Objective: To investigate the association between body composition and coronary artery calcification in patients with chronic kidney disease (CKD). Methods: This cross-sectional study enrolled patients with CKD hospitalized from May 2019 to April 2022 at Sun Yat-sen Memorial Hospital, Guangzhou, China. Skeletal muscle mass index and visceral fat area were measured by bioelectrical impedance analysis. Coronary artery calcification was assessed by computed tomography. Patients were divided into coronary artery calcification group and non-coronary artery calcification group according to the incidence of coronary artery calcification. Patients were categorized into tertile groups according to their skeletal muscle mass index and visceral fat area levels ranging from the lowest to the highest levels (T1 to T3). We defined skeletal muscle mass index≤30.4% as low muscle mass and visceral fat area≥80.6 cm2 as high visceral fat based on the results of the restricted cubic spline graph. All individuals were divided into 4 phenotypes: normal body composition, low muscle mass, high visceral fat, and low muscle mass with high visceral fat. Spearman correlation analysis and logistic regression analysis were used to assess the association between skeletal muscle mass index, visceral fat area and coronary artery calcification. Results: A total of 107 patients with CKD were enrolled, with an age of (60.0±14.1) years, including 41 female patients (38.3%). Patients of coronary artery calcification group had lower skeletal muscle mass index ((32.0±4.8) vs. (34.3±4.8), P=0.016) and higher visceral fat area ((70.8±32.6) cm2 vs. (47.9±23.8) cm2, P<0.001) than those of non-coronary artery calcification group. Patients in the T3 group of skeletal muscle mass index had a lower prevalence of coronary artery calcification (17 (48.6%) vs. 28 (77.8%)) and a lower coronary artery calcification score (0.5 (0, 124.0) vs. 12.0 (0.3, 131.0)) than those in the T1 group (P<0.05). Similarly, patients in the T1 group of visceral fat area had a lower prevalence of coronary artery calcification (14 (40.0%) vs. 29 (80.6%)) and a lower coronary artery calcification score (0 (0, 3.0) vs. 37.0 (2.0, 131.0)) than those in the T3 group (P<0.05). Likewise, patients with both low muscle mass and low muscle mass with high visceral fat had a higher prevalence of coronary artery calcification (11(78.6%) vs. 33 (47.8%); 15 (83.3%) vs. 33 (47.8%)) and a higher coronary artery calcification score (31.1 (0.8, 175.8) vs. 0 (0, 16.4); 27.6 (6.4, 211.4) vs. 0 (0, 16.4)) than those with normal body composition (P<0.05). Spearman correlation analysis showed that skeletal muscle mass index was inversely correlated with coronary artery calcification score (r=-0.212, P=0.028), and visceral fat area was positively correlated with coronary artery calcification score (r=0.408, P<0.001). Multivariate logistic regression analysis showed that increased skeletal muscle mass index was inversely associated with coronary artery calcification prevalence (T2: OR=0.208, 95%CI: 0.056-0.770, P=0.019; T3: OR=0.195, 95%CI: 0.043-0.887, P=0.034), and reduced visceral fat area was inversely associated with coronary artery calcification prevalence (T1: OR=0.256, 95%CI: 0.071-0.923, P=0.037; T2: OR=0.263, 95%CI: 0.078-0.888, P=0.031). Consistently, both low muscle mass and low muscle mass with high visceral fat were associated with coronary artery calcification prevalence (OR=6.616, 95%CI: 1.383-31.656, P=0.018; OR=5.548, 95%CI: 1.062-28.973, P=0.042). Conclusion: Reduced skeletal muscle mass index and increased visceral fat area are significantly associated with both the prevalence and severity of coronary artery calcification in patients with CKD.
目的： 探讨慢性肾脏病（CKD）患者身体成分与冠状动脉钙化的相关性。 方法： 本研究为横断面研究，收集中山大学孙逸仙纪念医院2019年5月至2022年4月住院治疗的CKD患者的临床资料，采用生物电阻抗分析法获得骨骼肌量指数和内脏脂肪面积，采用多层螺旋CT检测冠状动脉钙化程度。根据有无冠状动脉钙化发生分为冠状动脉钙化组和无冠状动脉钙化组，分别根据骨骼肌量指数和内脏脂肪面积三分位数进行分组（由低至高：T1、T2和T3）。根据限制性立方样条图的结果，将骨骼肌量指数≤30.4%定义为低骨骼肌量，内脏脂肪面积≥80.6 cm2定义为高内脏脂肪，并以此为切点将研究对象分为以下4种表型：身体成分正常、低骨骼肌量、高内脏脂肪、低骨骼肌量伴高内脏脂肪。采用Spearman相关性分析和logistic回归分析CKD患者骨骼肌量指数、内脏脂肪面积与冠状动脉钙化的相关性。 结果： 共纳入CKD患者107例，年龄（60.0±14.1）岁，其中女性41例（38.3%）。冠状动脉钙化组的骨骼肌量指数低于无冠状动脉钙化组［（32.0±4.8）比（34.3±4.8），P=0.016］，内脏脂肪面积高于无冠状动脉钙化组［（70.8±32.6）cm2比（47.9±23.8）cm2，P<0.001］。骨骼肌量指数中T3组的冠状动脉钙化检出率［17（48.6%）比28（77.8%）］及积分［0.5（0，124.0）比12.0（0.3，131.0）］均低于T1组（P<0.05）。内脏脂肪面积中T1组的冠状动脉钙化检出率［14（40.0%）比29（80.6%）］及积分［0（0，3.0）比37.0（2.0，131.0）］均低于T3组（P<0.05）。低骨骼肌量和低骨骼肌量伴高内脏脂肪患者的冠状动脉钙化检出率［11（78.6%）比33（47.8%）；15（83.3%）比33（47.8%）］及积分［31.1（0.8，175.8）比0（0，16.4）；27.6（6.4，211.4）比0（0，16.4）］均高于身体成分正常的患者（P<0.05）。Spearman相关分析显示，骨骼肌量指数与冠状动脉钙化积分（r=-0.212，P=0.028）呈负相关，内脏脂肪面积与冠状动脉钙化积分（r=0.408，P<0.001）呈正相关。多因素logistic回归分析显示，骨骼肌量指数升高是冠状动脉钙化检出率的负相关因素（T2：OR=0.208，95%CI：0.056~0.770，P=0.019；T3：OR=0.195，95%CI：0.043~0.887，P=0.034），内脏脂肪面积减少是冠状动脉钙化检出率的负相关因素（T1：OR=0.256，95%CI：0.071~0.923，P=0.037；T2：OR=0.263，95%CI：0.078~0.888，P=0.031）。低骨骼肌量、低骨骼肌量伴高内脏脂肪是冠状动脉钙化检出率的正相关因素（OR=6.616，95%CI：1.383~31.656，P=0.018；OR=5.548，95%CI：1.062~28.973，P=0.042）。 结论： CKD患者骨骼肌量指数下降、内脏脂肪面积增加与冠状动脉钙化的发生及其严重程度密切相关。.