相位角对维持性血液透析患者肌肉减少症与全因死亡间的修饰效应:一项单中心回顾性队列研究OA

Objective To explore the modifying effect of phase angle(PhA)on the relationship between muscle wasting and all-cause mortality in patients undergoing maintenance hemodialysis(MHD).Methods A total of 130 MHD patients who were treated in Suzhou Science City Hospital from May 2020 to May 2022 were selected:48 in the muscle atrophy group and 82 in the non-muscle atrophy group.After a 3-year follow-up,31 were in the death group and 99 in the survival group.The weighted generalized additive model and smooth curve fitting were used to analyze the association between PhA and the 5-item SARC-F scale for sarcopenia.A multivariate Cox re-gression analysis was conducted to investigate the association between sarcopenia,PhA and all-cause mortality in MHD patients.The generalized linear model was used to evaluate the influence of PhA on the regression relation-ship between sarcopenia and total mortality.The ROC and AUC curve were used to predict the risk of total mor-tality.The Kaplan-Meier method and Log rank test were used to analyze the differences in survival rates of the patients.The interaction between PhA and sarcopenia on all-cause mortality,the odds ratio(OR)and 95％con-fidence interval(CI)of the risk of death were analyzed.Results The age,intact parathyroid hormone(iPTH),C-reactive protein(CRP),and SARC-F score of the muscle atrophy group were significantly higher than those of the non-muscle atrophy group,while the levels of body composition characteristics such as urea clearance index(Kt/V)and PhA were significantly lower than those of the non-muscle atrophy group(P＜0.05).PhA levels were negatively correlated with SARC-F scores(P＜0.001).The age,CRP and SARC-F score of the death group were significantly higher than those of the survival group,while the proportion of patients with muscle atro-phy,Kt/V and PhA and other body composition characteristic indicators were significantly lower than those of the survival group(P＜0.05).High-level PhA can reduce the all-cause mortality risk of MHD patients(HR=0.479,95％CI:0.271-0.748,P＜0.001).Muscle atrophy increased the all-cause mortality risk of MHD pa-tients(HR=2.346,95％CI:1.679-3.021,P＜0.001).In patients with muscle atrophy,for every 1° de-crease in PhA level,the all-cause mortality risk will increase by 15.70％.As the PhA level increases,the posi-tive correlation between muscle atrophy and all-cause mortality gradually weakens(P＜0.001).The AUC of PhA for predicting all-cause mortality was 0.889,and the cut-off value of 4.15° yielded the best predictive per-formance.In sarcopenia,the all-cause mortality risk of MHD patients decreased with the increase of PhA level,and this trend still existed in the non-sarcopenia group.High PhA × muscle atrophy,low PhA × non-muscle atro-phy,and low PhA × muscle atrophy all had an interactive effect on all-cause mortality(P＜0.001).Conclusion A decrease in PhA is a risk factor for all-cause mortality in MHD patients.PhA has a significant modifying effect on the relationship between sarcopenia and all-cause mortality.As the level of PhA increases,the increasing effect of sarcopenia on the risk of death gradually weakens.