Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97004, Taiwan; Department of Public Health, Tzu Chi University, Hualien, 97004, Taiwan.
Department of Public Health, Tzu Chi University, Hualien, 97004, Taiwan.
Clin Nutr. 2020 Aug;39(8):2435-2441. doi: 10.1016/j.clnu.2019.10.027. Epub 2019 Nov 1.
BACKGROUND & AIMS: Muscle wasting is highly prevalent in patients with chronic kidney disease (CKD). However, the assessment of skeletal muscle mass and strength in clinical settings is not commonly available. We aimed to evaluate the feasibility of serum creatinine/cystatin C (Cr/CysC) ratio in the assessment of muscle wasting.
In 272 patients with CKD aged 66.5 ± 15.1 years, skeletal muscle mass and handgrip strength (HGS) were assessed. Skeletal muscle index (SMI) was calculated as skeletal muscle mass/height. Low muscle mass was defined as SMI below the sex-specific 10th percentile of study population and low handgrip strength as less than 26 Kg for men and 18 Kg for women.
The Cr/CysC ratio was significantly lower in both the low SMI and low HGS groups. Moreover, the Cr/CysC ratio correlated with SMI (r = .306, p < .001) and HGS (r = .341, p < .001). After adjusting for confounding factors, age, sex, waist circumference, body fat mass, and Cr/CysC ratio were independently associated with SMI, whereas age, sex, diabetes, hemoglobin, estimated glomerular filtration rate, urine protein/creatinine ratio, SMI, and Cr/CysC ratio were independently associated with HGS.
Cr/CysC ratio appears to be a promising surrogate marker for detecting muscle wasting in patients with CKD. Further studies are needed to extend our findings.
肌肉减少症在慢性肾脏病（CKD）患者中非常普遍。然而，在临床环境中评估骨骼肌质量和力量并不常见。我们旨在评估血清肌酐/胱抑素 C（Cr/CysC）比值评估肌肉减少症的可行性。
在 272 名年龄为 66.5±15.1 岁的 CKD 患者中，评估了骨骼肌质量和手握力（HGS）。通过骨骼肌质量/身高计算骨骼肌指数（SMI）。低肌肉质量定义为 SMI 低于研究人群的性别特异性第 10 百分位数，低手握力定义为男性低于 26kg 和女性低于 18kg。
低 SMI 和低 HGS 组的 Cr/CysC 比值均显著降低。此外，Cr/CysC 比值与 SMI（r=.306，p<.001）和 HGS（r=.341，p<.001）相关。调整混杂因素后，年龄、性别、腰围、体脂肪量和 Cr/CysC 比值与 SMI 独立相关，而年龄、性别、糖尿病、血红蛋白、估计肾小球滤过率、尿蛋白/肌酐比值、SMI 和 Cr/CysC 比值与 HGS 独立相关。
Cr/CysC 比值似乎是一种有前途的替代标志物，可用于检测 CKD 患者的肌肉减少症。需要进一步的研究来扩展我们的发现。
