慢性肾脏病患者血清IL-6、Cys C、TNF-α与肌肉减少症的关系及对患者死亡风险的影响

王雨涛; 柳娟

慢性肾脏病患者血清IL-6、Cys C、TNF-α与肌肉减少症的关系及对患者死亡风险的影响

王雨涛^{1, 2},
柳娟^1, ,

1.
泰州市姜堰中医院肾病科
2.
血透室，江苏泰州　225500

基金项目: 江苏省优势学科建设工程项目（YSHL1902-041）

详细信息

作者简介:
王雨涛（1981～），男，江苏泰州人，本科，副主任医师，主要从事肾病临床工作

通讯作者:
柳娟，E-mail：2608754498@qq.com

中图分类号: R692
计量
- 文章访问数: 33
- HTML全文浏览量: 45
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2024-08-01
- 网络出版日期: 2024-10-15

Relationship between Serum IL-6，Cys C，and TNF-α and Sarcopenia in Patients with Chronic Kidney Disease and Its Impact on Patient Mortality Risk

Yutao WANG^{1, 2},
Juan LIU^{1
, ,}

1.
Dept. of Nephrology，Jiangyan Hospital of Traditional Chinese Medicine
2.
Hemodialysis Room，Taizhou Jiangsu 225500，China

摘要

摘要: 目的探究慢性肾脏病（CKD）患者血清白细胞介素-6（IL-6）、胱抑素C（Cys C）、肿瘤坏死因子-α（TNF-α）与肌肉减少症的关系及对患者死亡风向的影响。方法选取2019年7月～2021年6月医院105例行维持性血液透析（MHD）的CKD患者临床资料进行回顾性研究，根据患者MHD期间有无肌肉减少症分组，分为肌肉减少组（n=27）与无肌肉减少组（n=78）。比较两组临床资料，分析血清IL-6、Cys C、TNF-α水平与SMI、HGS等人体资料的相关性，分析CKD患者血清IL-6、Cys C、TNF-α与MHD期间肌肉减少症的关系，分析CKD MHD患者生存情况，评价血清IL-6、Cys C、TNF-α水平对CKD患者死亡风险的影响。结果肌肉减少组SMI、HGS、GS均低于无肌肉减少组，血清IL-6、Cys C、TNF-α水平高于无肌肉减少组（P < 0.05）；肌肉减少症患者血清IL-6、Cys C、TNF-α水平与SMI、HGS、GS均呈负相关（P < 0.05）；血清IL-6、Cys C、TNF-α水平与CKD患者MHD期间肌肉减少症发生有关（P < 0.05），随着血清IL-6、Cys C、TNF-α水平升高，CKD患者MHD期间肌肉减少症发生风险逐渐增加（P < 0.05），且当血清IL-6、Cys C、TNF-α高水平时，CKD患者死亡风险分别是低水平的9.900倍、10.688倍、4.936倍。结论 CKD患者MHD前血清IL-6、Cys C、TNF-α水平升高与肌肉减少症发生有关，联合检测三者水平可用于肌肉减少症患者死亡风险评估。
- CKD /
- MHD /
- 肌肉减少症 /
- 白细胞介素-6 /
- 胱抑素C /
- 肿瘤坏死因子-α
Abstract: Objective To investigate the relationship between serum interleukin-6 （IL-6）, cystatin C （Cys C）, tumor necrosis factor-α （TNF-α） and sarcopenia in patients with chronic kidney disease （CKD）, and its impact on mortality risk. Methods A retrospective study was conducted on the clinical data of 105 CKD patients undergoing maintenance hemodialysis （MHD） in a hospital from July 2019 to June 2021. The patients were divided into two groups based on whether they had sarcopenia during MHD, namely the sarcopenia group （n=27） and the non- sarcopenia group （n=78）. The clinical data of the two groups were compared, and the correlation between serum IL-6, Cys C, TNF-α levels and human data such as SMI and HGS was analyzed. The relationship between serum IL-6, Cys C, TNF-α and sarcopenia during MHD in CKD patients was analyzed, and the survival of CKD MHD patients was analyzed. And The effects of serum levels of IL-6, CysC, and TNF-α on the risk of death in patients with CKD were evaluated. Results In the sarcopenia group, SMI, HGS, and GS were all lower than in the non-sarcopenia group, while serum levels of IL-6, Cys C, and TNF-α were higher （P < 0.05）. In sarcopenia patients, serum IL-6, Cys C, and TNF-α levels showed a negative correlation with SMI, HGS, and GS （P < 0.05）. Elevated levels of serum IL-6, Cys C, and TNF-α were associated with the occurrence of sarcopenia in CKD patients during MHD （P < 0.05）. As serum levels of IL-6, Cys C, and TNF-α increased, the risk of developing sarcopenia during MHD in CKD patients gradually rose （P < 0.05）, and when serum levels of IL-6, Cys C, and TNF-α were high, the risk of death for CKD patients was 9.900 times, 10.688 times, and 4.936 times higher, respectively, compared to low levels. Conclusion In CKD patients, higher pre-MHD serum levels of IL-6, Cys C, and TNF-α are related to the occurrence of sarcopenia. Testing all three levels together can be used to assess the mortality risk in patients with muscle loss.
- CKD /
- MHD /
- Sarcopenia /
- Interleukin-6 /
- Cystatin C /
- Tumor necrosis factor-α

