WO2022172926A1 - Dispositif pour calculer la masse musculaire et procédé pour calculer la masse musculaire - Google Patents

Dispositif pour calculer la masse musculaire et procédé pour calculer la masse musculaire Download PDF

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WO2022172926A1
WO2022172926A1 PCT/JP2022/004955 JP2022004955W WO2022172926A1 WO 2022172926 A1 WO2022172926 A1 WO 2022172926A1 JP 2022004955 W JP2022004955 W JP 2022004955W WO 2022172926 A1 WO2022172926 A1 WO 2022172926A1
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dialysis
uric acid
urea
muscle mass
distribution volume
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PCT/JP2022/004955
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English (en)
Japanese (ja)
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徹 新里
真幹 三輪
正富 佐々木
亘 水野
満隆 上田
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ニプロ株式会社
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Priority to JP2022580637A priority Critical patent/JPWO2022172926A1/ja
Publication of WO2022172926A1 publication Critical patent/WO2022172926A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
    • A61M1/16—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with membranes

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  • the technology disclosed in this specification relates to a technology for calculating the muscle mass of dialysis patients.
  • Muscle mass is known to be an important indicator of the nutritional status of dialysis patients.
  • Methods for obtaining muscle mass include MRI, DEXA, and CT (for example, Behrang Amini, et al: Approaches to Assessment of Muscle Mass and Myosteatosis on Computed Tomography. Journals of Gerontology: Medical Science, 2019, vol. 74 , No. 10), and a method of measuring muscle mass using the impedance method or the like is known.
  • a method of estimating muscle mass using creatinine production rate is also known.
  • the muscle mass of dialysis patients can be measured by using the MRI method, DEXA method, CT method, and impedance method.
  • the MRI method, DEXA method, and CT method require large-scale equipment for measurement. For this reason, it is costly and time-consuming, and it places a heavy burden on both the medical staff performing the measurement and the dialysis patient.
  • the impedance method can be performed using a relatively simpler device than the MRI method, DEXA method, and CT method, it can only measure an approximate value of muscle mass, and cannot accurately measure muscle mass. do not have.
  • the creatinine production rate is affected by many factors other than muscle mass, muscle mass cannot be accurately estimated.
  • This specification discloses a technique for acquiring the muscle mass of dialysis patients while reducing the burden on dialysis patients and medical staff.
  • the muscle mass calculation device disclosed herein includes a uric acid concentration acquisition unit that acquires the serum uric acid concentration of the dialysis patient before and after dialysis, a urea concentration acquisition unit that acquires the serum urea concentration of the dialysis patient before and after dialysis, and and a calculation unit for calculating the muscle mass based on the serum uric acid concentration of the dialysis patient and the serum urea concentration of the dialysis patient before and after dialysis.
  • the calculation unit calculates the difference between the urea distribution volume and the uric acid content volume based on the serum uric acid concentration before and after dialysis obtained by the uric acid concentration obtaining unit and the serum urea concentration obtained by the urea concentration obtaining unit.
  • the above muscle mass calculator uses the serum uric acid concentration and serum urea concentration before and after dialysis to calculate the difference between the urea distribution volume and the uric acid content volume.
  • the present inventors have found a method capable of calculating muscle mass from the difference between the urea distribution volume and the uric acid content volume.
  • the serum uric acid concentration and serum urea concentration before and after dialysis, which are used to calculate the difference between the urea distribution volume and the uric acid content volume can be easily obtained during dialysis. Therefore, the muscle mass of a dialysis patient can be calculated without using a device for acquiring muscle mass.
  • the muscle mass calculation method disclosed herein includes a urea concentration acquisition step of acquiring the serum urea concentration of the dialysis patient before and after dialysis, a uric acid concentration acquisition step of acquiring the serum uric acid concentration of the dialysis patient before and after dialysis, a calculating step of calculating muscle mass based on the difference between the urea distribution volume calculated from the obtained serum urea concentrations before and after dialysis and the uric acid distribution volume calculated from the obtained serum uric acid concentrations before and after dialysis.
