维持性血液透析患者骨骼肌减少与生活质量和心理状况的关系
|
摘要
目的调查维持性血液透析(MHD)患者骨骼肌减少症(以下简称肌少症)、生活质量及心理状况的现状,探讨患者肌少症与其生活质量、心理状况的关系。方法根据欧洲老年肌少症工作组制订的诊断标准将2017年12月在我院接收治疗的101例MHD患者分为肌少症组(51例)和无肌少症组(50例)。所有入组患者均应用人体成分分析仪进行人体成分测量,用SF-36简明健康量表进行生活质量评估,用医院焦虑和抑郁量表(HADS)进行焦虑和抑郁情况评估。采用多元线性回归分析探讨MHD患者肌少症与其生活质量、心理状况的关系。结果两组患者在年龄、性别、体质量指数(BMI)、Charlson合并症指数、握力、行走速度、体细胞质量、细胞外水分率(ECF/TBF)、高敏C-反应蛋白(hsCRP)、尿素清除指数(Kt/V)、焦虑、抑郁、生理功能、躯体疼痛、一般健康状况和精神健康方面的差异均有统计学意义(P<0.05,P<0.01),而在婚姻状况、受教育程度、年收入、透析龄、原发病、血红蛋白、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、前白蛋白、白蛋白、血钙、血磷、全段甲状旁腺激素、生理职能、精力、社会功能、情感职能方面的差异均无统计学意义(P均>0.05)。多元线性回归分析结果显示,骨骼肌质量、婚姻状况、合并症是伴肌少症MHD患者生活质量的影响因素(P均<0.05),而骨骼肌质量、BMI、年收入是伴肌少症MHD患者心理状况的影响因素(P<0.05,P<0.01)。结论 MHD患者中肌少症发病率较高。肌少症与较差的生活质量以及焦虑、抑郁症状之间有相关性,突出了早期发现并重视肌少症的重要性。
Objective To investigate the current status of skeletal muscle reduction(abbreviated as sarcopenia),quality of life and mental status of maintenance dialysis(MHD) patients, and to explore the relationship between sarcopenia and the quality of life and mental status. Methods According to the diagnostic criteria developed by the European Working Group on Sarcopenia in Older People, 101 MHD patients treated in our hospital in Dec, 2017 were divided into sarcopenia group(n=51) and non-sarcopenia group(n=50). The body composition was measured by human body composition monitor in all the patients. The quality of life was assessed using the SF-36 scale. The anxiety and depression were assessed with the hospital anxiety and depression scale(HADS). Multivariate linear regression analysis was used to explore the relationship between sarcopenia and the quality of life and mental status of the MHD patients. Results There were significant differences in the age, gender, body mass index(BMI), Charlson comorbidity index, grip strength, walking speed, somatic cell mass,extra-cellular fluid/total body fluid ratio(ECF/TBF), high-sensitivity C-reactive protein(hsCRP), urea clearance index(Kt/V), anxiety, depression, physical function, bodily pain, general health status and mental health between the two groups(P<0.05, P<0.01). While there were no significant differences in the marital status, education, annual income,dialysis age, primary disease, hemoglobin, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein,prealbumin, albumin, serum calcium, blood phosphorus, intact parathyroid hormone, physical role, vitality, social function and emotion role between the two groups(all P>0.05). Multivariate linear regression analysis showed that skeletal muscle mass, marital status and comorbidity were the influencing factors of the quality of life of MHD patients with sarcopenia(all P<0.05), and skeletal muscle mass, BMI and annual income were the influencing factors of mental status of MHD patients with sarcopenia(P<0.05, P<0.01). Conclusion The incidence of sarcopenia is high in MHD patients. Sarcopenia is related to poor quality of life, and anxiety and depressive symptoms, highlighting the importance of early detection and attention to sarcopenia.