HTML全文

图 1 病例入组流程图

Figure 1. Flow chart of case grouping

下载: 全尺寸图片幻灯片

表 1 2组临床资料比较[n（%）/（$\bar x \pm s $）]

Table 1. Comparison of clinical data between the two groups [n（%）/（$\bar x \pm s $）]

项目	肌肉减少组（n = 27）	无肌肉减少组（n = 78）	χ²/t	P
一般资料
性别
男	21（77.78）	46（58.97）	3.071	0.080
女	6（22.22）	32（41.03）
年龄（岁）	49.56 ± 7.24	50.24 ± 8.17	0.383	0.702
原发疾病
高血压肾病	6（22.22）	11（14.10）	1.826	0.609
糖尿病肾病	2（7.41）	5（6.41）
慢性肾炎	17（62.96）	59（75.64）
其他	2（75.64）	3（3.85）
透析时间（月）	16.73 ± 3.29	16.58 ± 3.41	0.199	0.843
人体资料
SMI（kg/m²）	5.27 ± 1.09	6.84 ± 1.33	5.520	<0.001^a
HGS（kg）	20.10 ± 3.56	33.49 ± 4.85	13.154	<0.001^a
GS（m/s）	0.72 ± 0.14	0.95 ± 0.16	6.637	<0.001^a
实验室数据
ALB（g/L）	35.71 ± 6.35	37.48 ± 5.96	1.308	0.194
TP（g/L）	64.19 ± 12.06	65.24 ± 11.87	0.395	0.694
iPTH（pg/mL）	546.92 ± 82.49	560.83 ± 90.57	0.703	0.484
Scr（μmol/L）	1127.98 ± 265.13	1137.69 ± 245.86	0.173	0.863
Ca²⁺（mmol/L）	2.35 ± 0.39	2.28 ± 0.40	0.789	0.432
P^3-（mmol/L）	1.92 ± 0.23	1.88 ± 0.21	0.832	0.407
TC（mmol/L）	3.32 ± 0.56	3.25 ± 0.52	0.591	0.556
LDL-C（mmol/L）	1.52 ± 0.36	1.57 ± 0.45	0.522	0.603
TG（mmol/L）	1.12 ± 0.26	1.15 ± 0.27	0.502	0.617
IL-6（ng/L）	5.07 ± 1.46	3.52 ± 1.09	5.813	<0.001^a
Cys C（mg/L）	1.49 ± 0.32	1.18 ± 0.27	4.898	<0.001^a
TNF-α（ng/L）	16.69 ± 2.14	12.98 ± 1.87	8.557	<0.001^a
^*P < 0.05。

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表 2 血清IL-6、Cys C、TNF-α水平与SMI、HGS等人体资料的相关性

Table 2. Correlation between serum IL-6，CysC，TNF-α levels and SMI，HGS

项目		SMI	HGS	GS
IL−6	r	−0.564	−0.632	−0.599
IL−6	P	<0.001^*	<0.001^*	<0.001^*
Cys C	r	−0.547	−0.624	−0.578
Cys C	P	<0.001^*	<0.001^*	<0.001^*
TNF−α	r	−0.539	−0.604	−0.587
TNF−α	P	<0.001^*	<0.001^*	<0.001^*
^*P < 0.05。

下载: 导出CSV

表 3 CKD患者血清IL-6、Cys C、TNF-α与MHD期间肌肉减少症的关系

Table 3. Relationship between serum IL-6，Cys C，and TNF-α and sarcopenia during MHD in patients with CKD

因素	β	S.E.	Waldχ²	P	OR	95%CI
IL-6（ng/L）	1.514	0.379	15.953	<0.001^*	4.544	2.374～8.697
Cys C（mg/L）	1.331	0.402	10.967	<0.001^*	3.786	1.162～12.335
TNF-α（ng/L）	1.138	0.325	12.253	<0.001^*	3.119	1.035～9.402
常量	−7.345	1.752	16.594	<0.001^*	0.001	～
^*P < 0.05。

下载: 导出CSV

表 4 血清IL-6、Cys C、TNF-α水平对CKD患者死亡风险的影响

Table 4. Effects of serum IL-6，CysC and TNF-α levels on the risk of death in CKDpatients

组别	例数	IL-6（ng/L）		Cys C（mg/L）		TNF-α（ng/L）
组别	例数	高水平	低水平	高水平	低水平	高水平	低水平
死亡	10	9	1	9	1	8	2
生存	95	41	54	39	56	39	56
RR（95%CI）		9.900（1.300～75.393）		10.688（1.404～81.375）		4.936（1.100～22.144）
U		2.684		2.811		2.241
P		0.007^*		0.005^*		0.025^*
^*P < 0.05。

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