Department of Nephrology, 455th Hospital of People's Liberation Army, the Institute of Nephrology in Nanjing Military Command, Shanghai 200052, China. Email:
Department of Nephrology, 455th Hospital of People's Liberation Army, the Institute of Nephrology in Nanjing Military Command, Shanghai 200052, China.
Chin Med J (Engl). 2013;126(24):4612-7.
An accelerated muscle wasting was the pivotal factor for protein-energy wasting in end stage renal disease. However, very few researches have examined the skeletal muscle quantity and quality in clinical patients. This study investigated the muscle morphologic changes by magnetic resonance imaging (MRI) and analyzed the related factors in hemodialysis patients.
Fifty-eight patients receiving maintenance hemodialysis (HD) were investigated and 28 healthy adults with gender and age matched were used as controls (Control). Anthropometry, cytokine factors, and laboratory data were measured. The muscle and intermuscular adipose tissues (IMAT) were analyzed via a Thigh MRI. The bicep samples were observed after HE staining. Homeostatic model assessment of insulin resistance (HOMA-IR) was measured and their association with muscle wasting was analyzed.
HD patients tended to have a lower protein diet, anthropometry data, and serum albumin, but the C reactive protein and interleukin-6 increased significantly. The MRI showed that HD patients had less muscle mass and a lower muscle/total ratio, but the fat/muscle and IMAT was higher when compared to the Control group. The muscle fiber showed atrophy and fat accumulation in the biceps samples come from the HD patients. Moreover, we found that the HD patients presented with a high level of plasma fasting insulin and increased HOMA-IR which negatively correlated with the muscle/total ratio, but positively with the fat/muscle ratio.
Muscle wasting presented early before an obvious malnutrition condition emerged in HD patients. The main morphological change was muscle atrophy along with intermuscular lipid accumulation. Insulin resistance was associated with muscle wasting in dialysis patients.
在终末期肾病中，肌肉的加速消耗是导致蛋白质-能量消耗的关键因素。然而，很少有研究检查过临床患者的骨骼肌量和质。本研究通过磁共振成像（MRI）检查了肌肉形态变化，并分析了血液透析患者的相关因素。
调查了 58 名接受维持性血液透析（HD）的患者，并选择了 28 名性别和年龄匹配的健康成年人作为对照组（Control）。测量了人体测量学、细胞因子因素和实验室数据。通过大腿 MRI 分析肌肉和肌间脂肪组织（IMAT）。观察 HE 染色后的二头肌样本。测量胰岛素抵抗的稳态模型评估（HOMA-IR），并分析其与肌肉消耗的关系。
HD 患者倾向于摄入较低的蛋白质饮食、人体测量学数据和血清白蛋白，但 C 反应蛋白和白细胞介素-6 显著增加。MRI 显示，与对照组相比，HD 患者的肌肉量和肌肉/总比降低，但脂肪/肌肉和 IMAT 更高。来自 HD 患者的二头肌样本显示肌肉纤维萎缩和脂肪堆积。此外，我们发现 HD 患者表现出较高的血浆空腹胰岛素水平和增加的 HOMA-IR，与肌肉/总比呈负相关，与脂肪/肌肉比呈正相关。
肌肉消耗在 HD 患者出现明显营养不良之前就已经出现。主要的形态变化是肌肉萎缩伴肌间脂肪堆积。胰岛素抵抗与透析患者的肌肉消耗有关。
