阻抗推导相位角作为维持性血液透析患者身体功能的指标

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Nutrition Pub Date : 2025-04-05 DOI:10.1016/j.nut.2025.112795

Xin Li M.D. , Kun Zhang M.Sc. , Qi Guo M.D., Ph.D. , Wei Ding M.D., Ph.D. , Jianying Niu M.D., Ph.D. , Junli Zhao M.D., Ph.D. , Liming Zhang M.Sc. , Hualin Qi M.D., Ph.D. , Suhua Zhang M.D., Ph.D. , Chen Yu M.D., Ph.D.

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引用次数: 0

摘要

目的维持性血液透析（MHD）患者经常损害身体功能，导致生活质量下降和死亡率增加。由生物电阻抗分析得出的相位角（PhA）已被提出作为肌肉减少症的预测因子，有望作为身体功能的潜在指标。本研究的目的是确定PhA与MHD患者身体功能之间的关系。方法：这是一项多中心、横断面研究，纳入了2020年至2021年来自7个透析中心的MHD患者。采用握力（HGS）、短时物理性能电池（SPPB）、4米步速和计时起跑测试（TUGT）测量身体功能。采用营养不良炎症评分（MIS）评价营养状况。采用生物电阻抗法测定体成分，包括50kHz时的PhA。肌少症是根据亚洲肌少症工作组2019年更新版本诊断的。采用多变量线性回归模型来确定PhA与身体功能之间的关系。结果共分析864例患者，其中男性61%，中位年龄63岁。中位PhA为4.5°（四分位数范围：3.9-5.2）。PhA与年龄、MIS、Charlson合并症指数、细胞外水/全身总水、脏脂肪面积、TUGT呈负相关，与血红蛋白、血清白蛋白、体重指数、身高、体重、骨骼肌质量指数（SMI）、SPPB、4米步速、HGS呈正相关。这些关联在整个身体和五个身体部位（右臂、左臂、躯干、右腿和左腿）的PhA值上是一致的。多变量线性回归分析表明，PhA与较高的SPPB评分独立相关(β = 0.33, P <；0.001)，更快的步速(β = 0.29, P <；0.001)，更高的HGS (β = 0.28, P <；0.001)和较短的TUGT时间(β = -0.20, P <；0.001)，在完全调整了年龄、性别、spKt/V、透析年份、Charlson合并症指数、MIS和骨骼肌指数后。亚组分析证实PhA与不同患者特征（包括肌肉减少症、营养不良、年龄、性别和糖尿病）的身体功能密切相关。结论较高的PhA与MHD患者较好的身体功能独立相关。我们的研究表明，PhA可以作为评估该人群功能状态的非侵入性、可靠的临床指标。

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Impedance-derived phase angle as an indicator of physical function in maintenance hemodialysis patients

Objectives

Maintenance hemodialysis (MHD) patients often impairs physical function, leading to reduced quality of life and increased mortality. Phase angle (PhA), derived by bioelectrical impedance analysis, has been proposed as a predictor of sarcopenia, holds promise as a potential indicator of physical function. The aim of this study was to identify the association between PhA and physical function in MHD patients.

Methods

This was a multicenter, cross-sectional study included MHD patients from seven dialysis centers from 2020 to 2021. Physical function was measured by handgrip strength (HGS), Short Physical Performance Battery (SPPB), 4-meter gait speed, and timed up and go test (TUGT). Nutritional status was assessed by malnutrition inflammation score (MIS). Body composition, including PhA at 50kHz, was measured by bioelectrical impedance analysis. Sarcopenia was diagnosed according to the 2019 update version of the Asian Working Group for Sarcopenia. Multivariable linear regression models were performed to determine the association between PhA and physical function.

Results

A total of 864 patients (61% male, median age 63 years) were analyzed. The median PhA was 4.5 (interquartile range: 3.9–5.2)°. PhA was negatively associated with age, MIS, Charlson comorbidity index, extracellular water/total body water, visceral fat area, and TUGT, and positively associated with hemoglobin, serum albumin, body mass index, height, weight, skeletal muscle mass index (SMI), SPPB, 4-meter gait speed, and HGS. These associations were consistent across PhA values of whole body and five body segments—right arm, left arm, trunk, right leg, and left leg. Multivariable linear regression analyses indicated that PhA was independently associated with higher SPPB scores (β = 0.33, P < 0.001), faster gait speed (β = 0.29, P < 0.001), greater HGS (β = 0.28, P < 0.001) and shorter TUGT time (β = –0.20, P < 0.001) after fully adjusted for age, sex, spKt/V, dialysis vintage, Charlson comorbidity index, MIS and skeletal muscle index. Subgroup analyses confirmed the robust association of PhA with physical function across different patient characteristics including sarcopenia, malnutrition, age, sex, and diabetes.

Conclusions

Higher PhA was independently associated with better physical function in MHD patients. Our study suggested that PhA may serve as a non-invasive, reliable clinical indicator for assessing functional status in this population.

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来源期刊

Nutrition 医学-营养学

CiteScore

7.80

自引率

2.30%

发文量

300

审稿时长

60 days

期刊介绍： Nutrition has an open access mirror journal Nutrition: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. Founded by Michael M. Meguid in the early 1980''s, Nutrition presents advances in nutrition research and science, informs its readers on new and advancing technologies and data in clinical nutrition practice, encourages the application of outcomes research and meta-analyses to problems in patient-related nutrition; and seeks to help clarify and set the research, policy and practice agenda for nutrition science to enhance human well-being in the years ahead.