Objective To investigate the current status of skeletal muscle reduction(abbreviated as sarcopenia),quality of life and mental status of maintenance dialysis(MHD) patients, and to explore the relationship between sarcopenia and the quality of life and mental status. Methods According to the diagnostic criteria developed by the European Working Group on Sarcopenia in Older People, 101 MHD patients treated in our hospital in Dec, 2017 were divided into sarcopenia group(n=51) and non-sarcopenia group(n=50). The body composition was measured by human body composition monitor in all the patients. The quality of life was assessed using the SF-36 scale. The anxiety and depression were assessed with the hospital anxiety and depression scale(HADS). Multivariate linear regression analysis was used to explore the relationship between sarcopenia and the quality of life and mental status of the MHD patients. Results There were significant differences in the age, gender, body mass index(BMI), Charlson comorbidity index, grip strength, walking speed, somatic cell mass,extra-cellular fluid/total body fluid ratio(ECF/TBF), high-sensitivity C-reactive protein(hsCRP), urea clearance index(Kt/V), anxiety, depression, physical function, bodily pain, general health status and mental health between the two groups(P<0.05, P<0.01). While there were no significant differences in the marital status, education, annual income,dialysis age, primary disease, hemoglobin, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein,prealbumin, albumin, serum calcium, blood phosphorus, intact parathyroid hormone, physical role, vitality, social function and emotion role between the two groups(all P>0.05). Multivariate linear regression analysis showed that skeletal muscle mass, marital status and comorbidity were the influencing factors of the quality of life of MHD patients with sarcopenia(all P<0.05), and skeletal muscle mass, BMI and annual income were the influencing factors of mental status of MHD patients with sarcopenia(P<0.05, P<0.01). Conclusion The incidence of sarcopenia is high in MHD patients. Sarcopenia is related to poor quality of life, and anxiety and depressive symptoms, highlighting the importance of early detection and attention to sarcopenia.
引文
[1]CRUZ-JENTOFT A J,BAEYENS J P,BAUER J MBOIRIE Y,CEDERHOLM T,LANDI F,et al;European Working Group on Sarcopenia in Older People.Sarcopenia:European consensus on definition and diagnosis:report of the European Working Group on Sarcopenia in Older People[J].Age Ageing,2010,39:412-423.
[2]任红旗,龚德华.尿毒症肌少症的发病机制和治疗[J].肾脏病与透析肾移植杂志,2015,24:181-185.
[3]LAMARCA F,CARRERO J J,RODRIGUES J C,BIGOGNO F G,FETTER R L,AVESANI C M.Prevalence of sarcophagi in elderly maintenance dialysis patients:the impact of different diagnostic criteria[J].JNutr Health Aging,2014,18:710-717.
[4]NORDIC M,LIMIDO A,MAGGIORE U,NICHELATTIM,POSTORINO M,QUINTALIANI G;Italian Dialysis and Transplantation Registry.Survival in patients treated by long-term dialysis compared with the general population[J].Am J Kidney Dis,2012,59:819-828.
[5]GEWANDTER J S,DALE W,MAGNUSON A,PANDYA C,HECKLER C E,LEMELMAN T,et al.Associations between a patient-reported outcome(PRO)measure of sarcophagi and falls,functional status,and physical performance in older patients with cancer[J].JGeriatr Oncol,2015,6:433-441.
[6]CRUZ-JENTOFT A J,BAHAT G,BAUER J,BOIRIEY,BRUY?RE O,CEDERHOLM T,et al;Writing Group for the European Working Group on Sarcopenia in Older People 2(EWGSOP2),and the Extended Group for EWGSOP2.Sarcophagi:revised European consensus on definition and diagnosis[J].Age Ageing,2019,48:16-31.
[7]何燕,赵龙超,刘丹萍,李宁秀.SF-36和SF-12在人群生命质量调查中的性能比较研究[J].现代预防医学,2017,44:852-862.
[8]NIPP R D,FUCHS G,EL-JAWAHRI A,MARIO J,TROSCHEL F M,GREER J A,et al.Sarcophagi is associated with quality of life and depression in patients with advanced cancer[J].Oncologist,2018,23:97-104.
[9]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[J].Ren Fail,2016,38:364-371.
[10]KIM J K,CHOI S R,CHOI M J,KIM S G,LEE Y K,NOH J W,et al.Prevalence of and factors associated with sarcophagi in elderly patients with end-stage renal disease[J].Clin Nutr,2014,33:64-68.
[11]IDA S,MURATA K,NAKAI M,ITO S,MALMSTROMT K,ISHIHARA Y,et al.Relationship between sarcophagi and depression in older patients with diabetes:an investigation using the Japanese version of SARC-F[J]Geriatr Gerontol Int,2018,18:1318-1322.
[12]KAHL K G,UTANIR F,SCHWEIGER U,KR?GER T H,FRIELING H,BLEICH S,et al.Reduced muscle mass in middle-aged depressed patients is associated with male gender and chronically[J].Prog Neuropsychopharmacol Biol Psychiatry,2017,76:58-64.
