维持性血液透析ESRD患者随访中骨骼肌指数下降与死亡风险
该回顾性研究纳入两家机构维持性血液透析的ESRD患者，通过基线及透析两年后腹部CT定量分析身体成分。内部队列187例中，透析前VFA和SMI为独立死亡预测因子，透析期间SMI下降幅度增大显著增加死亡风险。结论强调低透析前SMI及SMI下降是死亡风险因素，提示营养支持与肌肉保护的重要性。
要点
- 透析前低SMI是ESRD维持性血透患者死亡的独立预测因子。
- 透析期间SMI下降幅度越大，死亡风险越高。
- 腹部CT定量分析可用于评估ESRD患者身体成分及预后。
核心结论
- 低透析前SMI是维持性血液透析ESRD患者死亡的关键预测因子。
- 透析期间SMI下降幅度增大（ΔSMI或δSMI）显著增加死亡风险，强调营养支持与肌肉保护的重要性。
研究设计与样本
- 回顾性纳入机构A和B的维持性血液透析ESRD患者，内部队列187例（男113，女74；平均年龄52.43±19.01岁）。
- 基线及透析两年后行腹部CT，通过勾画ROI定量分析身体成分。
- 采用卡方检验和独立t检验比较变量，Cox回归模型估计HR和95%CI，ROC曲线确定最佳截断值。
诊断标准与关键数值
- 透析前VFA为独立死亡预测因子（HR=1.01，P=0.036）。
- 透析前SMI为独立死亡预测因子（HR=0.95，P=0.042）。
- ΔSMI增大显著增加死亡风险（HR=1.09，P=0.024）。
- δSMI增大同样提示死亡风险升高（HR=1.03，P=0.026）。
临床应用与阅片要点
- 在阅片报告中可关注腹部CT所示骨骼肌指数，低SMI提示预后不良。
- 随访复查时可对比SMI变化，下降明显者提示死亡风险增加。
局限性
- 回顾性研究设计。
- 仅纳入两家机构患者，样本量有限。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND AND OBJECTIVE: The obesity paradox is recognized in End-Stage Renal Disease (ESRD) patients on hemodialysis, but the specific impact of body composition and its changes on survival remains unclear. This study assesses the prognostic value of baseline metrics and pre- to post-dialysis changes.
METHODS: Patients with ESRD undergoing maintenance hemodialysis at institutions A and B were retrospectively enrolled. Abdominal CT was quantitatively analyzed by delineating Regions of Interest (ROI) at baseline and two years after dialysis. Categorical and continuous variables were compared using Chi-square and independent t-tests. Significant variables entered a Cox regression model to estimate Hazard Ratios (HRs) and 95% Confidence Intervals (CIs). Receiver Operating Characteristic (ROC) curves identified optimal cutoff values. Absolute change (Δ) was defined as pre- minus post-dialysis values, and relative change (δ) as Δ divided by the pre-dialysis value.
RESULTS: The internal and external validation cohorts were from Institutions A and B. The internal cohort included 187 ESRD patients on maintenance hemodialysis (113 males, 74 females; mean age, 52.43 ± 19.01 years). Pre-dialysis Visceral Fat Area (VFA) (HR = 1.01, P = 0.036) and Skeletal Muscle Index (SMI) (HR = 0.95, P = 0.042) were independent mortality predictors. Greater ΔSMI during dialysis significantly increased mortality risk (HR = 1.09, P = 0.024), and δSMI similarly indicated elevated risk (HR = 1.03, P = 0.026).
CONCLUSION: Low pre-dialysis SMI is a key predictor of mortality. Larger decreases in SMI (ΔSMI or δSMI) during dialysis increase risk, emphasizing the importance of nutritional support and muscle preservation.
引用
- Peng X, Wang Z, Tian R, et al. Reduced skeletal muscle index during follow-up as a mortality risk factor in maintenance hemodialysis patients with end-stage renal disease. Eur J Radiol. 2026. PMID: 42019374. doi:10.1016/j.ejrad.2026.112857
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。