老年糖尿病肾病患者透析相关肌少症的危险因素分析与预后观察

Analysis of risk factors and prognosis of dialysis-related sarcopenia in elderly diabetic nephropathy patients

中文关键词: 老年  糖尿病肾病  透析  肌少症

英文关键词: elderly  diabetic kidney disease  dialysis  sarcopenia

中文摘要:

      目的 研究老年糖尿病肾病(DKD)患者透析后继发肌少症的危险因素及预后,为其防治提供依据.方法 回顾性收集2022年3月-2023年3月于青岛市胶州中心医院接受透析治疗的80例老年DKD患者的临床资料,依据老年DKD患者透析是否存在肌少症分为观察组(n=38)与对照组(n=42),观察组患者透析后继发肌少症,对照组透析后未继发肌少症.收集患者的临床资料,通过Logistic回归分析探讨老年DKD透析患者继发肌少症的危险因素,并构建预测模型,通过受试者工作特征(ROC)曲线分析预测模型效能,比较2组预后.结果 观察组营养不良发生率、糖尿病病程、透析龄、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、超敏C反应蛋白(HsCRP)水平均明显高于对照组,握力、步速、维生素D3及骨密度水平均显著低于对照组,差异均有统计学意义(P＜0.05);Logistic多因素回归分析发现,营养不良、糖尿病病程、FBG、HsCRP均为老年DKD透析患者继发肌少症的独立危险因素,而握力、步速、维生素D3及骨密度均为老年DKD透析患者继发肌少症的独立保护因素(P＜0.05);根据上述Logistic回归分析结果构建模型:LogitP=-22.161+0.159 ×营养不良+0.542 ×糖尿病病程+1.003 ×透析不充分-0.540 ×握力-4.587 ×步速+0.282 × FBG+0.508 × HbA1c+1.626 × HsCRP-0.889 ×维生素D3-5.394 ×骨密度,ROC曲线证实预测效能较佳(P＜0.05);随访结果提示,观察组跌倒、认知功能下降以及衰弱发生率均较对照组高(P＜0.05).结论 营养不良、糖尿病病程长及FBG、HsCRP水平异常升高的老年DKD透析患者的肌少症发生风险可能较高,而握力、步速、维生素D3及骨密度水平越高的老年DKD透析患者的肌少症发生风险可能较低,而肌少症发生风险越低,有利于降低不良预后发生风险.

英文摘要:

      Objective To study the risk factors and prognosis of sarcopenia secondary to hemodialysis in elderly patients with diabetes nephropathy(DKD),and provide evidence for its prevention and treatment.Methods The clinical data of 80 elderly patients with DKD who underwent hemodialysis in Jiaozhou Central Hospital from March 2022 to March 2023 were col-lected retrospectively.They were divided into observation group(n=38)and control group(n=42)according to whether they had dialysis-related sarcopenia.The observation group had secondary sarcopenia after dialysis,while the control group had no secondary sarcopenia.Logistic regression analysis was used to explore the risk factors for secondary sarcopenia in eld-erly DKD dialysis patients,and a prediction model was constructed.The performance of the prediction model was analyzed by receiver operating characteristic(ROC)curve.The prognosis of the two groups was compared.Results The incidence of malnutrition,diabetes course,dialysis age,and the levels of fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),and hypersensitive C-reactive protein(hs-CRP)of the observation group were significantly higher or longer than those of the control group,and the levels of grip strength,walking speed,vitamin D3 and bone mineral density were signifi-cantly lower than those of the control group,with statistical significance(P＜0.05).Multivariate Logistic regression analy-sis showed that malnutrition,diabetes course,FBG and hs-CRP were independent risk factors for secondary sarcopenia in eld-erly DKD dialysis patients,while grip strength,walking speed,vitamin D3 and bone mineral density were independent protec-tive factors for secondary sarcopenia(P＜0.05).According to the results of Logistic regression analysis,a model was con-structed:LogitP=-22.161+0.159 x malnutrition+0.542 × diabetes course+1.003 × inadequate dialysis-0.540 × grip strength-4.587 × walking speed+0.282 × FBG+0.508 × HbA1c+1.626 × HsCRP-0.889 × vitamin D3-5.394 × bone mineral density.The ROC curve confirmed that the predictive performance of the model was high(P＜0.05).The follow-up results indicated that the incidence of fall,cognitive function decline and frailty in the observation group were higher than those in the control group(P＜0.05).Conclusion The risk of sarcopenia may be higher in elderly DKD dialysis patients with mal-nutrition,long course of diabetes and abnormal elevated levels of FBG and hs-CRP,while elderly DKD dialysis patients with higher levels of grip strength,walking speed,vitamin D3 and bone mineral density may have a lower risk of sarcopenia.The lower the risk of sarcopenia,the more beneficial it is to reduce the risk of poor prognosis.