[13]DIEL P.The role of the estrogen receptor in skeletal muscle mass homeostasis and regeneration[J].Acta Physiol(Oxf),2014,212:14-16.
[14]LU H,LEI X,KLAASSEN C.Gender differences in renal nuclear receptors and aryl hydrocarbon receptor in 5/6nephrectomized rats[J].Kidney Int,2006,70:1920-1928.
[15]KANG S Y,LIM J,PARK H S.Relationship between low handgrip strength and quality of life in Korean men and women[J].Qual Life Res,2018,27:2571-2580.
[16]TSEKOURA M,KASTRINIS A,KATSOULAKI M,BILLIS E,GLIATIS J.Sarcophagi and its impact on quality of life[J].Adv Exp Med Biol,2017,987:213-218.
[17]MANRIQUE-ESPINOZA B,SALINAS-RODR?GUEZA,ROSAS-CARRASCO O,GUTI?RREZ-ROBLEDOL M,AVILA-FUNES J A.Sarcophagi is associated with physical and mental components of health-related quality of life in older adults[J/OL].J Am Med Dir Assoc,2017,18:636.e1-636.e5.doi:10.1016/j.jamda.2017.04.005.
[18]HUS Y H,LIANG C K,CHOU M Y,LIAO M C,LIN YT,CHEN L K,et al.Association of cognitive impairment depressive symptoms and sarcophagi among healthy older men in the veterans retirement community in southern Taiwan:a correctional study[J].Geriatr Gerontol Int,2014,14(Suppl 1):102-108.
[19]ALSTON H,BURNS A,DAVENPORT A.Loss of appendicitis muscle mass in dialysis patients is associated with increased self-reported depression,anxiety and lower general health scores[J].Nephrology(Carlton),2018,23:546-551.
[20]SOARES J D P,GOMES T L N,SIQUEIRA J M,OLIVEIRA I C L,MOTA J F,LAVIANO A,et al.Muscle function loss is associated with anxiety in patients with gastrointestinal cancer[J].Clin Nutr ESPEN,2019,29:149-153.
[21]AGUDELO L Z,FEMEN?A T,ORHAN F,PORSMYR-PALMERTZ M,GOINY M,MARTINEZ-REDONDOV,et al.Skeletal muscle PGC-1α1 modulates Karenina metabolism and mediates resilience to stress-induced depression[J].Cell,2014,159:33-45.
[22]BYEON C H,KANG K Y,KANG S H,KIM H K,BAE E J.Sarcophagi is not associated with depression in Korean adults:results from the 2010-2011 Korean national health and nutrition examination survey[J].Korean J Fam Med,2016,37:37-43.
[23]KALYANI R R,CORRIERE M,FERRUCCI L.Agerelated and disease-related muscle loss:the effect of diabetes,obesity,and other diseases[J].Lancet Diabetes Endocrinol,2014,2:819-829.
[24]STEPHAN Y,SUTIN A R,TERRACCIANO A.Younger subjective age is associated with lower C-reactive protein among older adults[J].Brain Behav Immun,2015,43:33-36.
[2]任红旗,龚德华.尿毒症肌少症的发病机制和治疗[J].肾脏病与透析肾移植杂志,2015,24:181-185.
[3]LAMARCA F,CARRERO J J,RODRIGUES J C,BIGOGNO F G,FETTER R L,AVESANI C M.Prevalence of sarcophagi in elderly maintenance dialysis patients:the impact of different diagnostic criteria[J].JNutr Health Aging,2014,18:710-717.
[4]NORDIC M,LIMIDO A,MAGGIORE U,NICHELATTIM,POSTORINO M,QUINTALIANI G;Italian Dialysis and Transplantation Registry.Survival in patients treated by long-term dialysis compared with the general population[J].Am J Kidney Dis,2012,59:819-828.
[5]GEWANDTER J S,DALE W,MAGNUSON A,PANDYA C,HECKLER C E,LEMELMAN T,et al.Associations between a patient-reported outcome(PRO)measure of sarcophagi and falls,functional status,and physical performance in older patients with cancer[J].JGeriatr Oncol,2015,6:433-441.
[6]CRUZ-JENTOFT A J,BAHAT G,BAUER J,BOIRIEY,BRUY?RE O,CEDERHOLM T,et al;Writing Group for the European Working Group on Sarcopenia in Older People 2(EWGSOP2),and the Extended Group for EWGSOP2.Sarcophagi:revised European consensus on definition and diagnosis[J].Age Ageing,2019,48:16-31.
