Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil.
Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Campinas, SP, Brasil.
J Bras Nefrol. 2021 Apr-Jun;43(2):191-199. doi: 10.1590/2175-8239-JBN-2020-0119.
Patients with chronic kidney disease (CKD) are affected by dynapenia, sarcopenia, and vascular calcification. Advanced glycation end products (AGEs) may accumulate in peritoneal dialysis (PD) patients and favor sarcopenia via changes in collagen cross-linking, muscle protein breakdown, and the calcification of arterial smooth muscle cells via p38-MAPK activation. The aim of this study is to explore the relationships between AGEs, muscle degeneration, and coronary artery calcification.
This was a clinical observational study in patients with CKD undergoing PD, in which serum and skin AGEs (AGEs-sAF), cumulative glucose load, muscle strength and functional tests, muscle ultrasounds with elastography, coronary artery calcium (CAC) quantification, and muscle density by multislice computed tomography were measured.
27 patients aged 48±16 years, dialysis vintage of 27±17 months, had AGEs-sAF levels of 3.09±0.65 AU (elevated in 13 [87%] patients), grip strength levels of 26.2±9.2 kg (11 [42%] patients with dynapenia), gait speed of 1.04±0.3 m/s (abnormal in 14 [58%] patients) and "timed-up-and-go test" (TUG) of 10.5±2.2s (abnormal in 7 [26%] patients). Correlations between AGEs-sAF levels and femoral rectus elastography (R=-0.74; p=0.02), anterior-tibialis elastography (R= -0.68; p=0.04) and CAC (R=0.64; p=0.04) were detected. Cumulative glucose load correlated with femoral rectal elastography (R=-0.6; p=0.02), and serum glycated hemoglobin concentrations correlated with psoas muscle density (R= -0.58; p=0.04) and CAC correlated with psoas muscle density (R=0.57; p=0.01) and lumbar square muscle density (R=-0.63; p=0.005).
The study revealed associations between AGEs accumulation and lower muscle stiffness/density. Associations that linked muscle degeneration parameters with vascular calcification were observed.
患有慢性肾脏病（CKD）的患者会受到 dynapenia、肌肉减少症和血管钙化的影响。晚期糖基化终产物（AGEs）可能在腹膜透析（PD）患者中积累，并通过改变胶原交联、肌肉蛋白分解以及通过 p38-MAPK 激活使动脉平滑肌细胞钙化，从而有利于肌肉减少症的发生。本研究旨在探讨 AGEs、肌肉退化和冠状动脉钙化之间的关系。
这是一项对接受 PD 的 CKD 患者进行的临床观察性研究，其中测量了血清和皮肤 AGEs（AGEs-sAF）、累积葡萄糖负荷、肌肉力量和功能测试、肌肉超声弹性成像、冠状动脉钙（CAC）定量以及通过多层计算机断层扫描测量的肌肉密度。
27 名年龄 48±16 岁、透析时间 27±17 个月的患者，AGEs-sAF 水平为 3.09±0.65 AU（13 名患者[87%]升高），握力水平为 26.2±9.2 kg（11 名患者[42%]存在 dynapenia），步行速度为 1.04±0.3 m/s（14 名患者[58%]异常）和“计时起立行走测试”（TUG）为 10.5±2.2s（7 名患者[26%]异常）。AGEs-sAF 水平与股直肌弹性成像（R=-0.74；p=0.02）、前胫骨弹性成像（R=-0.68；p=0.04）和 CAC（R=0.64；p=0.04）之间存在相关性。累积葡萄糖负荷与股直肌弹性成像呈负相关（R=-0.6；p=0.02），糖化血红蛋白浓度与腰方肌密度呈负相关（R=-0.58；p=0.04），CAC 与腰方肌密度（R=0.57；p=0.01）和腰椎四方肌密度（R=-0.63；p=0.005）呈正相关。
本研究揭示了 AGEs 积累与较低的肌肉僵硬/密度之间的关联。观察到将肌肉退化参数与血管钙化联系起来的关联。