  • the uric acid distribution volume is calculated from the serum uric acid concentrations before and after dialysis in dialysis patients, which can be easily obtained during dialysis, and the urea distribution volume is calculated from the serum urea concentrations before and after dialysis in dialysis patients. Then, the muscle mass is calculated based on the difference between the calculated urea distribution volume and uric acid distribution volume. Therefore, it is possible to achieve the same effect as the muscle mass calculation device described above.
  • FIG. 4 is a flow chart showing an example of processing in which a computing device calculates muscle mass of a dialysis patient; Schematic diagram showing substances distributed in intracellular and extracellular compartments.
  • Fig. 2 shows the correlation between the difference between the urea distribution volume and the uric acid distribution volume, and the muscle mass calculated by multiplying the creatinine production rate by the value of creatinine equivalence.
  • the muscle mass calculation device disclosed in the present specification may further include a correlation formula storage unit that stores a correlation formula between the difference between the urea distribution volume and the uric acid distribution volume and the muscle mass.
  • the calculation unit may calculate the muscle mass based on the correlation between the difference between the urea distribution volume and the uric acid distribution volume and the muscle mass.
  • the muscle mass calculator 10 is used to calculate the muscle mass of a dialysis patient. As shown in FIG. 1 , the muscle mass calculation device 10 is composed of an arithmetic device 12 and an interface device 30 .
  • the computing device 12 can be configured by a computer including, for example, a CPU, a ROM, a RAM, and the like. By the computer executing the program, the arithmetic unit 12 functions as the calculation unit 20 shown in FIG.
  • the patient information storage unit 14 stores various information regarding dialysis patients.
  • the patient information storage unit 14 stores information on dialysis patients input via the interface device 30 and information on dialysis patients calculated by the calculation unit 20 .
  • the dialysis patient's information input via the interface device 30 is, for example, the uric acid concentration before and after dialysis, the urea concentration before and after dialysis, the creatinine concentration before and after dialysis, etc. of the dialysis patient.
  • the information about the dialysis patient calculated by the calculator 20 is the uric acid distribution volume, the urea distribution volume, and the muscle mass of the dialysis patient calculated based on the information input via the interface device 30 .
  • the dialysis information storage unit 16 stores various information related to dialysis.
  • the dialysis information storage unit 16 stores dialysis-related information input via the interface device 30 and dialysis-related information calculated by the calculation unit 20 .
  • the dialysis-related information calculated by the calculator 20 is, for example, the amount of urea removed, the amount of uric acid removed, and the like.
  • the correlation formula storage unit 18 stores a correlation formula between the difference between the urea distribution volume and the uric acid distribution volume and the muscle mass. The correlation formula will be detailed later.
  • the computing device 12 acquires various kinds of information used to calculate the muscle mass of the dialysis patient (S12).
  • the various information used to calculate the muscle mass of the dialysis patient are the urea concentration of the dialysis patient before and after dialysis, the uric acid concentration of the dialysis patient before and after dialysis, the amount of urea removed by dialysis of the dialysis patient, This is the amount of uric acid removed by dialysis in dialysis patients.
  • the uric acid and urea concentrations before and after dialysis can be obtained as actual measurements.
  • uric acid concentrations before and after dialysis are obtained by the following procedure. First, blood is collected from dialysis patients before and after dialysis. Then, the collected blood before dialysis is centrifuged into blood cells and plasma, and the uric acid concentration in the separated plasma is measured. The method for measuring the uric acid concentration in plasma is not particularly limited. The operator inputs the measured plasma uric acid concentrations before and after dialysis into the interface device 30 . The input pre- and post-dialysis plasma uric acid concentrations are output from the interface device 30 to the computing device 12 and stored in the patient information storage unit 14 .
  • the amount of uric acid removed and the amount of urea removed by dialysis can be calculated from various information obtained by dialysis.