[7]何燕,赵龙超,刘丹萍,李宁秀.SF-36和SF-12在人群生命质量调查中的性能比较研究[J].现代预防医学,2017,44:852-862.
[8]NIPP R D,FUCHS G,EL-JAWAHRI A,MARIO J,TROSCHEL F M,GREER J A,et al.Sarcophagi is associated with quality of life and depression in patients with advanced cancer[J].Oncologist,2018,23:97-104.
[9]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[J].Ren Fail,2016,38:364-371.
[10]KIM J K,CHOI S R,CHOI M J,KIM S G,LEE Y K,NOH J W,et al.Prevalence of and factors associated with sarcophagi in elderly patients with end-stage renal disease[J].Clin Nutr,2014,33:64-68.
[11]IDA S,MURATA K,NAKAI M,ITO S,MALMSTROMT K,ISHIHARA Y,et al.Relationship between sarcophagi and depression in older patients with diabetes:an investigation using the Japanese version of SARC-F[J]Geriatr Gerontol Int,2018,18:1318-1322.
[12]KAHL K G,UTANIR F,SCHWEIGER U,KR?GER T H,FRIELING H,BLEICH S,et al.Reduced muscle mass in middle-aged depressed patients is associated with male gender and chronically[J].Prog Neuropsychopharmacol Biol Psychiatry,2017,76:58-64.
[13]DIEL P.The role of the estrogen receptor in skeletal muscle mass homeostasis and regeneration[J].Acta Physiol(Oxf),2014,212:14-16.
[14]LU H,LEI X,KLAASSEN C.Gender differences in renal nuclear receptors and aryl hydrocarbon receptor in 5/6nephrectomized rats[J].Kidney Int,2006,70:1920-1928.
[15]KANG S Y,LIM J,PARK H S.Relationship between low handgrip strength and quality of life in Korean men and women[J].Qual Life Res,2018,27:2571-2580.
[16]TSEKOURA M,KASTRINIS A,KATSOULAKI M,BILLIS E,GLIATIS J.Sarcophagi and its impact on quality of life[J].Adv Exp Med Biol,2017,987:213-218.
[17]MANRIQUE-ESPINOZA B,SALINAS-RODR?GUEZA,ROSAS-CARRASCO O,GUTI?RREZ-ROBLEDOL M,AVILA-FUNES J A.Sarcophagi is associated with physical and mental components of health-related quality of life in older adults[J/OL].J Am Med Dir Assoc,2017,18:636.e1-636.e5.doi:10.1016/j.jamda.2017.04.005.
[18]HUS Y H,LIANG C K,CHOU M Y,LIAO M C,LIN YT,CHEN L K,et al.Association of cognitive impairment depressive symptoms and sarcophagi among healthy older men in the veterans retirement community in southern Taiwan:a correctional study[J].Geriatr Gerontol Int,2014,14(Suppl 1):102-108.
[19]ALSTON H,BURNS A,DAVENPORT A.Loss of appendicitis muscle mass in dialysis patients is associated with increased self-reported depression,anxiety and lower general health scores[J].Nephrology(Carlton),2018,23:546-551.
[20]SOARES J D P,GOMES T L N,SIQUEIRA J M,OLIVEIRA I C L,MOTA J F,LAVIANO A,et al.Muscle function loss is associated with anxiety in patients with gastrointestinal cancer[J].Clin Nutr ESPEN,2019,29:149-153.
[21]AGUDELO L Z,FEMEN?A T,ORHAN F,PORSMYR-PALMERTZ M,GOINY M,MARTINEZ-REDONDOV,et al.Skeletal muscle PGC-1α1 modulates Karenina metabolism and mediates resilience to stress-induced depression[J].Cell,2014,159:33-45.
[22]BYEON C H,KANG K Y,KANG S H,KIM H K,BAE E J.Sarcophagi is not associated with depression in Korean adults:results from the 2010-2011 Korean national health and nutrition examination survey[J].Korean J Fam Med,2016,37:37-43.
[23]KALYANI R R,CORRIERE M,FERRUCCI L.Agerelated and disease-related muscle loss:the effect of diabetes,obesity,and other diseases[J].Lancet Diabetes Endocrinol,2014,2:819-829.
[24]STEPHAN Y,SUTIN A R,TERRACCIANO A.Younger subjective age is associated with lower C-reactive protein among older adults[J].Brain Behav Immun,2015,43:33-36.