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
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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险的影响。 方法 选取2019年7月至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2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。 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. -
Key words:
- CKD /
- MHD /
- Sarcopenia /
- Interleukin-6 /
- Cystatin C /
- Tumor necrosis factor-α
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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* HGS（kg） 20.10 ± 3.56 33.49 ± 4.85 13.154 <0.001* GS（m/s） 0.72 ± 0.14 0.95 ± 0.16 6.637 <0.001* 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 ± 265.131137.69 ± 245.860.173 0.863 Ca2+（mmol/L） 2.35 ± 0.39 2.28 ± 0.40 0.789 0.432 P3-（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* Cys C（mg/L） 1.49 ± 0.32 1.18 ± 0.27 4.898 <0.001* TNF-α（ng/L） 16.69 ± 2.14 12.98 ± 1.87 8.557 <0.001* *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 相关系数 SMI HGS GS IL−6 r −0.564 −0.632 −0.599 P <0.001* <0.001* <0.001* Cys C r −0.547 −0.624 −0.578 P <0.001* <0.001* <0.001* TNF−α r −0.539 −0.604 −0.587 P <0.001* <0.001* <0.001* *P < 0.05。
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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。
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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 n IL-6（ng/L） Cys C（mg/L） TNF-α（ng/L） 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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