(myostain，MSTN)及白细胞介素-6(interleukin-6，IL-6)含量，ROC曲线分析两者单独及联合预测肌少症的诊断效能。将肌少症患者随机分为对照组和试验组，对照组予抗阻力运动、优质蛋白饮食，调节血压，维持水电解质平衡等常规治疗，试验组在对照组基础上予抗阻力运动联合益生菌治疗3个月，根据随访结果分析2组间患者生存质量的差异性。 结果 本研究纳入患者133例，MSTN(OR=1.243，95% CI：1.105～1.399，P＜0.001)、IL-6(OR=1.214，95%CI：1.107～1.331，P＜0.001)为MHD患者合并肌少症的危险因素。MSTN和IL-6两者联合诊断MHD合并肌少症的AUC最高为0.741，灵敏度：0.659，特异度：0.708，95% CI：0.651～0.831。肌少症试验组患者与对照组治疗后相比，试验组生理功能、精神健康均较高于对照组(t/Z =2.080、-3.752，P =-0.044、＜0.001)。 结论 MSTN联合IL-6可有效预测MHD患者发生肌少症，抗阻力运动联合益生菌可有效改善MHD合并肌少症患者的生存质量，有一定安全性。
Objective To explore the factors enable us to predict the diagnosis of sarcopenia, and the effects of anti-resistance exercise combined with probiotics on quality of life in the maintenance hemodialysis (MHD) patients with sarcopenia. Methods The MHD patients admitted to Tongzhou District People's Hospital of Nantong City from July 2023 to December 2023 were enrolled in this study. They were divided into sarcopenia group (n=44) and non-sarcopenia group (n=89) according to the diagnostic criteria of sarcopenia. The baseline data were compared between the two groups, serum myostain (MSTN) and interleukin-6 (IL-6) were measured, and the risk factors for sarcopenia were analyzed. ROC curve was used to analyze the efficacy of myostain (MSTN), interleukin-6 (IL-6) and MSTN combined with IL-6 on the diagnosis of sarcopenia. The patients in sarcopenia group were further and randomly divided into control group and experimental group. The patients in control group were treated with anti-resistance exercise, high quality protein diet, control of blood pressure, maintenance of water and electrolyte balance, and other routine methods; the patients in experimental group were treated with anti-resistance exercise and probiotics for 3 months in addition to the measures given to the control group. The quality of life during follow-up study was compared between the two groups. Results A total of 133 patients were included in this study. Serum MSTN (OR=1.243, 95% CI: 1.105～1.399, P＜0.001) and IL-6 (OR=1.214, 95% CI: 1.107～1.331, P＜0.001) were the risk factors for sarcopenia in MHD patients. The AUC of MSTN combined with IL-6 for the diagnosis of sarcopenia was 0.741, with the sensitivity of 65.9%, the specificity of 70.8%, and 95% CI: 0.651～0.831. After the intervention, physiological functions and mental health were better in experiment group than in control group. Conclusion Serum MSTN combined with IL-6 can effectively predict the presence of sarcopenia in MHD patients. Anti-resistance exercise combined with probiotics can successfully and safely improve the quality of life in MHD patients with sarcopenia.
