肌肉生长抑制素、炎症标志物与慢性肾脏病患者肌少症的关系。

The Relationship Between Myostatin, Inflammatory Markers, and Sarcopenia in Patients With Chronic Kidney Disease.

机构信息

Gazi University, Faculty of Medicine, Department of Nephrology, Ankara, Turkey.

Gazi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey.

出版信息

J Ren Nutr. 2022 Nov;32(6):677-684. doi: 10.1053/j.jrn.2022.01.011. Epub 2022 Feb 2.

DOI:10.1053/j.jrn.2022.01.011

PMID:35122995

Abstract

OBJECTIVE

To determine the prevalence of sarcopenia in patients with chronic kidney disease (CKD), investigate the relationship of the serum myostatin level with sarcopenia and inflammatory markers.

METHODS

The study was conducted with four patient groups: renal transplantation (TX), stage 3-5 non-dialysis-dependent CKD (NDD-CKD), hemodialysis (HD), and peritoneal dialysis (PD). Laboratory parameters, serum myostatin, C-reactive protein, and interleukin-6 levels were studied. Body composition was estimated using a multifrequency bioimpedance analysis. Handgrip strength (HGS) was evaluated with a handgrip dynamometer. The HGS and appendicular skeletal muscle index measurements were used to determine sarcopenia presence.

RESULTS

The study included 130 patients (72 [55%] male patients). The patient distribution in groups was as follows: 37 in HD, 28 in PD, 37 in renal TX, and 28 in NDD-CKD. The highest level of myostatin was measured in the HD group, and the lowest in the TX group (P < .001). The HGS measurement in the PD group was significantly lower than that in the TX group (P = .025). The myostatin was negatively correlated with HGS, albumin, estimated glomerular filtration rate, and Kt/V. However, myostatin had no correlation with inflammatory markers or appendicular skeletal muscle index. Sarcopenia was present in 37 (29%) patients: 15 (40%) in the HD group, nine (32%) in NDD-CKD, seven (25%) in PD, and six (16%) in TX. When the patients with and without sarcopenia were compared, only myostatin was higher in the former (P = .045). As a result of multivariate analysis, myostatin was the only independent factor which predicts sarcopenia (odds ratio: 1.002, 95% confidence interval: 1.001-1.005, P = .048).

CONCLUSION

To prevent devastating events associated with sarcopenia in patients with CKD, renal transplantation seems to be the best treatment solution. For the early recognition of sarcopenia, the measurement of the serum myostatin level may be a promising diagnostic approach.

摘要

目的

确定慢性肾脏病（CKD）患者中肌少症的患病率，研究血清肌抑素水平与肌少症和炎症标志物的关系。

方法

本研究纳入了四个患者组：肾移植（TX）、3-5 期非透析依赖性 CKD（NDD-CKD）、血液透析（HD）和腹膜透析（PD）。研究了实验室参数、血清肌抑素、C 反应蛋白和白细胞介素 6 水平。使用多频生物阻抗分析估计身体成分。使用握力计评估握力（HGS）。使用 HGS 和四肢骨骼肌指数测量来确定肌少症的存在。

结果

本研究纳入了 130 名患者（72 名[55%]男性患者）。患者在各组中的分布如下：HD 组 37 例，PD 组 28 例，TX 组 37 例，NDD-CKD 组 28 例。HD 组的肌抑素水平最高，TX 组最低（P<0.001）。PD 组的 HGS 测量值明显低于 TX 组（P=0.025）。肌抑素与 HGS、白蛋白、估计肾小球滤过率和 Kt/V 呈负相关。然而，肌抑素与炎症标志物或四肢骨骼肌指数均无相关性。37 名（29%）患者存在肌少症：HD 组 15 名（40%），NDD-CKD 组 9 名（32%），PD 组 7 名（25%），TX 组 6 名（16%）。比较有肌少症和无肌少症的患者时，仅前者的肌抑素水平更高（P=0.045）。多元分析结果表明，肌抑素是唯一预测肌少症的独立因素（比值比：1.002，95%置信区间：1.001-1.005，P=0.048）。