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

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