Clinical Collage of Medicine, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China.
Department of Nephrology, The 2nd People's Hospital of Bijie, Bijie, Guizhou, People's Republic of China.
Int Urol Nephrol. 2023 Sep;55(9):2257-2266. doi: 10.1007/s11255-023-03526-z. Epub 2023 Feb 28.
This study investigated the association between insulin-like growth factor-1 and nutritional status indicators in patients undergoing maintenance hemodialysis (MHD).
Patients undergoing MHD for > 3 months were included in this single-center cross-sectional study in March 2021. Clinical, demographic, and body mass data and blood samples were collected before the hemodialysis sessions. Serum insulin-like growth factor-1 (IGF-1) levels were measured using a radioimmunoassay, and serum IGF-1 standard deviation score (SDS) was calculated for MHD patients according to age and sex. The nutritional status of patients was assessed using serum albumin, serum prealbumin, handgrip strength, pinching strength, upper arm muscle circumference, lean body mass, phase angle, seven-point subjective global assessment (SGA) score, and geriatric nutritional risk index (GNRI). The patients were divided into groups according to tertiles of serum IGF-1 SDS levels. Spearman correlation analyses and univariate and multivariate binary logistic regression analyses were used to determine the association between serum IGF-1 SDS and nutritional status parameters.
A total of 155 MHD patients (male: female = 90:65) were enrolled in the study, with a median dialysis vintage of 28.0 (11.0, 55.0) months, and an average age of 66 (65.5 ± 13.0) years. The median of IGF-1 SDS was - 0.1 (- 0.6 to 0.6). Compared to patients with higher IGF-1 SDSs, patients with lower IGF-1 SDSs had lower levels of serum ceruloplasmin (341.0 [287.5, 416.0] vs 395.0 [327.0, 451.0] vs 409.0 [349.5, 507.5], p = 0.002), serum albumin (34.7 ± 3.0 vs 37.0 ± 3.1 vs 37.8 ± 2.6, p < 0.001), serum prealbumin (270.3 [233.7, 327.8] vs 326.0 [279.3, 355.6] vs 363.0 [324.2, 398.2], p < 0.001), handgrip strength (13.8 [10.0, 20.7] vs 17.7 [10.7, 22.5] vs 23.3 [16.6, 27.8], p < 0.001), pinch strength (4.6 [3.9, 6.0] vs 4.9 (3.9, 6.9) vs 6.5 [4.7, 8.7], p = 0.002), phase angle (3.3 [3.0, 3.8] vs 3.9 [3.4, 4.7] vs 4.3 [3.6, 5.2, p < 0.001), modified Creatinine Index (83.1 ± 19.7 vs 93.1 ± 23.4 vs 113.9 ± 24.3, p < 0.001), intracellular water (14.5 ± 4.4 vs 16.1 ± 4.9 vs 16.9 ± 4.4, p = 0.031), higher extracellular water (26.9 ± 5.8 vs 25.7 ± 5.5 vs 25.1 ± 3.1, p = 0.042), and higher malnutrition risk as defined by GNRI (49.0% vs 15.7% vs 11.5%, p < 0.001) and SGA (53.9% vs 23.5% vs 7.7%, p < 0.001).
Lower IGF-1 SDSs are independently associated with higher malnutrition risk in patients with MHD.
本研究旨在探讨胰岛素样生长因子-1（IGF-1）与维持性血液透析（MHD）患者营养状况指标之间的关系。
2021 年 3 月，我们纳入了这项单中心横断面研究中的 155 名 MHD 患者，这些患者的 MHD 治疗时间超过 3 个月。收集患者血液透析治疗前的临床、人口统计学和身体质量数据及血样。使用放射免疫分析法测量血清 IGF-1 水平，并根据年龄和性别计算血清 IGF-1 标准差评分（SDS）。使用血清白蛋白、血清前白蛋白、握力、捏力、上臂肌肉周长、瘦体重、相位角、七点总体主观评估（SGA）评分和老年营养风险指数（GNRI）评估患者的营养状况。根据血清 IGF-1 SDS 水平的三分位数将患者分为三组。使用 Spearman 相关分析和单变量及多变量二项逻辑回归分析来确定血清 IGF-1 SDS 与营养状况参数之间的关系。
155 名 MHD 患者（男：女=90：65）纳入本研究，中位透析龄为 28.0（11.0，55.0）个月，平均年龄为 66（65.5±13.0）岁。IGF-1 SDS 的中位数为-0.1（-0.6 至 0.6）。与 IGF-1 SDS 较高的患者相比，IGF-1 SDS 较低的患者血清铜蓝蛋白水平更低（341.0 [287.5，416.0] vs 395.0 [327.0，451.0] vs 409.0 [349.5，507.5]，p=0.002），血清白蛋白水平更低（34.7±3.0 vs 37.0±3.1 vs 37.8±2.6，p<0.001），血清前白蛋白水平更低（270.3 [233.7，327.8] vs 326.0 [279.3，355.6] vs 363.0 [324.2，398.2]，p<0.001），握力更低（13.8 [10.0，20.7] vs 17.7 [10.7，22.5] vs 23.3 [16.6，27.8]，p<0.001），捏力更低（4.6 [3.9，6.0] vs 4.9 [3.9，6.9] vs 6.5 [4.7，8.7]，p=0.002），相位角更低（3.3 [3.0，3.8] vs 3.9 [3.4，4.7] vs 4.3 [3.6，5.2]，p<0.001），改良肌酐指数更高（83.1±19.7 vs 93.1±23.4 vs 113.9±24.3，p<0.001），细胞内液更多（14.5±4.4 vs 16.1±4.9 vs 16.9±4.4，p=0.031），细胞外液更多（26.9±5.8 vs 25.7±5.5 vs 25.1±3.1，p=0.042），GNRI 定义的营养不良风险更高（49.0% vs 15.7% vs 11.5%，p<0.001）和 SGA 更高（53.9% vs 23.5% vs 7.7%，p<0.001）。
IGF-1 SDS 较低与 MHD 患者的营养不良风险增加独立相关。
