摘要
目的 探讨血清肉碱水平是否是老年血液透析患者合并肌少症的生物标志物,及是否能预测老年透析患者合并肌少症的不良事件风险.方法 回顾性选取2021年5月至2023年5月在首都医科大学附属北京友谊医院接受治疗的150例老年血液透析患者(年龄≥60岁).按照患者是否发生肌少症分为肌少症组(n=64)和非肌少症组(n=86).记录两组的临床资料和肌肉相关参数[骨骼肌质量指数(SMI)、握力、腿围、步速].采用靶向液相色谱串联质谱(LC-MS/MS)方法测定血清肉碱[总肉碱(TC)、游离肉碱(FC)、酰基肉碱(AC)]水平,并计算AC/FC.采用Spearman相关性分析研究血清肉碱水平与患者肌少症的相关性.随访1年,采用多变量回归模型分析预测老年透析患者合并肌少症发生不良事件(跌倒、骨折、心脑血管事件)的风险.结果 与非肌少症组相比,肌少症组的男性比例较低,年龄较大,透析时间较长,差异均有统计学意义(P＜0.05);与非肌少症组相比,肌少症组的SMI、手握力、步速和小腿围均较低,血清白蛋白、肌酐和C反应蛋白水平均明显较低,营养不良风险更高,差异均有统计学意义(P＜0.05).肌少症组的FC、TC水平分别为18.53(15.22,21.85)、25.13(22.58,27.76)μmol/L,均明显低于非肌少症组[21.56(17.66,26.75)、29.78(25.33,35.68)µmol/L],差异均有统计学意义(P＜0.05);非肌少症组与肌少症组的AC水平比较,差异无统计学意义(P＞0.05);肌少症组AC/FC＞0.4的患者比例为43.8％,显著高于非肌少症组(20.9％),差异有统计学意义(P＜0.05).Spearman相关性分析,AC/FC与年龄呈正相关(P＜0.05),与SMI、握力呈负相关(P＜0.05).多变量回归模型分析结果显示,年龄、肌少症和肉碱缺乏与跌倒和骨折的发生呈独立正相关(P＜0.05),年龄和肌少症与心血管和脑血管事件的发生呈独立正相关(P＜0.05).结论 血清肉碱水平和AC/FC可作为简单、客观、快速的标志物,用于评估老年透析患者的肌少症,评估老年透析患者1年内发生不良事件的风险,预防肌少症的发生,并确定是否需要采取干预措施,有望为老年肌少症的防治提供新思路和新靶点.
Abstract
Objective To investigate whether serum carnitine levels are biomarkers and influencing factors for sarcopenia in elderly hemo-dialysis patients and whether they can predict the risk of adverse events in elderly dialysis patients with sarcopenia.Methods A total of 150 eld-erly hemodialysis patients(aged≥60 years)who received treatment at Beijing Friendship Hospital,Capital Medical University from May 2021 to May 2023 were retrospectively selected.According to whether the patient had sarcopenia,they were divided into the sarcopenia group(n=64)and the non sarcopenia group(n=86).The clinical data and muscle related parameters[skeletal muscle index(SMI),grip strength,leg circ-umference,and gait speed]were recorded for two groups.The levels serum carnitine[including free carnitine(FC),total carnitine(TC),and acylcarnitine(AC)]were measured using targeted liquid chromatography tandem mass spectrometry(LC-MS/MS),and AC/FC was calculated.The correlation between serum carnitine levels and sarcopenia in patients was studied using Spearman correlation analysis.During a one-year fol-low-up,the risk of adverse events(falls,fractures,cardiovascular and cerebrovascular events)in elderly dialysis patients with sarcopenia was predicted using the multivariate regression model analysis.Results Compared with the non sarcopenia group,the proportion of males in the sar-copenia group was lower,with older age and longer dialysis time,and the differences were statistically significant(P＜0.05);compared with the non sarcopenia group,the SMI,grip strength,gait speed,and calf circumference in the sarcopenia group were lower,as well as the levels of serum albumin,creatinine,and C-reactive protein in the sarcopenia group were lower,the risk of malnutrition was higher in the sarcopenia group,and the differences were statistically significant(P＜0.05).The levels of FC and total carnitine in the sarcopenia group were 18.53(15.22,21.85)and 25.13(22.58,27.76)μmol/L,respectively,which were significantly lower than those in the non sarcopenia group[21.56(17.66,26.75)and 29.78(25.33,35.68)μ mol/L],and the differences were statistically significant(P＜0.05);there was no statistically significant differ-ence in AC levels between the non sarcopenia group and the sarcopenia group(P＞0.05);the proportion of patients with AC/FC＞0.4 in the sarcopenia group was 43.8％,which was significantly higher than that in the non sarcopenia group(20.9％),and the difference was statistically significant(P＜0.05).Spearman correlation analysis showed that AC/FC was positively correlated with age(P＜0.05),and negatively corre-lated with SMI and grip strength(P＜0.05).The results of multivariate regression model analysis showed that age,sarcopenia,and carnitine de-ficiency were independently positively correlated with the occurrence of falls and fractures(P＜0.05),while age and sarcopenia were independ-ently positively correlated with the occurrence of cardiovascular and cerebrovascular events(P＜0.05).Conclusion Serum carnitine levels and AC/FC can serve as simple,objective,and rapid biomarkers for evaluating sarcopenia in elderly dialysis patients,assessing the risk of adverse e-vents within one year,preventing sarcopenia,and determining whether intervention measures are needed.This is expected to provide new ideas and targets for the prevention and treatment of sarcopenia in the elderly.
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