Poor muscle quality rather than reduced lean body mass is responsible for the lower serum creatinine level in hemodialysis patients with diabetes mellitus.
Poor muscle quality rather than reduced lean body mass is responsible for the lower serum creatinine level in hemodialysis patients with diabetes mellitus.
复制标题
患有糖尿病的血液透析患者血清肌酐水平较低的原因是肌肉质量差，而不是去脂体重减少。
DOI：
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发表时间：
2010
影响因子：
1.1
通讯作者：
Yoshiki Nishizawa
中科院分区：
文献类型：
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作者：
Masaaki Inaba;Masafumi Kurajoh;S. Okuno;Y. Imanishi;S. Yamada;Katsuhito Mori;E. Ishimura;T. Yamakawa;Yoshiki Nishizawa
背景
营养良好的糖尿病(DM)血液透析患者的血清肌酐水平显著低于非DM患者，尽管这些患者存在无尿。与这一发现相关的因素尚未确定。
患者和方法
我们对102例糖尿病血液透析患者和208例非糖尿病血液透析患者进行了一项横断面研究，以确定糖尿病患者肌肉质量较差是否可以解释血清肌酐水平下降的原因。所有糖尿病患者均营养良好。采用握力测力仪和双能X线骨密度仪(DXA)分别测量HGS和LMI。
结果
糖尿病组较非糖尿病组血肌酐和糖化血红蛋白显著降低，但上肢整体LMI和LMI无明显差异。糖尿病患者的血肌酐/全身LMI、血肌酐/手臂LMI、HGS/全身LMI、HGS/ARM LMI比值均显著低于对照组。两组患者的血肌酐水平均与HGS、全身和上肢LMI显著相关。然而，LMI与血肌酐和HGS的回归分析显示，糖尿病患者的斜率明显低于非糖尿病患者。
结论
这表明，在糖尿病血液透析患者中，每单位肌肉质量产生的肌肉力量显著减少，而血清肌酐水平很好地反映了这一点。因此，我们的结果表明，与非糖尿病血液透析患者相比，糖尿病血液透析患者的血清肌酐水平显著降低，这可能是由于肌肉质量差而不是肌肉质量减少或营养不良造成的。
BACKGROUND
The serum creatinine level is significantly lower in well-nourished hemodialysis patients with diabetes mellitus (DM) than in their non-DM counterparts, despite the presence of anuria in these patients. The factors associated with this finding have not been determined.
PATIENTS AND METHODS
We evaluated the association of serum creatinine with handgrip strength (HGS) and lean body mass index (LMI) in a cross-sectional study of 102 DM and 208 non-DM hemodialysis patients to determine if poorer muscle quality in DM patients could explain the reduced level of serum creatinine. All the DM patients were well-nourished. Grip dynamometry and dual-energy X-ray absorptiometry (DXA) were used to measure HGS and LMI, respectively.
RESULTS
The DM patients had a significantly lower serum creatinine level and HGS compared to the non-DM patients, but whole-body LMI and LMI of the upper limbs did not differ between the two groups of patients. The DM patients had significantly lower serum creatinine/whole-body LMI, serum creatinine/arm LMI, HGS/whole-body LMI, and HGS/arm LMI ratios. The serum creatinine level was significantly correlated with HGS and with whole-body and upper limb LMI in both groups of patients. However, regression analyses of LMI with serum creatinine and HGS gave significantly shallower slopes for the DM patients compared to the non-DM patients.
CONCLUSION
This suggests that the muscle strength generated per unit of muscle mass, which is reflected well by the serum creatinine level, is significantly reduced in DM hemodialysis patients. Therefore, our results show that the significantly lower serum creatinine levels in DM hemodialysis patients compared to non-DM hemodialysis patients may be explained by poor muscle quality rather than by reduced muscle mass or malnutrition.