  • the amount of uric acid removed by dialysis can be calculated by measuring the concentration of uric acid in the effluent dialysate after dialysis and multiplying the measured uric acid concentration by the amount of effluent dialysate.
  • it can be calculated using other information obtainable by dialysis.
  • a method for calculating the amount of uric acid removed and the amount of urea removed using other information that can be obtained by dialysis is disclosed in, for example, International Publication No. WO 2019/138917, and detailed description thereof will be omitted.
  • the calculator 20 calculates the urea distribution volume using the various information acquired in step S12 (S14).
  • An example of a method for calculating the urea distribution volume will be described below.
  • the urea distribution volume can be calculated by dividing the amount of urea removed by the urea concentration difference before and after dialysis. Therefore, the formula represented by Equation 1 below is established.
  • urea V indicates urea distribution volume
  • urea E indicates urea removal amount
  • urea Cs indicates urea concentration before dialysis
  • urea Ce indicates urea concentration after dialysis.
  • the calculation unit 20 substitutes the pre-dialysis urea concentration urea Cs, the post-dialysis urea concentration urea Ce, and the urea removal amount urea E obtained in step S12 into the above equation (1) to obtain the urea distribution volume Calculate urea V.
  • the urea distribution volume was calculated from the urea concentration urea Cs before dialysis, the urea concentration urea Ce after dialysis, and the urea removal amount urea E, but the configuration is not limited to this.
  • the urea distribution volume may be calculated using other information obtainable by dialysis.
  • a method of calculating the urea distribution volume using other information that can be obtained by dialysis is disclosed in, for example, International Publication No. 2019/138917.
  • urea passes through both the cell membrane 42 and the capillary membrane 56, so it is distributed throughout the body's water compartments (the combined range of the intracellular compartment 40 and the extracellular compartment 50).
  • the urea distribution volume therefore corresponds to the total body fluid volume. Therefore, for example, the urea distribution volume can also be calculated by using the method for calculating the total body fluid volume disclosed in International Publication No. 2019/138917.
  • the calculator 20 calculates the uric acid distribution volume using the various information acquired in step S12 (S16).
  • the uric acid distribution volume can be calculated by dividing the uric acid removal amount by the uric acid concentration difference before and after dialysis. Therefore, the following formula (2) is established.
  • Acid V indicates the uric acid distribution volume
  • acid E indicates the amount of uric acid removed
  • acid Cs indicates the uric acid concentration before dialysis
  • acid Ce indicates the uric acid concentration after dialysis.
  • the calculation unit 20 substitutes the pre-dialysis uric acid concentration acid Cs, the post-dialysis uric acid concentration acid Ce, and the uric acid removal amount acid E obtained in step S12 into the above equation (2) to obtain the uric acid distribution volume Calculate acid V.
  • the uric acid distribution volume was calculated from the uric acid concentration acid Cs before dialysis, the uric acid concentration acid Ce after dialysis, and the uric acid removal amount acid E, but the configuration is not limited to this.
  • the uric acid distribution volume may be calculated using other information obtainable by dialysis.
  • a method of calculating the uric acid distribution volume using other information that can be obtained by dialysis is disclosed in, for example, International Publication No. 2019/138917.
  • uric acid does not pass through the cell membrane 42 but passes through the capillary membrane 56, so it is distributed only in the extracellular compartment 50 among the water compartments in the body, and is not distributed in the intracellular compartment 40. . Therefore, the uric acid distribution volume corresponds to the extracellular fluid volume. Therefore, for example, the uric acid distribution volume can also be calculated by using the extracellular fluid amount calculation method disclosed in International Publication No. 2019/138917.
  • the calculation unit 20 stores the urea distribution volume calculated in step S14, the uric acid distribution volume calculated in step S16, and the correlation formula storage.
  • the muscle mass is calculated using the correlation formula stored in the unit 18 (S20).
  • the correlation formulas stored in the correlation formula storage unit 18 will be described.
