肌少症合并腹型肥胖对住院老年人肌力及躯体功能的影响

doi:10.16138/j.1673-6087.2023.02.003

摘要/Abstract

摘要：

目的: 探讨肌少症合并腹型肥胖对老年人肌力和躯体功能的影响。方法: 选取符合纳入标准的2021年1月至6月入住上海市第四康复医院九病区及综合病区患者94例。使用生物电阻抗分析法（bioelectrical impedance analysis，BIA）测所有受试者体成分，并评估肌力及躯体功能，采用腰3椎体CT图像分析法评估所有肌少症患者的脂肪分布情况。采用逐步回归分析肌少症患者肌力及躯体功能的影响因素。结果: 老年住院患者的肌少症患病率为男性70.7%、女性69.8%，同时合并腹型肥胖比例为男性39.0%、女性40.0%。肌少症合并腹型肥胖患者中男性的肌力及躯体功能评分显著低于非肌少症组（P<0.05），亦较单纯肌少症组评分低，其中5次起坐时间显著长于单纯肌少症组（P<0.05）；女性结果则相反，肌力及躯体功能评分虽显著低于非肌少症组（P<0.05），但高于单纯肌少症组或与之相当，其中握力显著大于单纯肌少症组（P<0.05）。逐步回归分析显示肌少症男性患者5次起坐时间与腰围呈正相关（P<0.05），与四肢骨骼肌质量指数（appendicular skeletal muscle mass index，ASMI）呈负相关（P<0.05）；女性患者握力与体质量指数（body mass index，BMI）呈负相关，与ASMI、皮下脂肪面积（subcutaneous fat area，SFA）呈正相关（均P<0.05），骨矿含量（bone mineral content，BMC）与5次起坐时间呈负相关（P<0.05）。结论: 腹型肥胖加重男性肌少症患者肌力及躯体功能的恶化，对女性肌少症患者的保护作用可能是因为一定的皮下脂肪量，并且得益于更高的ASMI及BMC。

关键词: 老年, 肌少症, 腹型肥胖, 肌力, 躯体功能

Abstract:

Objective To investigate the effect of sarcopenia combined with abdominal obesity on muscle strength and somatic function in the elderly. Methods A total of 94 patients who met the admission criteria were enrolled in the ninth ward and comprehensive ward of Shanghai Fourth Rehabilitation Hospital from January to June in 2021. Bioelectrical impedance analysis(BIA) was used to measure the body composition in all subjects, and muscle strength and somatic function were evaluated, and lumbar 3 vertebral CT image analysis was used to assess the fat distribution in all patients with sarcopenia. Stepwise regression was used to analyze the influencing factors of muscle strength and somatic function in them. Results The prevalence of sarcopenia among elderly hospitalized patients was 70.7% in men and 69.8% in women, and the proportion of abdominal obesity was 39.0% in men and 40.0% in women. In patients with sarcopenia and abdominal obesity, the scores of muscle strength and somatic function in men were significantly lower than those in the non-sarcopenia group (P<0.05), and also lower than those in the sarcopeniaonly only group, in which the five-repetition-sit-to-stand test (5STS) time were significantly longer than those in the sarcopeniaonly only group (P<0.05). While the results in women were converse, in which the scores of muscle strength and somatic function significantly were lower than those in the non-sarcopenia group (P<0.05), while higher than or comparable to those in the sarcopeniaonly only group, in which the grip strength was significantly greater than that in the sarcopeniaonly only group(P<0.05). Stepwise regression analysis showed that 5STS time in male patients with sarcopenia was positively correlated with waist circumference, and negatively correlated with appendicular muscle mass index (ASMI) (P<0.05); in female patients: grip strength was negatively correlated with body mass index (BMI), and positively correlated with ASMI and subcutaneous fat area (SFA) (P<0.05). Bone mineral content(BMC) was negatively correlated with 5STS(P<0.05). Conclusions Abdominal obesity aggravated the deterioration of muscle strength and somatic function in male sarcopenia patients, and the protective effect on female sarcopenia patients could be due to a certain amount of subcutaneous fat and higher ASMI and BMC.

Key words: Elderly, Sarcopenia, Abdominal obesity, Muscle strength, Somatic function

中图分类号:

R337

张音, 沈宏华, 许轶明, 任蕾, 李骏, 吴顺军, 凌小楠. 肌少症合并腹型肥胖对住院老年人肌力及躯体功能的影响[J]. 内科理论与实践, 2023, 18(02): 76-82.

