Serum creatinine to cystatin C ratio is associated with major adverse cardiovascular events in patients with obstructive coronary artery disease

Background & aimsSarcopenia is a clinical syndrome that features muscle atrophy and weakness, and has been associated with cardiovascular events and poor clinical outcomes. Recently, the sarcopenia index (SI) was developed as a simple screening tool based upon the serum creatinine to cystatin C (CysC) ratio. We investigated the association between SI and the prevalence of major adverse cardiovascular events (MACE) in patients with obstructive CAD.Methods & ResultsBetween January 2010 and December 2018, patients with angina pectoris and obstructive CAD requiring coronary artery intervention were enrolled. Serum levels of CysC and other biomarkers were assessed. Patients were divided into two groups according to the SI ([Cr/CysC] x 100). Demographic characteristics and clinical outcomes of the two groups were evaluated. A total of 427 patients (79.6% men, mean age 69.55 ± 12.04 years) were enrolled. Patients with SI < 120 (n = 214, 28%) were older, more likely to be of the female gender, and to have more hypertension and congestive heart failure (all p < 0.05). The prevalence of major adverse cardiovascular events (MACE) composed of myocardial infarction, stroke, and all-cause mortality was higher in patients with lower SI (p = 0.026). After adjusting for potential confounding factors, multivariate Cox regression (hazard ratio 2.08, p = 0.045) and Kaplan–Meier analyses (log-rank p = 0.0371) revealed that lower SI was significantly associated with a higher prevalence of MACE.ConclusionsSerum creatinine to cystatin C ratio (SI) may be a useful surrogate marker to predict the future prevalence of MACE in patients with obstructive CAD.     

血清维生素D水平对维持性血液透析患者下肢肌力减退的预测作用

目的探讨维持性血液透析(MHD)患者血清维生素D水平对下肢肌力减退的预测作用。 方法横断面研究设计,选择2018年9月至10月于战略支援部队特色医学中心血液净化中心的95例MHD患者,检测其血清25-羟维生素D₃[25(OH)D₃]水平,采用5次站立-坐下实验(5-STS)评价其下肢肌力。根据5-STS完成时间将MHD患者分为下肢肌力正常组(n＝85)与减退组(n＝10),比较两组患者人口学特征、实验室指标。采用多因素Logistic回归分析下肢肌力减退的影响因素,绘制受试者工作特征(ROC)曲线分析上述因素预测MHD患者发生下肢肌力减退的特异度和敏感度。 结果95例MHD患者血清25(OH)D₃水平为11.00~99.50 nmol/L,中位数31.23(19.90~43.30)nmol/L;5-STS完成时间为3.55 s~18.71 s,中位数9.81(7.12,12.43)s,下肢肌力减退者10例(10.53%)。多因素Logistic回归分析显示,血清25(OH)D₃是MHD患者下肢肌力减退的保护性因素[OR＝0.761,95%CI(0.592~0.978),P＝0.033]。进一步ROC曲线分析显示,25(OH)D₃对应的ROC曲线下面积为0.815,其预测MHD患者发生下肢肌力减退的敏感度为80.00%,特异度为80.00%。 结论MHD患者血清25(OH)D₃水平普遍较低,下肢肌力减退者更为明显;血清维生素D水平对MHD患者是否存在下肢肌力减退具有较好的预测价值。     

Muscle plasticity of aged subjects in response to electrical stimulation training and inversion and/or limitation of the sarcopenic process

This review addresses the possible structural and functional adaptations of the muscle function to neuromuscular electrical stimulation (NMES) training in frail and/or aged (without advanced chronic disease) subjects. Evidence suggests that the sarcopenic process and its structural and functional effects would be limited and/or reversed through NMES training using excito-motor currents (or direct currents). From a structural viewpoint, NMES helps reduce muscle atrophy. From a functional viewpoint, NMES enables the improvement of motor output (i.e., muscle strength), gait, balance and activities of daily living which enhances the quality of life of aged subjects. Muscle plasticity of aged subjects in response to NMES training turns out to be undeniable, although many mechanisms are not yet explained and deserve to be explore further. Mechanistic explanations as well as conceptual models are proposed to explain how muscle plasticity operates in aged subjects through NMES training. NMES could be seen as a clinically applicable training technique, safe and efficient among aged subjects and could be used more often as part of prevention of sarcopenia. Therapists and physical conditioners/trainers could exploit this new knowledge in their professional practice to improve life conditions (including the risk of fall) of frail and/or aged subjects.     

老年慢性阻塞性肺疾病合并肌少症诊断工具的研究进展

肌少症是一种老年综合征,在过去的十年中,人们对它的认识逐步提高。它作为慢性阻塞性肺疾病(COPD)多种常见合并症之一,能加速疾病进程,增加跌倒风险、住院率、病死率。目前我国已步入老龄社会,肌少症在临床实践中经常诊断不足,本文对肌少症合并COPD患者在不同的环境中选择经济、方便、准确的检测工具进行综述,以期为临床决策提供...     

Difference between old and young adults in contribution of β‐cell function and sarcopenia in developing diabetes mellitus

Aims/Introduction

To investigate the difference in contributing factors in developing diabetes between old and young adults.

Materials and Methods

Subjects with recent‐onset diabetes were selected from a nationwide survey data and classified according to age: elderly (age ≥75 years), middle‐age (age 45–64 years) and young (age 25–39 years). The homeostasis model assessment of insulin resistance and β‐cell function were calculated. Sarcopenia was assessed using dual‐energy X‐ray absorptiometry.

Results

The prevalence of recent‐onset diabetes was 13.5%, 8.0%, and 1.4% in patients aged ≥75 years (unweighted n = 1,082), 45–64 years (unweighted n = 6,532), and 25–39 years (unweighted n = 5,178), respectively. Homeostasis model assessment of β‐cell function along with homeostasis model assessment of insulin resistance showed increasing trends as onset age increased in recent‐onset diabetes (P for trend < 0.001 in both). Elderly‐onset diabetic patients had significantly higher homeostasis model assessment of β‐cell function and homeostasis model assessment of insulin resistance compared with the middle‐age‐onset group (P < 0.001 and 0.014, respectively). Multivariate analysis showed that sarcopenia was significantly associated with recent‐onset diabetes only in patients aged ≥75 years (odds ratio [OR] 2.478, 95% confidence interval [CI] 1.379–4.452) but not in patients aged 45–64 years. In the middle‐age group, abdominal obesity (OR 2.933, 95% CI 2.086–4.122), hypertriglyceridemia (OR 1.529, 95% CI 1.078–2.169]) and low high‐density lipoprotein cholesterolemia (OR 1.930, 95% CI 1.383–2.695) were associated with recent‐onset diabetes.

Conclusions

Elderly‐onset diabetic patients had higher insulin resistance and relatively preserved β‐cell function compared with middle‐age‐onset patients. Sarcopenia might play a more important role in developing diabetes in the elderly population.     

恶性肿瘤患者肌肉减少症的诊断与营养干预

肌肉减少症是恶性肿瘤患者常见的临床综合征之一，可视为发病、死亡等不良预后的一项独立危险因素。主要评估方法为CT、MRI、PET等成像技术。肌肉减少症的发生、发展与肿瘤恶病质关系密切，且与抗肿瘤治疗相互影响。近年来，不断涌现出采取营养支持、药物和运动等综合干预手段的临床研究，其中不少取得了效果。肌肉减少症在恶性肿瘤治疗中具有不可忽视的临床价值，其发病机制复杂，疗效和安全性尚需更多高级别循证依据支持。