小腿围在评估维持性血液透析患者骨骼肌质量下降中的效果研究

doi:10.3761/j.issn.0254-1769.2021.08.011

摘要/Abstract

摘要：

目的探讨维持性血液透析患者小腿围与骨骼肌质量指数、握力、步速的关系,分析小腿围在评估肌少症中的效果,为护理人员筛查维持性血液透析患者肌少症高危人群提供参考。方法 2020年5月—9月,采用便利抽样法,选取江苏省连云港市和徐州市2所三级甲等医院的613例维持性血液透析患者进行横断面研究,其中男379例,女234例。采用生物电阻抗法测量患者的骨骼肌质量指数,并进行握力、步速、小腿围等指标的测量。分析小腿围与骨骼肌质量指数、握力、步速之间的关系,采用受试者工作特征曲线得出小腿围的最佳截断值。结果小腿围与骨骼肌质量指数、握力、步速呈正相关。小腿围与骨骼肌质量下降的受试者工作特征曲线显示,男性小腿围的最佳截断值为32.7 cm（曲线下面积为0.909,灵敏度为0.889,特异度为0.799）;女性小腿围的最佳截断值为30.2 cm（曲线下面积为0.837,灵敏度为0.744,特异度为0.808）。小腿围与肌少症的受试者工作特征曲线显示,男性小腿围的最佳截断值为32.7 cm（曲线下面积为0.889,灵敏度为0.907,特异度为0.745）;女性小腿围的最佳截断值为29.7 cm（曲线下面积为0.844,灵敏度为0.766,特异度为0.797）。结论维持性血液透析患者小腿围与骨骼肌质量指数、握力、步速均呈正相关,当男性<32.7 cm,女性<29.7 cm时,提示患者有可能存在骨骼肌质量下降及发生肌少症,护理人员可通过测量小腿围筛查维持性血液透析患者肌少症高危人群,早期采取预防性干预措施。

关键词: 维持性血液透析, 肌少症, 骨骼肌质量, 小腿围, 护理

Abstract:

Objective To explore the relationship between calf circumference and skeletal muscle index（SMI）,handgrip strength,and usual gait speed in maintenance hemodialysis（MHD） patients,and to investigate the effect of calf circumference in the evaluation and diagnosis of sarcopenia. Methods A cross-sectional study was conducted in 613 MHD patients（379 men and 234 women）from 2 tertiary hospitals in Lianyungang city and Xuzhou city,Jiangsu Province by the convenience sampling method. The SMI of the patients was measured by bioelectrical impedance analysis,and the indicators such as handgrip strength,usual gait speed and calf circumference were measured. The correlation between calf circumference and SMI,handgrip strength,and usual gait speed was analyzed. The area under the receiver operating characteristic curves（AUC） was used to test the accuracy of calf circumference to predict decreased skeletal muscle mass（DSMM）,low muscle strength,low physical performance and to diagnose sarcopenia. Results The calf circumference of MHD patients was positively correlated with SMI,handgrip strength,and usual gait speed. The optimal cut-off values of calf circumference for predicting DSMM were 32.7 cm（with the AUC of 0.909,the sensitivity of 0.889,the specificity of 0.799） in men and 30.2 cm（with the AUC of 0.837,the sensitivity of 0.744,the specificity of 0.808） in women. The optimal cut-off values of calf circumference for predicting sarcopenia were 32.7 cm（with the AUC of 0.889,the sensitivity of 0.907,the specificity of 0.745）in men and 29.7 cm （with the AUC of 0.844,the sensitivity of 0.766,the specificity of 0.797） in women. Conclusion Calf circumference is positively correlated with SMI,handgrip strength,and usual gait speed. When the calf circumference is less than 32.7 cm in men and 29.7 cm in women,it indicates that the patients are very likely to suffer from DSMM and sarcopenia.

Key words: Maintenance Hemodialysis, Sarcopenia, Skeletal Muscle Mass, Calf Circumference, Nursing Care

杜晓菊,张海林,尹丽霞,陈管洁,李晓亮,王政灵雪,郭桂,周起帆. 小腿围在评估维持性血液透析患者骨骼肌质量下降中的效果研究[J]. 中华护理杂志, 2021, 56(8): 1187-1192.

DU Xiaoju,ZHANG Hailin,YIN Lixia,CHEN Guanjie,LI Xiaoliang,WANG Zhenglingxue,GUO Gui,ZHOU Qifan. Application of calf circumference in evaluating decreased skeletal muscle mass in maintenance hemodialysis patients[J]. Chinese Journal of Nursing, 2021, 56(8): 1187-1192.

图/表 5

表1 不同性别维持性血液透析患者一般资料、小腿围、握力等指标的比较

Table 1 Comparison of general data,calf circumference,handgrip strength and other indicators of maintenance hemodialysis patients of different sex

表2 男性骨骼肌质量下降组与非骨骼肌质量下降组、肌少症组与非肌少症组一般资料、小腿围、握力等指标的比较

Table 2 Comparison of general data,calf circumference,handgrip strength,and other indicators in men with DSMM group and non-DSMM group,sarcopenia group and non-sarcopenia group.

表3 女性骨骼肌质量下降组与非骨骼肌质量下降组、肌少症组与非肌少症组一般资料、小腿围、握力等指标的比较

Table 3 Comparison of general data, calf circumference, handgrip strength, and other indicators in women with DSMM group and non-DSMM group, sarcopenia group and non-sarcopenia group.