  • the correlation formula stored in the correlation formula storage unit 18 is a formula showing the correlation between the difference between the urea distribution volume and the uric acid distribution volume and the muscle mass.
  • the urea distribution volume corresponds to the total body fluid volume
  • the uric acid distribution volume corresponds to the extracellular fluid volume. Therefore, the value obtained by subtracting the uric acid distribution volume from the urea distribution volume agrees with the value obtained by subtracting the extracellular fluid volume from the total body fluid volume, ie, the permeable intracellular fluid volume.
  • Intracellular fluid volume is known to correlate with muscle mass. Therefore, it can be said that there is a correlation between the difference between the urea distribution volume and the uric acid distribution volume and the muscle mass. A method of calculating the correlation formula will be described below.
  • the muscle mass in the correlation formula is calculated.
  • About 98% of creatine in the body is distributed in muscle. Creatine is irreversibly non-enzymatically converted to creatinine at approximately 2% per day. Therefore, the amount of creatine converted to creatinine per day (ie, creatinine production rate) is proportional to the amount of creatine in the body. That is, the rate of creatinine production is proportional to the muscle mass in the body.
  • the ratio between the amount of creatinine produced per day (creatinine production rate) and muscle mass is called creatinine equivalence.
  • the creatinine equivalence is reported to be 0.0186 when the unit of weight is kg. That is, multiplying the creatinine production rate in mg/day by the creatinine equivalence value (0.0186) yields muscle mass in kg. Therefore, if the creatinine production rate can be obtained, the muscle mass can be calculated.
  • a kinetic model of creatinine is analyzed to calculate the creatinine production rate.
  • the total amount of creatinine removed by dialysis three times a week corresponds to the total amount of creatinine produced in one week. Therefore, the amount of creatinine produced per day (that is, the creatinine production rate) is calculated from the total amount of creatinine removed by dialysis three times a week.
  • the amount of creatinine removed by one dialysis is equal to the amount of creatinine present in the body before dialysis minus the amount of creatinine present in the body after dialysis.
  • the amount of creatinine present in the body before dialysis is equal to the product of the creatinine distribution volume and the serum creatinine concentration before dialysis
  • the amount of creatinine present in the body after dialysis is the creatinine distribution volume and the serum creatinine concentration after dialysis equal to the product of Therefore, the following formula (3) holds.
  • R indicates the amount of creatinine removed by one dialysis
  • V indicates the creatinine distribution volume
  • Cpre indicates the serum creatinine concentration before dialysis
  • Cpost indicates the serum creatinine concentration after dialysis.
  • the creatinine volume of distribution can be estimated by multiplying the post-dialysis body weight by 0.49. From the above, the amount of creatinine removed by one dialysis can be calculated from the serum creatinine concentration before dialysis, the serum creatinine concentration after dialysis, and the body weight after dialysis. Then, the amount of creatinine removed three times a week is calculated, and the calculated amounts of creatinine removed are totaled to calculate the amount of creatinine removed for one week. By dividing this by 7, the amount of creatinine removed per day, that is, the creatinine production rate can be calculated.
  • muscle mass can be calculated by multiplying the creatinine production rate by the creatinine equivalence value.
  • creatinine production rate is also affected by many factors other than muscle mass. For example, the amount of creatinine excreted into the urine, which indicates the rate of creatinine production, fluctuates by 4-8% even under normal circumstances, and increases by 5-10% with vigorous exercise. increased by 10-30% when switched to Therefore, the muscle mass calculated by multiplying the creatinine production rate by the creatinine equivalence value fluctuates greatly from day to day.
  • muscle cells are the only cells in the body that can expand or shrink. This suggests that there is a proportional relationship between intracellular fluid and muscle mass.
  • the urea distribution volume corresponds to the total water content in the body
  • the uric acid distribution volume corresponds to the extracellular fluid content. Therefore, the value obtained by subtracting the uric acid distribution volume from the urea distribution volume is considered to match the intracellular fluid volume. This suggests that the value obtained by subtracting the uric acid distribution volume from the urea distribution volume correlates with muscle mass.
