Changes Of Serum Irisin In Maintenance Hemodialysis Patients With Sarcopenia

Objective:Because of the high morbidity and the impact on patient's life quality,uremic sarcopenia have occupied a place in maintenance hemodialysis(MHD).Clarifying its influence on MHD patient-related factors is of great significance to the exploration of its clinical diagnosis and treatment strategy.Irisin was discovered by Bostrom in 2012,which synthesis and secretion depend on the contraction of skeletal muscle.It can promote myocyte growth and myoblast proliferation,thus maintaining normal muscle mass and function.Furthermore,Irisin also plays an important role in mediating muscle and kidney metabolism.To explore the changes of Irisin in MHD patients with sarcopenia and whether Irisin has protective effect on the complications of uraemic sarcopenia patients can help us use serum Irisin improve the diagnosis and treatment of clinical diseases.Methods:The MHD patients were come from the People's Hospital affiliated to Shanxi Medical University,and 56 healthy patients were selected in the health examination center.Lean tissue index(LTI)and fat tissue index(FTI)were measured by Body Composition Monitor(BCM).According to the diagnostic criteria of the Asian working group for muscular dystrophy,the patients were divided into the uremia sarcopenia group and the non-sarcopenia group.We collected blood of all the patients to detect the results of general clinical data and biochemical indicators.The serum Irisin levels were detected by enzyme-linked immunosorbent assay(Elisa).The muscle cross-sectional area at the third lumbar(L3)level was measured by computed Tomography(CT).Finally use the SPSS 21.0 software to complete the final analysis and processing.Results:1.Clinical Features:A total of 56 MHD patients were enrolled,whose average age was 50.16±10.576(27~65)years and dialysis age was 2.25±1.59 years.Subgroup analysis of MHD patients showed a total of 25 patients in the non-sarcopenia group,in which 12 patients aged 50~65(48.00%);The sarcopenia uremia group included 31 cases,55.36% of total MHD patients,which include 17 patients aged 50~65(54.84%).The proportion of patients over 50 years old in uremia group was higher than that in non-sarcopenia group.2.Comparison of biochemical and serum Irisin between MHD and control group:There was no significant difference in TG,TC,LDL and blood phosphorus.The blood calcium of MHD group was higher than healthy control group,however Alb was lower than control group.The serum Irisin levels of the two groups were compared,and the MHD group was decreased significantly.3.MHD Patients Related Single Factor Analysis: The serum Irisin concentration in uremic sarcopenia group was lower than non-sarcopenia group [175.46(126.00,220.52)vs 459.10(233.83,616.91)];The step speed,grip strength,thickness of skin fold of triceps brachii and LTI in uremic sarcopenia group was lower than non-sarcopenia group(P<0.05),but Scr and BUN were higher than that in non-sarcopenia group.There were no significant differences between the two groups in age,sex,dialysis age,BMI,FTI and other clinical characteristics.4.Correlation analysis of Irisin,BMI with factors in MHD Patients: The results of spearman correlation analysis showed that serum Irisin level was positively correlated with LTI,however negatively correlated with Scr,and the difference was statistically significant(P< 0.05).There was no significant correlation between BMI and traditional nutritional status assessment indicators,and positive correlation with arm circumference,FTI and thickness of skin fold of triceps brachii.5.Multivariate analysis of factors in uremia sarcopenia group: Taking diagnosis of sarcopenia as a dependent variable,grip strength,thickness of skin fold of triceps brachii,LTI,BUN,Scr and Irisin as independent variables.Then multivariate logistic regression analysis was carried out.The results showed that Irisin and grip strength were protective factor in uremia sarcopenia patients.6.Analysis of CT results of uraemic sarcopenia patients: Twelve patients in sarcopenia uremia group tested the CT examination.The L3 skeletal muscle index in all patients were less than cut off point,but one case was at the edge of the decision point.And the mean serum Irisin concentration of uraemic sarcopenia patients(165.04 pg/ml)was lower than that of non-sarcopenia group patients.Conclusion:Serum Irisin in MHD patients was lower than in healthy patients.The level of circulating Irisin in uremia sarcopenia patients is lower than that in non-sarcopenia.LTI combined with serum Irisin results can make the assessment of muscle nutritional status of patients more accurate,and can be used in the diagnosis of uraemic sarcopenia.Irisin is the protective factor of uremia sarcopenia,and the increase of circulating Irisin concentration can reduce the risk of uraemic sarcopenia.