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
-
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
-
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。 
下载: 导出CSV
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。
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 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。
下载: 导出CSV
-
[1] Noce A,Marrone G,Ottaviani E,et al. Uremic sarcopenia and its possible nutritional approach[J]. Nutrients,2021,13(1):147. doi: 10.3390/nu13010147 [2] 蔡茜,张祖隆. 终末期肾脏病行维持性血液透析患者发生肌少症的相关影响因素分析[J]. 实用临床医药杂志,2023,27(10):84-90. doi: 10.7619/jcmp.20230632 [3] Wilkinson T J,Miksza J,Yates T,et al. Association of sarcopenia with mortality and end-stage renal disease in those with chronic kidney disease: A UK Biobank study[J]. J Cachexia Sarcopenia Muscle,2021,12(3):586-598. doi: 10.1002/jcsm.12705 [4] Teraž K,Marusic U,Kalc M,et al. Sarcopenia parameters in active older adults - an eight-year longitudinal study[J]. BMC Public Health,2023,23(1):917. doi: 10.1186/s12889-023-15734-4 [5] Harvey N C,Orwoll E,Kwok T,et al. Sarcopenia Definitions as predictors of fracture risk independent of FRAX® ,falls,and BMD in the osteoporotic fractures in men (MrOS) study: A Meta-Analysis[J]. J Bone Miner Res,2021,36(7): 1235-1244. [6] 罗楠,李新伦,陈凤锟,等. 维持性血液透析相关肌肉减少症的患病率及危险因素的横断面调查[J]. 中国血液净化,2021,20(8):536-539,545. doi: 10.3969/j.issn.1671-4091.2021.08.008 [7] Gadelha A B,Cesari M,Corrêa H L,et al. Effects of pre-dialysis resistance training on sarcopenia,inflammatory profile,and anemia biomarkers in older community-dwelling patients with chronic kidney disease: A randomized controlled trial[J]. Int Urol Nephrol,2021,53(10):2137-2147. doi: 10.1007/s11255-021-02799-6 [8] Ito S,Nakashima H,Ando K,et al. Association between Low Muscle Mass and Inflammatory Cytokines[J]. Biomed Res Int,2021,27(20):5572-5742. [9] Lapauw L,Dupont J,Amini N,et al. Trial in elderly with musculoskeletal problems due to underlying sarcopenia-faeces to unravel the gut and inflammation translationally (TEMPUS-FUGIT): Protocol of a cross-sequential study to explore the gut-muscle axis in the development and treatment of sarcopenia in community-dwelling older adults[J]. BMC Geriatr,2023,23(1):599. doi: 10.1186/s12877-023-04291-5 [10] 沈冬明,严春霞. 慢性肾脏病患者钙磷代谢、NT-proBNP、Cys-C水平与心力衰竭发生的关系[J]. 海南医学,2023,34(12):1762-1765. doi: 10.3969/j.issn.1003-6350.2023.12.021 [11] Chen L K,Liu L K,Woo J,et al. Sarcopenia in asia: Consensus report of the asian working group for sarcopenia[J]. J Am Med Dir Assoc,2014,15(2):95-101. doi: 10.1016/j.jamda.2013.11.025 [12] Di Vincenzo O,Marra M,Di Gregorio A,et al. Bioelectrical impedance analysis (BIA) -derived phase angle in sarcopenia: A systematic review[J]. Clin Nutr,2021,40(5):3052-3061. doi: 10.1016/j.clnu.2020.10.048 [13] 马原,吴银银,窦俊凯,等. 5种肌少症评估工具筛查维持性血液透析患者肌少症效果比较[J]. 护理学杂志,2022,37(13):13-16. doi: 10.3870/j.issn.1001-4152.2022.13.013 [14] 杜雯,陈孜瑾,王雪洁,等. 维持性血液透析患者肌少症的患病率及相关影响因素[J]. 中华肾脏病杂志,2021,37(5):407-413. doi: 10.3760/cma.j.cn441217-20200727-00060 [15] Ridker P M,Rane M. Interleukin-6 Signaling and Anti-Interleukin-6 therapeutics in cardiovascular disease[J]. Circ Res,2021,128(11):1728-1746. doi: 10.1161/CIRCRESAHA.121.319077 [16] Hailemichael Y,Johnson D H,Abdel-Wahab N,et al. Interleukin-6 blockade abrogates immunotherapy toxicity and promotes tumor immunity[J]. Cancer Cell,2022,40(5):509-523. doi: 10.1016/j.ccell.2022.04.004 [17] Kaizu Y,Ohkawa S,Odamaki M,et al. Association between inflammatory mediators and muscle mass in long-term hemodialysis patients[J]. Am J Kidney Dis,2003,42(2):295-302. doi: 10.1016/S0272-6386(03)00654-1 [18] Jang D I,Lee A H,Shin H Y,et al. The role of tumor necrosis factor alpha (TNF-α) in autoimmune disease and current TNF-α inhibitors in therapeutics[J]. Int J Mol Sci,2021,22(5):2719. doi: 10.3390/ijms22052719 [19] He S D,Zhang L,Yu S Y,et al. Association between tumor necrosis factor-alpha(TNF-a) polymorphisms and Schizophrenia: An updated meta-analysis[J]. Int J Psychiatry Clin Pract,2022,26(3):294-302. doi: 10.1080/13651501.2021.2009879 [20] 丁捷,刘红娇,黄鑫,等. 维持性血液透析患者肌少症发病的临床表现及与TNF-α基因多态性的关系研究[J]. 中国中西医结合肾病杂志,2021,22(8):725-727. doi: 10.3969/j.issn.1009-587X.2021.08.023 [21] Abe K,Yano T,Katano S,et al. Utility of the sarcopenia index for assessment of muscle mass and nutritional status in patients with chronic heart failure: Comparison with anthropometric parameters[J]Geriatr Gerontol Int,2020,20(4): 388-389. [22] 贾晨,高俊瑞,王鹤宏. 胱抑素C对维持性血液透析患者肌肉减少症的预测价值分析[J]. 中国中西医结合肾病杂志,2021,22(8):709-711. doi: 10.3969/j.issn.1009-587X.2021.08.017 [23] Hirai K,Tanaka A,Homma T,et al. Serum creatinine/cystatin C ratio as a surrogate marker for sarcopenia in patients with chronic obstructive pulmonary disease[J]Clin Nutr,2021,40(3): 1274-1280. [24] 邓巧妮,王军焕,何家财. 不同活动度过敏性紫癜性肾炎患儿血清cysC、IL-6、TNF-α水平比较[J]. 医学临床研究,2022,39(11):1756-1758. doi: 10.3969/ji.ssn.1671-7171.2022.11.047 [25] 王亚美,刘风勋,邢利,等. Irisin与维持性血液透析患者肌肉减少症的相关性研究[J]. 中国血液净化,2019,18(10):677-680. doi: 10.3969/j.issn.1671-4091.2019.10.005 -
点击查看大图
图(1) / 表(4)
计量
- 文章访问数: 138
- HTML全文浏览量: 167
- PDF下载量: 10
- 被引次数: 0