ZHANG Yin, SHEN Honghua, XU Yiming, REN Lei, LI jun, WU Shunjun, LING Xiaonan. Effect of sarcopenia combined with abdominal obesity on muscle strength and physical function in hospitalized elderly[J]. Journal of Internal Medicine Concepts & Practice, 2023, 18(02): 76-82.

图/表 7

表1

表2

一般资料特征[（$\bar{x}±s$）/n（%）]

项目	男性			F/χ²	P	女性			F/χ²	P
项目	非肌少症（n=12）	单纯肌少症（n=13）	肌少症合并腹型肥胖（n=16）	F/χ²	P	非肌少症（n=16）	单纯肌少症（n=16）	肌少症合并腹型肥胖（n=21）	F/χ²	P
年龄（岁）	72.25±7.11	79.69±6.63¹⁾	82.25±7.34¹⁾	7.230	0.002	83.75±7.70	84.44±7.32	85.67±6.57	0.344	0.711
ALB（g/L）	38.99±4.15	36.68±3.72	36.18±4.12	1.822	0.176	34.87±4.71	36.68±3.72	36.90±3.93	1.328	0.274
TG（mmol/L）	1.79±0.71	1.25±0.69	1.29±0.47	2.954	0.064	1.62±1.44	1.25±0.69	1.43±0.41	0.220	0.803
合并症[n（%）]
冠心病	5 (41.7)	7 (53.8)	10 (62.5)	1.197	0.550	10 (62.5)	11 (68.7)	15 (71.4)	0.340	0.844
脑卒中	8 (66.7)	9 (69.2)	12 (75.0)	—^*	0.913	9 (56.3)	11 (68.7)	16 (76.2)	1.660	0.435
慢性气道疾病	7 (58.3)	9 (69.2)	11 (68.8)	—^*	0.841	6 (37.5)	11 (68.7)	13 (61.9)	3.580	0.167
糖尿病	5 (41.7)	6 (46.2)	9 (56.2)	0.638	0.728	7 (43.7)	8 (50.0)	15 (71.4)	3.240	0.198
身高（m）	1.73±0.04	1.70±0.06	1.71±0.05	1.122	0.336	1.57±0.05	1.57±0.05	1.56±0.05	0.390	0.679
体重（kg）	76.42±5.25	60.23±6.78¹⁾	66.00±7.98¹⁾	23.410	<0.000 1	65.63±9.43	45.69±4.94¹⁾	54.98±7.28^1),2)	30.770	<0.000 1
BMI（kg/m²）	25.63±1.89	20.96±2.85¹⁾	22.64±2.36¹⁾	13.440	0.000	26.39±3.59	18.58±1.99¹⁾	22.59±3.21^1),2)	31.810	<0.000 1
颈围（cm）	38.75±2.77	35.42±2.01¹⁾	38.09±3.23²⁾	7.096	0.004	36.53±3.09	31.19±1.52¹⁾	35.64±2.91²⁾	29.920	<0.000 1
腰围（cm）	98.04±6.61	84.85±4.79¹⁾	97.97±6.32²⁾	25.900	<0.000 1	102.00±9.70	79.03±4.72¹⁾	92.86±6.22^1),2)	50.240	<0.000 1
臀围（cm）	97.42±4.46	90.46±3.88¹⁾	98.75±7.37²⁾	11.900	0.000	102.50±9.13	86.56±4.54¹⁾	95.64±3.57^1),2)	29.450	<0.000 1
腰臀比	1.00±0.05	0.94±0.04¹⁾	0.99±0.05²⁾	8.872	0.001	1.00±0.06	0.91±0.03¹⁾	0.97±0.05²⁾	16.180	<0.000 1
小腿围（cm）	33.79±3.37	30.92±1.57¹⁾	32.75±3.64	4.411	0.025	33.31±3.79	24.94±2.90¹⁾	30.19±3.82^1),2)	26.320	<0.000 1

表2

表3

表4

图1

表5

表6

参考文献 22

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指标	n	非肌少症（n=28）	单纯肌少症（n=29）	肌少症合并腹型肥胖（n=37）	χ^2*	P
体重过低
男性	2	0（0.0）	2（100.0）	0（0.0）	-	1.000
女性	14	0（0.0）	11（78.6）	3（21.4）
体重正常
男性	18	3（16.7）	10（55.5）	5（27.8）	3.965	0.155
女性	20	4（20.0）	5（25.0）	11（55.0）
超重
男性	20	8（40.0）	1（5.0）	11（55.0）	-	0.830
女性	13	7（53.8）	0（0.0）	6（46.2）
肥胖
男性	1	1（100.0）	0（0.0）	0（0.0）	-	1.000
女性	6	5（83.3）	0（0.0）	1（16.7）

