细胞外质量与体细胞质量比作为血液透析患者消瘦和液体超负荷的潜在指标：一项病例对照研究。

Extracellular mass to body cell mass ratio as a potential index of wasting and fluid overload in hemodialysis patients. A case-control study.

作者信息

Ruperto Mar, Sánchez-Muniz Francisco J, Barril Guillermina

机构信息

Human Nutrition Department, Faculty of Health Sciences, University Alfonso X el Sabio, 28697, Villanueva de la Cañada, Madrid, Spain.

Nutrition and Bromatology Department (Nutrition), Faculty of Pharmacy, Universidad Complutense de Madrid, Spain.

出版信息

Clin Nutr. 2020 Apr;39(4):1117-1123. doi: 10.1016/j.clnu.2019.04.021. Epub 2019 Apr 24.

DOI:10.1016/j.clnu.2019.04.021

PMID:31060893

Abstract

BACKGROUND & AIMS: Extracellular mass-to-body cell mass ratio (ECM/BCM ratio) which differentiates the proportion between intraextracellular compartments, could be a nutrition index of being wasted overloaded in hemodialysis (HD) patients. This study aimed to describe a cut-off point of the ECM/BCM ratio and, to find out the relationship between the nutritional-hydration status and this ratio in HD patients.

METHODS

A case-control study was carried out in 64 HD patients individually age-gender-matched to controls. Demographic, clinical and laboratory parameters were recorded. Bioelectrical impedance analysis was used to estimate ECM/BCM ratio as an indicator of the nutritional hydration status. Receiver operator characteristic (ROC) curve analysis was applied to determine the optimal cut-off point for identification of ECM/BCM ratio. An univariate and multivariate conditional logistic regression for the ECM/BCM ratio ≥1.20 was performed.

RESULTS

Median of ECM/BCM ratio was 1.50 (IQR:0.66) in HD patients, whereas 0.87 (IQR: 0.35) was found in controls (p < 0.001). HD-patients had lower body weight, serum albumin (s-albumin) and higher serum C-reactive protein (s-CRP) than controls. By ROC curve analysis, a cut-off point of 1.20 for the ECM/BCM ratio best discriminates to be wasted-overhydrated (sensitivity: 81.2%; specificity: 87.5%). Conditional logistic regression showed that for each 10%, ECM/BCM ratio increase the probability of developing fluid overload was increased 63% (OR: 1.63; 95% CI, 1.15-2.29), whereas an inverse association with s-albumin (OR: 0.15; 95% CI, 0.03-0.61) and other nutritional indicators were found.

CONCLUSIONS

The ECM/BCM ratio appears as a sensitive index that discriminates nutritional and/or hydration status in HD patients compared with age-gender-matched-controls. ECM/BCM ratios ≥1.20 are indicators of wasting and fluid overload in HD patients.

摘要

背景与目的

细胞外质量与体细胞质量比（ECM/BCM 比）可区分细胞内和细胞外成分的比例，可能是血液透析（HD）患者营养过剩或不足的一个指标。本研究旨在确定 ECM/BCM 比的临界值，并找出 HD 患者营养-水合状态与该比值之间的关系。

方法

对 64 例 HD 患者进行病例对照研究，这些患者在年龄和性别上与对照组个体匹配。记录人口统计学、临床和实验室参数。采用生物电阻抗分析来估计 ECM/BCM 比，作为营养水合状态的指标。应用受试者工作特征（ROC）曲线分析来确定识别 ECM/BCM 比的最佳临界值。对 ECM/BCM 比≥1.20 进行单因素和多因素条件逻辑回归分析。

结果

HD 患者的 ECM/BCM 比中位数为 1.50（四分位间距：0.66），而对照组为 0.87（四分位间距：0.35）（p < 0.001）。HD 患者的体重、血清白蛋白（s-白蛋白）低于对照组，血清 C 反应蛋白（s-CRP）高于对照组。通过 ROC 曲线分析，ECM/BCM 比的临界值为 1.20 时，最能区分营养过剩或水合过度（敏感性：81.2%；特异性：87.5%）。条件逻辑回归显示，ECM/BCM 比每增加１０％，发生液体超负荷的概率增加 63%（比值比：1.63；95%可信区间，1.15 - 2.29），而与 s-白蛋白呈负相关（比值比：0.15；95%可信区间，0.03 - 0.61），且发现与其他营养指标也存在类似关系。