社区老年人不同程度肌少症与跌倒风险的关系研究

周璇; 陈文英; 张珊; 洪秀芳; 熊艳华

doi:10.16766/j.cnki.issn.1674-4152.001926

社区老年人不同程度肌少症与跌倒风险的关系研究

doi: 10.16766/j.cnki.issn.1674-4152.001926

浙江医院综合内科，浙江杭州 310000

基金项目:

浙江省医药卫生科技计划项目 2019KY005

浙江省医药卫生科技计划项目 2020KY386

详细信息

通讯作者:
周璇，E-mail: 15257270087@163.com

中图分类号: R197.61 R685
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- 文章访问数: 102
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- 被引次数: 0
出版历程
- 收稿日期: 2020-04-05
- 网络出版日期: 2022-02-16

Study on the relationship between different degrees of sarcopenia and the risk of falls in the elderly in the community

Department of General Medicine, Zhejiang Hospital, Hangzhou, Zhejiang 310000, China

摘要

摘要: 目的研究社区老年人不同程度肌少症与跌倒风险的关系。方法选取杭州市5个社区街道卫生服务中心辖区内的500例老年人作为研究对象，并将其分为非肌少症、肌少症前期、肌少症和肌少症严重期4组，随机顺序测量姿势稳定性相关指标，对不同程度肌少症与跌倒风险相关的因素进行单因素分析和Spearman分析。结果 FAEO、FAEC、FTEO和FTEC 4种状态下肌少症严重期CoP平均速度明显高于非肌少症和肌少症前期，FAEO、FAEC、FTEO和FTEC 4种状态下肌少症严重期ML移动距离明显长于非肌少症和肌少症前期(均P < 0.05)，而AP移动距离相比差异无统计学意义(P＞0.05)；4组在年龄、吸烟史、饮酒史、过去1年内跌倒史、平衡功能受损、反应下降、下肢肌力减退、BMI和MFES评分方面相比差异有统计学意义(均P < 0.05)；Spearman分析发现，不同程度肌少症与平衡功能受损、反应下降、下肢肌力减退均呈正相关，与BMI呈负相关；肌少症严重期和肌少症与过去1年内跌倒史、MFES评分均呈正相关，肌少症严重期与饮酒史、CoP平均速度、ML移动距离也呈正相关。结论肌少症严重期老年人的跌倒风险与过去1年内跌倒史、反应下降、下肢肌力减退、平衡功能受损、姿势稳定性及跌倒恐惧心理有关，应基于这些风险因素完善社区干预策略。
- 肌少症 /
- 跌倒风险 /
- 肌力 /
- 恐惧心理 /
- 反应
Abstract: Objective The aim of this study was to explore the relationship between sarcopenia and the risk of falls among the elderly in the community. Methods This study selected 500 elderly people in the districts of five community street health service centers in Hangzhou as the research objects, and divide them into Non-myopathy group, pre-sarcopenia group, myopathy group and severe myopathy group, the postural stability related indexes were measured in random sequence, and the factors related to fall risk in patients with different degrees of myopathy were analyzed by single factor analysis and Spearman analysis. Results The average speed of centre of pressure (CoP) in the severe stage of sarcopenia is significantly higher in feet apart/eyes closed feet apart with eyes closed (FAEC), feet together/eyes open feet close together eyes open (FTEO) and feet together/eyes closed feet together eyes close (FTEC) than in the prophase of non-sarcopenia and pre-sarcopenia. the mediolateral (ML) movement distance in the severe stage of sarcopenia is significantly longer in Feet apart with eyes open (FAEO), FAEC, FTEO and FTEC than in the non-sarcopenia and pre-sarcopenia (all P < 0.05), while the difference in anteroposterior (AP) movement distance is not statistically significant (P > 0.05). There were statistically significant differences in age, smoking history, drinking history, fall history in the past year, impaired balance function, decreased reaction, lower limb muscle strength, body mass index (BMI) and modified falls efficacy scale (MFES) scores among the four groups (all P < 0.05); Spearman analysis found that different degrees of myopathy were positively correlated with impaired balance function, decreased response and decreased lower limb muscle strength, while negatively correlated with BMI. The severity of sarcopenia and sarcopenia were positively correlated with the fall history and MFES score in the past year. The severity of sarcopenia was also positively correlated with the drinking history, CoP average speed and ML moving distance. Conclusion The risk of falls in the elderly with severe stage of sarcopenia is related to the history of falls, decreased response, lower limb muscle strength, impaired balance function, posture stability, and fear of falls in the past year. Community intervention strategies should be improved based on these risk factors.
- Sarcopenia /
- Fall risk /
- Muscle strength /
- Feared state of mind /
- Reaction

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表 1 4组受试者不同状态CoP平均速度对比(x±s，cm/s)

组别	例数	FAEO	FAEC	FTEO	FTEC
非肌少症	337	1.31±0.22	1.17±0.21	1.63±0.32	1.69±0.51
肌少症前期	72	1.52±0.23	1.47±0.24	0.51±0.13	1.92±0.38
肌少症	46	1.96±0.31^ab	1.88±0.32^ab	2.12±0.34^ab	2.33±0.45^ab
肌少症严重期	45	2.66±0.56^ab	2.46±0.48^ab	2.65±0.55^ab	2.67±0.67^ab
F值		356.530	389.720	308.137	278.904
P值		＜0.001	＜0.001	＜0.001	＜0.001
注：与非肌少症比较，^aP＜0.05；与肌少症前期比较，^bP＜0.05。

