Medical Sciences Graduation Program, Federal University Fluminense, Niterói, Brazil.
Nutrition. 2011 Nov-Dec;27(11-12):1125-9. doi: 10.1016/j.nut.2010.12.012. Epub 2011 Mar 30.
To evaluate muscle function (MF) of patients on hemodialysis (HD) and to investigate the dialysis determinants of maximal voluntary handgrip strength (HGS).
Forty-three patients on HD (25 men, six diabetics, 54.5 ± 12.2 y of age, 62.2 ± 51.4 mo on dialysis) were studied. HGS was measured three times with a mechanical dynamometer (Jamar) before and after HD sessions on the non-fistula side and the highest value was used for analysis. HGS values lower than the 10th percentile of an age-, gender-, and region-specific reference were considered MF loss. Biochemical and dialysis variables (ultrafiltration, interdialytic body weight gain, urea clearance, urea before and after HD, systolic and diastolic blood pressures before and after HD, and difference in systolic and diastolic blood pressures) were also examined.
The HGS values before and after HD values were significantly higher in men but were not statistically different before and after the HD sessions (29.8 ± 10.3 and 30.2 ± 9.9 kg for men, 14.1 ± 7.0 and 14.5 ± 6.3 kg for women). MF loss was observed in 24 patients (55.8%), 12 women and 12 men. Dialysis variables were not different between patients with and without MF loss and did not correlate with HGS measured before or after an HD session.
Patients using HD presented a high prevalence of MF loss as assessed by HGS, and it was not influenced by dialysis variables. HGS may be used as a reliable nutritional marker in HD, measured before or after HD sessions.
评估血液透析（HD）患者的肌肉功能（MF），并探讨透析对最大自主握力（HGS）的影响。
本研究纳入了 43 名接受 HD 治疗的患者（25 名男性，6 名糖尿病患者，年龄 54.5±12.2 岁，透析时间 62.2±51.4 个月）。使用机械测力计（Jamar）在 HD 治疗前后分别测量非造瘘侧的 HGS 3 次，取最高值进行分析。HGS 值低于年龄、性别和地区特异性参考值第 10 百分位数被认为是 MF 损失。还检查了生化和透析变量（超滤量、透析间体重增加、尿素清除率、透析前后尿素值、透析前后收缩压和舒张压、收缩压和舒张压差值）。
男性患者的 HGS 值在 HD 治疗前后均显著升高，但在 HD 治疗前后并无统计学差异（男性分别为 29.8±10.3kg 和 30.2±9.9kg，女性分别为 14.1±7.0kg 和 14.5±6.3kg）。24 名患者（55.8%）出现 MF 损失，其中包括 12 名女性和 12 名男性。MF 损失患者和无 MF 损失患者的透析变量无差异，且与 HD 治疗前后的 HGS 值均无相关性。
使用 HD 治疗的患者中，MF 损失的发生率较高，通过 HGS 评估，MF 损失不受透析变量的影响。HGS 可作为 HD 患者可靠的营养标志物，可在 HD 治疗前后进行测量。
