Correlation of skeletal muscle mass index with nutritional indexes in hemodialysis patients
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摘要:目的 探讨骨骼肌质量指数（SMI）与营养指标的关联以及其在诊断营养不良中的作用。方法 纳入84例维持性血液透析（MHD）患者，根据SMI分为低SMI组26例和正常SMI组58例。分析2组人体成分数据和生化指标；采用主观全面评估（SGA）对患者进行营养评分。结果 84例MHD患者营养不良28例，营养状态良好56例。低SMI组营养不良23例，正常SMI组营养不良5例。低SMI组营养不良发生率为88.46%，高于正常SMI组的8.62%，差异有统计学意义（P < 0.05）；相关分析发现SMI与蛋白质、肌肉量（SLM）、去脂体质量（FFM）、骨骼肌（SMM）、身体细胞量（BCM）、基础代谢率（BMR）、去脂体质量指数等营养指标呈正相关（P < 0.05）；受试者工作特征（ROC）曲线分析显示，SMI对营养不良诊断的曲线下面积为0.9，SMI用于诊断营养不良具有统计学意义（P < 0.05）。结论 SMI与主要营养指标呈正相关，并可用于营养不良的诊断。Abstract:Objective To investigate the relationship between skeletal muscle mass index (SMI) and nutritional indicators and its role in the diagnosis of malnutrition.Methods A total of 84 maintenance hemodialysis(MHD)patients were enrolled and divided into low SMI group (n=26) and normal SMI group (n=58) according to SMI. The body composition data and biochemical indexes of the two groups were analyzed. Patients were evaluated by subjective global assessment (SGA).Results Among 84 MHD patients, 28 were malnourished and 56 were in good nutritional state. There were 23 cases of malnutrition in the low SMI group and 5 cases in the normal SMI group. The incidence of malnutrition in the low SMI group was 88.46%, which was significantly higher than 8.62% in the normal SMI group (P < 0.05). Correlation analysis showed that SMI was positively correlated with protein, soft lean mass (SLM), fat-free mass (FFM), skeletal muscle mass (SMM), body cell mass (BCM), basal metabolic rate (BMR), fat-free mass index (P < 0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve for the diagnosis of malnutrition by SMI was 0.9. SMI used to diagnose malnutrition had statistically significant difference (P < 0.05).Conclusion SMI is positively correlated with major nutritional indicators and can be used for the diagnosis of malnutrition.
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表 1 2组MHD患者营养相关指标比较(x±s)[n(%)]
指标 正常SMI组(n=58) 低SMI组(n=26) 年龄/岁 51.05±11.75 65.73±11.84* 身高/cm 164.48±8.14 158.34±8.27* 体质量/kg 66.25±13.00 50.42±9.01* 蛋白质/kg 9.82±1.89 7.37±1.43* 矿物质/kg 3.38±0.70 2.73±0.49* 体脂/kg 15.91±8.15 12.24±4.70* SLM/kg 47.57±9.06 35.90±6.87* FFM/kg 50.34±9.62 38.18±7.22* SMM/kg 27.65±5.67 20.17±4.35* PBF/% 23.44±8.68 24.03±7.72 BMI/(kg/m2) 24.34±3.71 19.95±2.13* ECW/TBW 0.38±0.01 0.39±0.01* BCM/kg 32.56±6.24 24.36±4.77* BMC/kg 2.77±0.59 2.28±0.39* AC/cm 30.85±3.68 26.58±2.61* AMC/cm 25.99±2.91 22.16±2.13* WC/cm 82.77±12.49 77.63±11.17 VFA/cm2 74.56±41.12 67.71±32.85 BMR/kcal 1 457.38±207.99 1 194.81±155.92* PA 5.62±1.09 4.75±1.16* ALB/(g/L) 40.23±6.41 36.14±4.35* PAB/(mg/L) 364.34±78.80 300.20±107.61* Hb/(g/L) 104.00±26.81 101.12±24.80 营养不良 5(8.62) 23(88.46)* SLM: 肌肉量; FFM: 去脂体重; SMM: 骨骼肌;
PBF: 体脂百分比; BMI: 身体质量指数;
ECW/TBW: 水分比率; BCM: 身体细胞量;
BMC: 骨矿物质含量; AC: 上臂围; AMC: 上臂肌围;
WC: 腰围; VFA: 内脏脂肪面积; BMR: 基础代谢率;
PA: 相位角; ALB: 白蛋白; PAB: 前白蛋白; Hb: 血红蛋白。
与正常SMI组比较, *P < 0.05。
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