Harada Kazuhiro, Suzuki Susumu, Ishii Hideki, Aoki Toshijiro, Hirayama Kenshi, Shibata Yohei, Negishi Yosuke, Sumi Takuya, Kawashima Kazuhiro, Kunimura Ayako, Shimbo Yusaku, Tatami Yosuke, Kawamiya Toshiki, Yamamoto Dai, Morimoto Ryota, Yasuda Yoshinari, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Am J Cardiol. 2017 Apr 15;119(8):1275-1280. doi: 10.1016/j.amjcard.2017.01.003. Epub 2017 Jan 25.
Sarcopenia, defined as skeletal muscle loss and dysfunction, is attracting considerable attention as a novel risk factor for cardiovascular events. Although the loss of skeletal muscle is common in chronic kidney disease (CKD) patients, the relation between sarcopenia and cardiovascular events in CKD patients is not well defined. Therefore, we aimed to investigate the relation between skeletal muscle mass and major adverse cardiovascular events (MACE) in CKD patients. We enrolled 266 asymptomatic CKD patients (median estimated glomerular filtration rate: 36.7 ml/min/1.73 m). To evaluate skeletal muscle mass, we used the psoas muscle mass index (PMI) calculated from noncontrast computed tomography. The patients were divided into 2 groups according to the cut-off value of PMI for MACE. There were significant differences in age and body mass index between the low and high PMI groups (median age: 73.5 vs 69.0 years, p = 0.002; median body mass index: 22.6 vs 24.2 kg/m, p <0.001, respectively). During the follow-up period (median: 3.2 years), patients with low PMI had significantly higher risk of MACE than those with high PMI (31.7% and 11.2%, log-rank test, p <0.001). The Cox proportional hazard model showed that low PMI is an independent predictor of MACE in CKD patients (hazard ratio 3.98, 95% confidence interval 1.65 to 9.63, p = 0.0022). In conclusion, low skeletal muscle mass is an independent predictor of MACE in CKD patients. The assessment of skeletal muscle mass may be a valuable screening tool for predicting MACE in clinical practice.
肌肉减少症，定义为骨骼肌量减少和功能障碍，作为心血管事件的一种新的危险因素正受到广泛关注。虽然骨骼肌量减少在慢性肾脏病（CKD）患者中很常见，但CKD患者中肌肉减少症与心血管事件之间的关系尚未明确界定。因此，我们旨在研究CKD患者骨骼肌量与主要不良心血管事件（MACE）之间的关系。我们纳入了266例无症状CKD患者（估计肾小球滤过率中位数：36.7 ml/min/1.73 m²）。为评估骨骼肌量，我们使用了从非增强计算机断层扫描计算得出的腰大肌质量指数（PMI）。根据MACE的PMI临界值将患者分为两组。低PMI组和高PMI组在年龄和体重指数方面存在显著差异（年龄中位数：73.5岁对69.0岁，p = 0.002；体重指数中位数：22.6对24.2 kg/m²，p <0.001）。在随访期（中位数：3.2年）内，低PMI患者发生MACE的风险显著高于高PMI患者（分别为31.7%和11.2%，对数秩检验，p <0.001）。Cox比例风险模型显示，低PMI是CKD患者发生MACE的独立预测因素（风险比3.98，95%置信区间1.65至9.63，p = 0.0022）。总之，低骨骼肌量是CKD患者发生MACE的独立预测因素。骨骼肌量评估可能是临床实践中预测MACE的一种有价值的筛查工具。
