【摘要】 目的 探讨25-羟维生素D在维持性血液透析（MHD）患者不同久坐时间与肌少症关联中的中介作用。方法 纳入2019年1月至2022年12月在南阳市中心医院肾病内科进行治疗的MHD患者325例。按照是否有肌少症分为肌少症组（99例）和无肌少症组（226例）,比较两组的基本资料、血液生化指标、骨骼肌量、强度、身体活动能力及久坐时间。采用logistic回归分析久坐时间与MHD患者肌少症的关系；多元线性回归分析久坐时间与25-羟维生素D的关系；Process插件分析25-羟维生素D在久坐时间对MHD患者肌少症影响中的中介效应。结果 共纳入MHD患者325例，肌少症患病率为30.46%（99/325）。肌少症组与非肌少症组的年龄、体重指数、久坐时间、C-反应蛋白、白蛋白、β₂-微球蛋白、25-羟维生素D、握力、椅立、4 m步行速度、四肢骨骼肌量指数比较，差异有统计学意义（P<0.05）。logistic分析显示，在调整年龄、白蛋白、25-羟维生素D等后，久坐时间4.60～7.00 h（OR=3.705,95%CI:1.130～12.147）、>7 h（OR=9.803,95%CI:2.796～34.376）的MHD患者患肌少症的风险高于久坐时间≤2.5 h者（P<0.05）,且久坐时间≤2.50 h组、2.60～4.50 h组、4.60～7.00 h组、>7 h组肌少症风险OR值的增加趋势有统计学意义（P<0.05）。多重线性分析显示，在控制性别、年龄后，久坐时间独立解释MHD患者血清25-羟维生素D水平的变异值增加37.70%（P<0.05）。中介效应分析显示，血清25-羟维生素D在久坐时间与肌少症之间的中介效应值为0.050,存在部分中介作用。结论 伴肌少症的MHD患者的久坐时间更长、25-羟维生素D水平更低。在MHD患者中，久坐时间不仅对肌少症产生直接影响，同时可通过血清25-羟维生素D对其产生间接影响。更多还原

【Abstract】 Objective To analyze the mediating role of 25-hydroxyvitamin D in the association between different sedentary time and sarcopenia in maintenance hemodialysis(MHD) patients. Methods A total of 325 MHD patients who received treatment in the Department of Nephrology in Central Hospital of Nanyang from January 2019 to December 2022 were included in this study. The patients were divided into a sarcopenia group(99 cases) and a non-sarcopenia group(226 cases) based on the presence or absence of sarcopenia. The basic data, blood biochemical indicators, skeletal muscle mass, strength, physical activity ability, and sedentary time were compared between the two groups. Logistic regression analysis was used to analyze the relationship between sedentary time and sarcopenia in MHD patients. Multiple linear regression analysis was used to analyze the relationship between sedentary time and serum 25-hydroxyvitamin D levels. The Process plugin was used to analyze the mediating effect of serum 25-hydroxyvitamin D on the impact of sedentary time on sarcopenia in MHD patients. Results A total of 325 MHD patients were included in the study, and the prevalence of sarcopenia was 30.46%(99/325). There were statistically significant differences in age, body mass index, sedentary time, C-reactive protein, albumin, beta-2 microglobulin, serum 25-hydroxyvitamin D levels, grip strength, chair stands, 4-meter walking speed, and limb skeletal muscle mass index between the sarcopenia group and the non-sarcopenia group(P<0.05). Logistic regression analysis showed that after adjusting for age, albumin, serum 25-hydroxyvitamin D, etc., MHD patients with sedentary time of 4.60-7.00 hours(OR=3.705, 95% CI: 1.130-12.147) and >7 hours(OR=9.803, 95% CI: 2.796-34.376) had a higher risk of developing sarcopenia compared to those with sedentary time ≤2.5 hours(P<0.05). There was a statistically significant increasing trend in the risk of sarcopenia with increasing sedentary time in the ≤2.5 hours, 2.60-4.50 hours, 4.60-7.00 hours, and >7 hours groups(P<0.05). Multiple linear regression analysis showed that after controlling for gender and age, sedentary time independently explained 37.70% of the variation in serum 25-hydroxyvitamin D levels in MHD patients(P<0.05). Mediation analysis showed that serum 25-hydroxyvitamin D had a partial mediating effect(mediation effect value=0.050) between sedentary time and sarcopenia. Conclusion MHD patients with sarcopenia have longer sedentary time and lower levels of 25-hydroxyvitamin D. In MHD patients, sedentary time can have a direct impact on sarcopenia and can also have an indirect impact through serum 25-hydroxyvitamin D.更多还原