项目	非肌少症（n=12）	单纯肌少症（n=13）	肌少症合并腹型肥胖（n=16）	F	P
体成分
LBM（kg）	47.08±11.91	32.53±11.61¹⁾	35.68±8.53¹⁾	5.280	0.013
SMM（kg）	31.71±8.94	30.26±13.91	27.91±7.80	0.479	0.623
ASM（kg）	22.73±1.64	18.02±1.97¹⁾	17.93±1.93¹⁾	31.250	<0.000 1
ASMI（kg/m²）	7.63±0.62	6.23±0.36¹⁾	6.14±0.47¹⁾	26.660	<0.000 1
VFA（cm²）	131.4±38.7	99.62±53.59	147.70±51.71²⁾	3.508	0.040
PBF（%）	32.79±5.66	28.22±10.11	35.58±7.93	2.943	0.065
BMC（g）	2.75±0.40	2.41±0.13¹⁾	2.38±0.32¹⁾	4.073	0.032
肌肉力量指标
握力（kg）	25.74±8.24	17.89±7.26¹⁾	15.49±3.76¹⁾	7.870	0.003
伸膝肌肌力（kg）	23.84±6.37	16.48±5.01¹⁾	12.92±3.04¹⁾	15.360	<0.000 1
躯体功能指标
6 m步速（m/s）	0.71±0.21	0.48±0.17¹⁾	0.42±0.14¹⁾	8.500	0.002
SPPB	7.75±2.38	5.54±1.66¹⁾	4.63±2.13¹⁾	6.380	0.006
5次起坐时间（s）	30.79±13.49	44.76±11.67¹⁾	58.79±15.09^1),2)	12.990	0.000

项目	非肌少症（n=16）	单纯肌少症（n=16）	肌少症合并腹型肥胖（n=21）	F	P
体成分
LBM（kg）	37.11±9.65	23.99±7.02¹⁾	29.49±11.42	9.530	0.001
SMM（kg）	27.87±9.42	18.41±8.59¹⁾	23.10±9.11	4.330	0.022
ASM（kg）	17.34±2.94	10.30±2.12¹⁾	12.17±1.85^1),2)	29.970	<0.000 1
ASMI（kg/m²）	6.95±1.00	4.17±0.81¹⁾	4.97±0.58^1),2)	37.630	<0.000 1
VFA（cm²）	146.1±61.44	132.6±57.05	136.60±73.49	0.180	0.835
PBF（%）	39.39±8.52	34.69±10.64	37.03±12.64	0.740	0.483
BMC（g）	2.35±0.33	1.81±0.36	2.73±2.96	1.070	0.350
肌力指标
握力（kg）	15.66±4.18	10.21±4.01¹⁾	13.89±4.57²⁾	7.320	0.002
伸膝肌肌力（kg）	11.37±2.51	9.72±2.63	10.01±1.91	2.030	0.150
躯体功能指标
6 m步速（m/s）	0.57±0.18	0.39±0.12¹⁾	0.38±0.13¹⁾	7.250	0.003
SPPB	6.63±1.82	4.38±2.03¹⁾	3.38±1.94¹⁾	13.720	<0.000 1
5次起坐时间（s）	44.01±11.10	58.43±18.72¹⁾	53.65±18.06¹⁾	4.240	0.023

项目	单纯肌少症		t	P	肌少症合并腹型肥胖		t	P
项目	男性	女性	t	P	男性	女性	t	P
VFA	105.60±55.45	66.51±57.27	1.858	0.075	151.40±50.96	143.20±81.75	0.350	0.729
SFA	74.20±41.73	89.47±52.25	0.854	0.401	96.51±35.94	168.20±80.07	3.327	0.002
VSR	1.50±0.34	0.72±0.26	7.025	<0.000 1	1.65±0.45	0.82±0.26	7.045	<0.000 1

变量	β	调整R²	P
男性
5次起坐时间
腰围	0.45	0.34	0.007
ASMI-BIA	-0.44		0.008
女性
握力
BMI	-0.73	0.45	0.003
ASMI-BIA	0.49		0.001
SFA-CT	0.47		0.030
5次起坐时间
BMC-BIA	-0.35	0.1	0.035