  • the inventors calculated the urea distribution volume and the uric acid distribution volume for 74 patients, and then calculated the difference between the urea distribution volume and the uric acid distribution volume. Also, for 74 patients, the creatinine production rate was calculated, and then the muscle mass was calculated by multiplying the creatinine production rate by the value of creatinine equivalence. As shown in FIG.
  • the muscle mass calculated by multiplying the creatinine production rate by the creatinine equivalence value is distributed above and below the regression line so that the total deviation (residual error) is minimized.
  • the calculated creatinine production rate includes creatinine contained in meat and fish ingested in meals and creatinine leaked from muscles during exercise. Therefore, this deviation is due not only to measurement errors in the creatinine production rate, but also to fluctuations in the creatinine production rate due to diet and exercise, and fluctuations in the natural creatinine production rate.
  • the values on the regression line are values obtained by averaging variations in dietary protein intake and exercise amounts. That is, when using this regression line to calculate the muscle mass from the difference between the urea distribution volume and the uric acid distribution volume, the muscle mass is calculated without errors due to diet and exercise.
  • step S18 the calculation unit 20 substitutes the value obtained by subtracting the uric acid distribution volume calculated in step S16 from the urea distribution volume calculated in step S14 into the correlation expression stored in the correlation expression storage unit 18. Thereby, the muscle mass can be calculated with high accuracy.
  • a correlation formula was created using the value of creatinine equivalence reported by Picou et al.
  • the value of creative equivalence is not limited to this.
  • a correlation may be created using creatinine equivalence values reported by other researchers.
  • the computing device 12 may have an analysis function for obtaining the above correlation formula. Since the arithmetic unit 12 has such an analysis function, the error in the correlation between the difference D between the urea distribution volume and the uric acid distribution volume and the muscle mass is reduced, and the difference between the urea distribution volume and the uric acid distribution volume is reduced. The accuracy of calculating the muscle mass from the difference D can be improved.

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Abstract

La présente invention comporte : une unité d'acquisition de concentration d'urée pour acquérir les concentrations sériques d'urée d'un patient dialysé avant et après une dialyse ; une unité d'acquisition de concentration d'acide urique pour acquérir les concentrations sériques d'acide urique d'un patient dialysé avant et après une dialyse ; et une unité de calcul pour calculer la masse musculaire sur la base de la différence entre le volume de distribution d'urée calculé à partir des concentrations sériques d'urée acquises avant et après une dialyse et le volume de distribution d'acide urique calculé à partir des concentrations sériques d'acide urique acquises avant et après une dialyse.
PCT/JP2022/004955 2021-02-12 2022-02-08 Dispositif pour calculer la masse musculaire et procédé pour calculer la masse musculaire WO2022172926A1 (fr)

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH11218536A (ja) * 1998-01-30 1999-08-10 Toru Niisato 血液透析データを用いたクレアチニン産生速度の算定方法
WO2019138917A1 (fr) * 2018-01-10 2019-07-18 ニプロ株式会社 Appareil de calcul de quantité de fluide extracellulaire et procédé de calcul de quantité de fluide extracellulaire
JP2020174739A (ja) * 2019-04-15 2020-10-29 ニプロ株式会社 細胞外液量標準化装置、これを備える細胞外液量評価装置及び細胞外液量を標準化するためのコンピュータプログラム

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH11218536A (ja) * 1998-01-30 1999-08-10 Toru Niisato 血液透析データを用いたクレアチニン産生速度の算定方法
WO2019138917A1 (fr) * 2018-01-10 2019-07-18 ニプロ株式会社 Appareil de calcul de quantité de fluide extracellulaire et procédé de calcul de quantité de fluide extracellulaire
JP2020174739A (ja) * 2019-04-15 2020-10-29 ニプロ株式会社 細胞外液量標準化装置、これを備える細胞外液量評価装置及び細胞外液量を標準化するためのコンピュータプログラム

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