Noce Annalisa, Ceravolo Maria Josè, Gualtieri Paola, Marrone Giulia, Romano Lorenzo, Shoshi Amir, Di Lauro Manuela, De Lorenzo Antonino
Department of Systems Medicine, University of Rome Tor Vergata, Rome, RM, Italy.
UOSD Nephrology and Dialysis, Policlinico Tor Vergata, Rome, RM, Italy.
Front Med (Lausanne). 2024 Nov 1;11:1372668. doi: 10.3389/fmed.2024.1372668. eCollection 2024.
Sarcopenia is a chronic pathological condition, first defined in 2010 and revised in 2018. The most recent definition of sarcopenia focuses mostly on "low muscle strength." A secondary form of sarcopenia is represented by uremic sarcopenia (US), a condition that characterizes end-stage kidney disease (ESKD) patients. The intramuscular adipose tissue (IMAT) seems to impact negatively on muscle strength, as it would seem to replace muscle fibers with a non-contractile component. The study aims to compare body composition parameters-both standardized and innovative-related to the diagnosis of US in hemodialysis (HD) patients, stratified by sarcopenia diagnosis. Furthermore, the different indices of sarcopenia are compared in order to evaluate their predictive capacity.
We analyzed 48 ESKD patients according to the sarcopenia diagnosis, obtained using dual-energy X-ray absorptiometry (DXA). Moreover, we assessed the presence of IMAT and calculated the sarcopenia index (SI).
For the study, the enrolled population was divided according to the sarcopenia diagnosis: no sarcopenic patients had higher transferrin ( = 0.03), total proteins ( = 0.04), and azotemia pre-dialysis ( = 0.05) values. On the contrary, atherogenic indices were lower in no sarcopenic patients. Moreover, we observed an indirect correlation between the SI and parathyroid hormone (PTH) ( = 0.00138, = 0.54). Finally, we calculated the prevalence of sarcopenia and sarcopenia adjusted for IMAT. We showed a different prevalence between sarcopenia diagnosed with a standard index and an index adjusted for IMAT ( = 0.043). In conclusion, we believe that the most important result obtained is the indirect correlation between SI and PTH. These data corroborate the theories, in which PTH seems to play a central role in the cachexia genesis. Moreover, the SI adjusted for IMAT seems to be a more reliable parameter for the early identification of subjects at risk of developing US, allowing timely implementation of targeted therapeutic strategies.
肌肉减少症是一种慢性病理状况，于2010年首次定义并于2018年修订。肌肉减少症的最新定义主要侧重于“低肌肉力量”。尿毒症性肌肉减少症（US）是肌肉减少症的一种继发形式，是终末期肾病（ESKD）患者的特征性病症。肌内脂肪组织（IMAT）似乎会对肌肉力量产生负面影响，因为它似乎会用非收缩性成分替代肌纤维。本研究旨在比较与血液透析（HD）患者US诊断相关的标准化和创新性身体成分参数，并按肌肉减少症诊断进行分层。此外，还比较了肌肉减少症的不同指标，以评估其预测能力。
我们根据使用双能X线吸收法（DXA）获得的肌肉减少症诊断结果，分析了48例ESKD患者。此外，我们评估了IMAT的存在情况并计算了肌肉减少症指数（SI）。
在本研究中，纳入人群根据肌肉减少症诊断进行了划分：非肌肉减少症患者的转铁蛋白（=0.03）、总蛋白（=0.04）和透析前氮质血症（=0.05）值较高。相反，非肌肉减少症患者的致动脉粥样硬化指数较低。此外，我们观察到SI与甲状旁腺激素（PTH）之间存在间接相关性（=0.00138，=0.54）。最后，我们计算了肌肉减少症和经IMAT调整后的肌肉减少症的患病率。我们发现，用标准指数诊断的肌肉减少症与经IMAT调整后的指数之间存在不同的患病率（=0.043）。总之，我们认为获得的最重要结果是SI与PTH之间的间接相关性。这些数据证实了相关理论，其中PTH似乎在恶病质发生过程中起核心作用。此外，经IMAT调整后的SI似乎是早期识别有发生US风险受试者的更可靠参数，从而能够及时实施有针对性的治疗策略。
