Exercise, Health and Performance Research Group, School of Biomedical and Health Sciences, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW 1797, Australia.
Nephrology (Carlton). 2010 Jun;15(4):454-63. doi: 10.1111/j.1440-1797.2009.01261.x.
A more precise understanding of the aetiology and sequelae of muscle wasting in end-stage renal disease (ESRD) is required for the development of effective interventions to target this pathology.
We investigated 49 patients with ESRD (62.6 +/- 14.2 years, 0.3-16.7 years on haemodialysis). Thigh muscle cross-sectional area (CSA), intramuscular lipid and intermuscular adipose tissue (IMAT) were measured via computed tomography as indices of muscle quantity (i.e. CSA) and quality (i.e. intramuscular lipid and IMAT). Additional health and clinical measures were investigated to determine associations with these variables.
Age, energy intake, disease burden, pro-inflammatory cytokines, nutritional status, strength and functioning were related to muscle quantity and quality. Potential aetiological factors entered into forward stepwise regression models indicated that hypoalbuminaemia and lower body mass index accounted significantly and independently for 32% of the variance in muscle CSA (r = 0.56, P < 0.001), while older age and interleukin-8 accounted for 41% of the variance in intramuscular lipid (r = 0.64, P < 0.001) and body mass index accounted for 45% of the variance in IMAT (r = 0.67, P < 0.001). Stepwise regression models revealed that intramuscular lipid was independently predictive of habitual gait velocity and 6 min walk distance, while CSA was independently predictive of maximal isometric strength (P < 0.05).
Ageing, poor nutritional status and elevated interleukin-8 are factors potentially contributing to the loss of muscle quality and quantity in ESRD. These deficits can predict functional impairments, with intramuscular lipid accumulation most closely related to decline of submaximal musculoskeletal performance (walking), and low muscle CSA most closely related to decline of maximal performance (peak isometric strength).
为了开发针对肌肉减少症的有效干预措施，需要更准确地了解终末期肾病（ESRD）中肌肉减少症的病因和后果。
我们调查了 49 名 ESRD 患者（62.6 +/- 14.2 岁，血液透析 0.3-16.7 年）。通过计算机断层扫描测量大腿肌肉横截面积（CSA）、肌肉内脂肪和肌肉间脂肪组织（IMAT），作为肌肉数量（即 CSA）和质量（即肌肉内脂肪和 IMAT）的指标。还研究了其他健康和临床指标，以确定与这些变量的关系。
年龄、能量摄入、疾病负担、促炎细胞因子、营养状况、力量和功能与肌肉数量和质量有关。向前逐步回归模型中的潜在病因因素表明，低白蛋白血症和低体重指数分别独立解释了肌肉 CSA 变化的 32%（r = 0.56，P < 0.001），而年龄较大和白细胞介素-8 分别解释了肌肉内脂肪变化的 41%（r = 0.64，P < 0.001）和体重指数变化的 45%（r = 0.67，P < 0.001）。逐步回归模型显示，肌肉内脂肪独立预测习惯性步态速度和 6 分钟步行距离，而 CSA 独立预测最大等长力量（P < 0.05）。
年龄增长、营养状况差和白细胞介素-8 升高是导致 ESRD 中肌肉质量和数量减少的潜在因素。这些缺陷可以预测功能障碍，肌肉内脂肪堆积与亚最大肌肉骨骼性能（步行）下降最密切相关，而 CSA 最低与最大性能（峰值等长力量）下降最密切相关。
