肌少症指数与CKD患者骨骼肌肉相关指标的相关性

Correlation of Sarcopenia Index with Skeletal Muscle Parameters in Chronic Kidney Disease

摘要: 目的：分析肌少症指数(sarcopenia Index, SI)与慢性肾脏病(chronic kideny disease, CKD)患者肌肉含量、肌肉力量的相关性，探讨采用SI早期筛查CKD肌少症的可能性。方法：选择2024年9月至2025年9月在广州市红十字会医院就诊的105例慢性肾脏病(Chronic Kidney Disease, CKD)患者作为研究对象，收集血清肌酐(creatinine, Cr)、胱抑素C (Cystatin C, CysC)、白蛋白、血脂谱等，使用人体成分分析仪(bioelectrical impedance analysis, BIA)测量四肢骨骼肌质量(appendicular skeletal muscle mass, ASMM)、四肢骨骼肌指数(appendicular skeletal muscle index, ASMI)、体脂肪指数(body fat mass index, BFMI)、去脂体重指数(Fat-Free Mass Index, FFMI)、相位角，测量握力、捏力。以(Cr/Cysc)*100计算SI，以CysC计算估算肾小球滤过率(estimated glomerular filtration rate based on CysC, eGFR_CysC),并计算Cr*eGFR_CysC作为新型肌少症指标。应用Shapiro-Wilk进行正态性检验；t检验、曼–惠特尼秩和检验比较组间差异；Pearson或Spearman进行相关性分析，并使用单因素、多因素线性回归分析。通过SI、Cr*eGFR_CysC与亚洲肌少症工作组(Asian working group for sarcopenia, AWGS) 2019肌少症诊断金标准进行比较评估其诊断效能。结果：SI在CKD晚期患者显著升高，SI与ASMM、BFMI、捏力的相关性在弱至中等程度(|r| = 0.077~0.403)，Cr*eGFR_CysC与握力相关。多因素线性回归分析中，在调整了性别、BMI、相位角等混杂因素后，SI仍与ASMM呈独立正相关(β = 1.68, P = 0.036)。基于AWGS 2019诊断标准，评估SI、Cr*eGFR_CysC的诊断效能，结果提示SI在CKD肌少症评估中具有较高的灵敏度(77.8%)，较低的特异度(35.8%)；Cr*eGFR_CysC具有较低的灵敏度(18.5%)，较高的特异度(97.0%)。结论：SI与CKD患者ASMM、BFMI、捏力有相关性，SI与CKD患者ASMM独立相关。SI可能是CKD肌少症筛查和诊断的一种良好工具。

Abstract: Objective: To analyze the correlation between the sarcopenia index (SI) and muscle mass、muscle strength in patients with chronic kidney disease (CKD), and to explore the potential of SI for early screening of sarcopenia in CKD. Methods: A total of 105 patients with CKD treated at Guangzhou Red Cross Hospital from September 2024 to September 2025 were enrolled. Serum creatinine (Cr), cystatin C (CysC), albumin, and lipid profiles were collected. Appendicular skeletal muscle mass (ASMM), appendicular skeletal muscle index (ASMI), body fat mass index (BFMI), fat-free mass index (FFMI), and phase angle were measured using bioelectrical impedance analysis (BIA). Grip strength and pinch strength were also measured. SI was calculated as (Cr/CysC)*100. The estimated glomerular filtration rate based on CysC (eGFR_CysC) was calculated, and Cr × eGFR_CysC was derived as a novel sarcopenia indicator. The Shapiro-Wilk test was used for normality testing. Differences between groups were compared using the t-test or Mann-Whitney U test. Correlations were analyzed using Pearson or Spearman correlation coefficients, and univariate and multivariate linear regression analyses were performed. The diagnostic performance of SI and Cr*eGFR_CysC was evaluated against the 2019 Asian Working Group for Sarcopenia (AWGS) diagnostic criteria. Results: SI was significantly higher in patients with advanced CKD. The correlations of SI with ASMM, BFMI, and pinch strength were weak to moderate (|r| = 0.077 − 0.403). Cr*eGFR_CysC was correlated with grip strength. In multivariate linear regression analysis, after adjusting for confounding factors such as sex, BMI, and phase angle, SI remained independently and positively correlated with ASMM (β =1.68, P = 0.036). Based on the AWGS 2019 criteria, the diagnostic performance of SI and Cr*eGFR_CysC was evaluated. The results indicated that SI had high sensitivity (77.8%) but low specificity (35.8%) for assessing sarcopenia in CKD, whereas Cr*eGFR_CysC had low sensitivity (18.5%) but high specificity (97.0%). Conclusion: SI is correlated with ASMM, BFMI, and pinch strength in CKD patients, and is independently correlated with ASMM. SI may serve as a useful tool for screening and diagnosing sarcopenia in CKD.