表4 维持性血液透析患者小腿围与其他指标的相关性

Table 4 Correlation between calf circumference and clinical indicators in maintenance hemodialysis patients

表5 小腿围评估维持性血液透析患者肌少症的受试者工作特征曲线值

Table 5 The receiver operating characteristic curve of calf circumference predicting the sarcopenia in maintenance hemodialysis patients

参考文献 20

[1]	Fahal IH. Uraemic sarcopenia:aetiology and implications[J]. Ne-phrol Dial Transplant, 2014, 29(9):1655-1665.
[2]	Hendriks FK, Smeets JSJ, Broers NJH, et al. End-stage renal di-sease patients lose a substantial amount of amino acids during hemodialysis[J]. J Nutr, 2020, 150(5):1160-1166. DOI PMID
[3]	Mori K, Nishide K, Okuno S, et al. Impact of diabetes on sarco-penia and mortality in patients undergoing hemodialysis[J]. BMC Nephrol, 2019, 20(1):105. DOI URL
[4]	Lamarca F, Carrero JJ, Rodrigues JCD, et al. Prevalence of sarcopenia in elderly maintenance hemodialysis patients:the impact of different diagnostic criteria[J]. J Nutr Heal Aging, 2014, 18(7):710-717.
[5]	Kim JK, Kim SG, Oh JE, et al. Impact of sarcopenia on long-term mortality and cardiovascular events in patients undergoing hemodialysis[J]. Korean J Intern Med, 2019, 34(3):599-607. DOI URL
[6]	Giglio J, Kamimura MA, Lamarca F, et al. Association of sarcopenia with nutritional parameters,quality of life,hospitalization,and mortality rates of elderly patients on hemodialysis[J]. J Ren Nutr, 2018, 28(3):197-207. DOI URL
[7]	Chen LK, Woo J, Assantachai P, 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. DOI URL
[8]	高雅靖, 单岩, 杜理平, 等. 终末期肾脏病患者肌少症的研究进展[J]. 中华护理杂志, 2019, 54(9):1423-1426.
	Gao YJ, Shan Y, Du LP, et al. Research progress on sarcopenia in end-stage renal disease patients[J]. Chin J Nurs, 2019, 54(9):1423-1426.
[9]	Chen CY, Tseng WC, Yang YH, et al. Calf circumference as an optimal choice of four screening tools for sarcopenia among ethnic chinese older adults in assisted living[J]. Clin Interv Aging, 2020, 15:2415-2422. DOI URL
[10]	Kawakami R, Miyachi M, Sawada SS, et al. Cut-offs for calf circumference as a screening tool for low muscle mass:Waseda’s health study[J]. Geriatr Gerontol Int, 2020, 20(10):943-950. DOI PMID
[11]	Pauzi FA, Sahathevan S, Khor BH, et al. Exploring metabolic signature of protein energy wasting in hemodialysis patients[J]. Metabolites, 2020, 10(7):291. DOI URL
[12]	Battaglia Y, Ullo I, Massarenti S, et al. Ultrasonography of quadriceps femoris muscle and subcutaneous fat tissue and body composition by biva in chronic dialysis patients[J]. Nutrients, 2020, 12(5):1388. DOI URL
[13]	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(9):20-24.
	Dong ZJ, Zhang HL. Risk factors associated with sarcopenia among patients on maintenance hemodialysis[J]. J Nurs Sci, 2018, 33(9):20-24.
[14]	Bossola M, Tazza L. Postdialysis fatigue:a frequent and debilitating symptom[J]. Semin Dial, 2016, 29(3):222-227. DOI URL
[15]	王思远, 高敏, 赵岳. 中文版慢性病治疗功能评估-疲劳量表在维持性血液透析患者中的信效度评定[J]. 中华护理杂志, 2014, 49(5):613-617.
	Wang SY, Gao M, Zhao Y. Reliability and validity of Chinese version of the Function Assessment of Chronic Illness Therapy-Fatigue(FACIT-F)in patients undergoing maintenance hemodialysis[J]. Chin J Nurs, 2014, 49(5):613-617.
[16]	Nishikawa H, Yoh K, Enomoto H, et al. Calf circumference as a useful predictor of sarcopenia in patients with liver diseases[J]. In Vivo, 2020, 34(5):2561-2569. DOI PMID
[17]	Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia:revised European consensus on definition and diagnosis[J]. Age Ageing, 2019, 48(1):16-31. DOI PMID
[18]	Lear SA, Humphries KH, Kohli S, et al. Visceral adipose tissue accumulation differs according to ethnic background:results of the multicultural community health assessment trial(M-CHAT)[J]. Am J Clin Nutr, 2007, 86(2):353-359. DOI URL
[19]	邢焕民, 吕冬梅, 王晓慧, 等. 术后谵妄风险预测模型的构建及应用[J]. 中华护理杂志, 2019, 54(1):8-13.
	Xing HM, Lü DM, Wang XH, et al. The development and application of a risk prediction model for postoperative delirium in ICU patients[J]. Chin J Nurs, 2019, 54(1):8-13.
[20]	Schorr M, Dichtel LE, Gerweck AV, et al. Sex differences in body composition and association with cardiometabolic risk[J]. Biol Sex Differ, 2018, 9(1):28. DOI URL