Division of Blood Purification, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan.
Nephrol Dial Transplant. 2011 Jun;26(6):1967-76. doi: 10.1093/ndt/gfq652. Epub 2010 Oct 27.
In haemodialysis (HD) patients, abdominal visceral fat is accumulated while lean body mass is decreased irrespective of their body mass indexes (BMI). However, it is poorly understood which changes of fat and muscle masses are more associated with changes of arteriosclerosis. We aimed at examining the associations of abdominal visceral fat and thigh muscle masses with markers of arteriosclerosis in chronic HD patients in a cross-sectional fashion.
We measured abdominal visceral fat mass area (AVFA), abdominal subcutaneous fat mass area (ASFA), thigh muscle area (TMA) and TMA standardized for femoral shaft area (TMA/FSA) by computed tomography (CT) in 161 HD patients (age: 61 ± 11 years, time on HD: 12 ± 10 years, male/female = 113/48, non-diabetes/diabetes = 127/34). We also investigated carotid artery intima-media thickness (CA-IMT) using the ultrasound instrument, and brachial-ankle pulse wave velocity (baPWV), cardio-ankle vascular index (CAVI) and ankle-brachial pressure index (ABI) using the waveform device (CAVI-VaSera VS-1000).
AVFA was significantly and positively related to CA-IMT in both non-diabetic (r = 0.23, P < 0.05) and diabetic HD patients (r = 0.38, P < 0.05). There was a significant and positive correlation between AVFA and hs-CRP in all patients (r = 0.26, P < 0.01). ASFA was also significantly correlated with CA-IMT (r = 0.53, P < 0.01) in diabetic HD patients. TMA/SFA ratio was negatively associated with CA-IMT (r = - 0.21, P < 0.05), while positively with ABI (r = 0.28, P < 0.01) in non-diabetic patients. TMA/SFA ratio was inversely related to baPWV (r = - 0.41, P < 0.01) and CAVI (r = - 0.41, P < 0.05) in diabetic HD patients. Multiple regression analysis revealed that AVFA was a significant determinant of CA-IMT. TMA/AFA was also significantly associated with CA-IMT, baPWV, CAVI and ABI.
Accumulated abdominal visceral fat is associated with CA-IMT. In addition, reduced thigh muscle mass area is independently related to CA-IMT, baPWV, CAVI and ABI, suggesting that sarcopenia in the leg is closely associated with systemic changes of arteriosclerosis in HD patients.
在血液透析（HD）患者中，无论其体重指数（BMI）如何，腹部内脏脂肪都会增加，而身体瘦肉量则会减少。然而，人们对哪些脂肪和肌肉量的变化与动脉硬化的变化关系更大还了解甚少。我们的目的是通过横断面研究检查腹部内脏脂肪和大腿肌肉量与慢性 HD 患者动脉硬化标志物之间的关系。
我们通过计算机断层扫描（CT）测量了 161 名 HD 患者的腹部内脏脂肪质量面积（AVFA）、腹部皮下脂肪质量面积（ASFA）、大腿肌肉面积（TMA）和股骨干区标准化的 TMA（TMA/FSA）（年龄：61±11 岁，HD 时间：12±10 年，男/女=113/48，非糖尿病/糖尿病=127/34）。我们还使用超声仪器测量颈动脉内膜中层厚度（CA-IMT），使用波形仪测量肱踝脉搏波速度（baPWV）、心踝血管指数（CAVI）和踝臂血压指数（ABI）。
在非糖尿病（r=0.23，P<0.05）和糖尿病 HD 患者中（r=0.38，P<0.05），AVFA 与 CA-IMT 显著正相关。在所有患者中，AVFA 与 hs-CRP 呈显著正相关（r=0.26，P<0.01）。ASFA 与糖尿病 HD 患者的 CA-IMT 也呈显著相关（r=0.53，P<0.01）。TMA/SFA 比值与 CA-IMT 呈负相关（r=-0.21，P<0.05），与非糖尿病患者的 ABI 呈正相关（r=0.28，P<0.01）。在糖尿病 HD 患者中，TMA/SFA 比值与 baPWV（r=-0.41，P<0.01）和 CAVI（r=-0.41，P<0.05）呈负相关。多元回归分析显示，AVFA 是 CA-IMT 的显著决定因素。TMA/AFA 与 CA-IMT、baPWV、CAVI 和 ABI 也显著相关。
腹部内脏脂肪堆积与 CA-IMT 有关。此外，大腿肌肉质量面积减少与 CA-IMT、baPWV、CAVI 和 ABI 独立相关，提示 HD 患者腿部的肌肉减少症与动脉硬化的全身变化密切相关。