[1]. 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. Ren Fail. 2016;38(3):364-71.</br>[2]. Cao F, Jin L, Gao Y, Ding Y, Wen H, Qian Z, Zhang C, Hong L, Yang H, Zhang J, Tong Z, Wang W, Chen X, Mao Z. Artificial-enzymes-armed Bifidobacterium longum probiotics for alleviating intestinal inflammation and microbiota dysbiosis. Nat Nanotechnol. 2023 Jun;18(6):617-627. </br>[3]. 刘超星,智丽丹,任薛,等. 抗阻力运动对老年人肌少症治疗和预防效果的系统评价[J]. 中华老年医学杂志,2023,42(10):1248-1253. DOI:10.3760/cma.j.issn.0254-9026.2023.10.020.</br>[4]. 姜 珊 ,康 琳 ,刘 晓 红 .2019 亚 洲 肌 少 症 诊 断 及 治 疗 共 识 解 读 [J]. 中华老年医学杂志,2020,39(4):373-376.</br>[5]. Liem YS, Bosch JL, Arends LR, Heijenbrok-Kal MH, Hunink MG. Quality of life assessed with the Medical Outcomes Study Short Form 36-Item Health Survey of patients on renal replacement therapy: a systematic review and meta-analysis. Value Health. 2007 Sep-Oct;10(5):390-7.</br>[6]. Ikizler TA, Cano NJ, Franch H, Fouque D, Himmelfarb J, Kalantar-Zadeh K, Kuhlmann MK, Stenvinkel P, TerWee P, Teta D, Wang AY, Wanner C; International Society of Renal Nutrition and Metabolism. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int. 2013 Dec;84(6):1096-107.</br>[7]. Kopple JD. National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis. 2001 Jan;37(1 Suppl 2):S66-70.</br>[8]. Wong MMY, Tu C, Li Y, Perlman RL, Pecoits-Filho R, Lopes AA, Narita I, Reichel H, Port FK, Sukul N, Stengel B, Robinson BM, Massy ZA, Pisoni RL; CKDopps Investigators. Anemia and iron deficiency among chronic kidney disease Stages 3-5ND patients in the Chronic Kidney Disease Outcomes and Practice Patterns Study: often unmeasured, variably treated. Clin Kidney J. 2019 Aug 3;13(4):613-624.</br>[9]. Wang B, Li ZL, Zhang YL, Wen Y, Gao YM, Liu BC. Hypoxia and chronic kidney disease. EBioMedicine. 2022 Mar;77:103942.</br>[10]. Antu?a E, Cachán-Vega C, Bermejo-Millo JC, Potes Y, Caballero B, Vega-Naredo I, Coto-Montes A, Garcia-Gonzalez C. Inflammaging: Implications in Sarcopenia. Int J Mol Sci. 2022 Nov 30;23(23):15039.</br>[11]. Meng SJ, Yu LJ. Oxidative stress, molecular inflammation and sarcopenia. Int J Mol Sci. 2010 Apr 12;11(4):1509-26.</br>[12]. Nardone OM, de Sire R, Petito V, Testa A, Villani G, Scaldaferri F, Castiglione F. Inflammatory Bowel Diseases and Sarcopenia: The Role of Inflammation and Gut Microbiota in the Development of Muscle Failure. Front Immunol. 2021 Jul 13;12:694217.</br>[13]. Wang S, Fang L, Cong L, Chung JPW, Li TC, Chan DYL. Myostatin: a multifunctional role in human female reproduction and fertility - a short review. Reprod Biol Endocrinol. 2022 Jul 2;20(1):96.</br>[14]. Nardone OM, de Sire R, Petito V, Testa A, Villani G, Scaldaferri F, Castiglione F. Inflammatory Bowel Diseases and Sarcopenia: The Role of Inflammation and Gut Microbiota in the Development of Muscle Failure. Front Immunol. 2021 Jul 13;12:694217.</br>[15]. Liu C, Cheung WH, Li J, Chow SK, Yu J, Wong SH, Ip M, Sung JJY, Wong RMY. Understanding the gut microbiota and sarcopenia: a systematic review. J Cachexia Sarcopenia Muscle. 2021 Dec;12(6):1393-1407.</br>[16]. 周艳艳,赵旭兰,张世阳,等. 抗阻力运动结合营养干预对老年肌少症患者的影响[J]. 中国医药导报,2023,20(19):100-103. </br>[17]. Li Y, Zhu B, Shen J, Miao L. Depression in maintenance hemodialysis patients: What do we need to know? Heliyon. 2023 Aug 24;9(9):e19383.</br>[18]. Alli SR, Gorbovskaya I, Liu JCW, Kolla NJ, Brown L, Müller DJ. The Gut Microbiome in Depression and Potential Benefit of Prebiotics, Probiotics and Synbiotics: A Systematic Review of Clinical Trials and Observational Studies. Int J Mol Sci. 2022 Apr 19;23(9):4494.</br>