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表 2 4组受试者不同状态AP移动距离对比(x±s，cm)

组别	例数	FAEO	FAEC	FTEO	FTEC
非肌少症	337	2.52±0.62	2.60±0.61	2.78±0.61	2.77±0.51
肌少症前期	72	2.82±0.65	3.02±0.66	3.02±0.71	3.08±0.71
肌少症	46	2.79±0.60	2.97±0.59	2.95±0.69	3.15±0.58
肌少症严重期	45	3.06±0.47	3.07±0.62	3.14±0.23	3.23±0.70
F值		0.889	1.094	1.136	1.270
P值		0.764	0.820	0.825	0.833

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表 3 4组受试者不同状态ML移动距离对比(x ±s，cm)

组别	例数	FAEO	FAEC	FTEO	FTEC
非肌少症	337	1.71±0.62	1.68±0.55	1.66±0.54	1.87±0.48
肌少症前期	72	1.72±0.60	1.67±0.47	1.71±0.62	0.86±0.25
肌少症	46	2.99±0.72^ab	2.99±0.68^ab	3.21±0.73^ab	3.44±0.78^ab
肌少症严重期	45	3.59±0.80^ab	3.49±0.74^ab	3.94±0.81^ab	4.02±0.89^ab
F值		301.420	269.480	274.109	255.40
P值		＜0.001	＜0.001	＜0.001	＜0.001
注：与非肌少症比较，^aP＜0.05；与肌少症前期比较，^bP＜0.05。

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表 4 不同程度肌少症受试者跌倒风险的单因素分析[例(%)]

项目	类别	非肌少症(n=337)	肌少症前期(n=72)	肌少症(n=46)	肌少症严重期(n=45)	统计量	P值
性别	男性	144(42.73)	31(43.06)	19(41.30)	20(44.44)	0.258^a	0.800
	女性	193(57.27)	41(56.94)	27(58.70)	25(55.56)
年龄(岁)	60~69	51(15.13)	11(15.28)	13(28.26)	1(2.22)	245.124^a	＜0.001
	70~79	184(54.60)	39(54.17)	19(41.30)	31(68.89)
	≥80	102(30.27)	22(30.56)	14(30.43)	13(28.89)
受教育程度	小学及以下	31(9.20)	7(9.72)	4(8.70)	5(11.11)	1.482^a	0.049
	初中	169(50.15)	36(50.00)	23(50.00)	23(51.11)
	高中	103(30.56)	22(30.56)	14(30.43)	14(31.11)
	高中以上	33(9.80)	7(9.72)	5(10.87)	4(8.90)
吸烟史	从不吸烟	26(7.72)	6(8.33)	4(8.70)	3(6.67)	106.312^a	＜0.001
	已戒烟	237(70.33)	51(70.83)	38(82.61)	26(56.62)
	吸烟	73(21.66)	16(22.22)	4(8.70)	16(35.56)
饮酒史	从不饮酒	53(15.73)	11(15.28)	10(21.74)	5(11.11)	246.246^a	＜0.001
	已戒酒	223(66.17)	48(66.67)	22(65.22)	19(42.22)
	饮酒	61(18.10)	13(18.06)	14(30.43)	21(46.67)
过去1年内跌倒史		92(27.30)	33(45.83)	18(39.13)	23(51.11)	77.835^a	0.005
规律服用药物4种以上		130(38.58)	8(11.11)	16(34.78)	16(35.56)	2.241^a	0.058
精神科药物使用		56(16.62)	0(0.00)	3(6.52)	13(28.89)	1.905^a	0.069
视力衰弱		0(0.00)	3(4.17)	6(13.04)	0(0.00)	1.683^a	0.117
触觉减弱		18(5.34)	4(5.56)	7(15.22)	8(17.78)	1.219^a	0.480
平衡功能受损		128(37.98)	31(43.06)	24(52.17)	25(55.56)	209.783^a	0.001
反应下降		57(16.91)	24(33.33)	16(34.78)	40(88.89)	311.042^a	＜0.001
下肢肌力减退		19(5.64)	25(34.72)	23(50.00)	26(57.78)	213.379^a	＜0.001
BMI(x±s)		23.43±3.02	22.05±2.99	20.96±2.43	20.12±2.33	313.200^b	＜0.001
MFES评分(x±s，分)		26.12±1.51	27.32±1.29	28.34±1.65	32.39±1.78	277.012^b	＜0.001
注：^a为χ²值，^b为F值。

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表 5 不同程度肌少症与跌倒相关风险因素的关系分析

因素	非肌少症		肌少症前期		肌少症		肌少症严重期
因素	r值	P值	r值	P值	r值	P值	r值	P值
年龄	0.017	0.131	0.022	0.201	0.102	0.069	0.437	0.046
吸烟史	0.007	0.377	0.012	0.375	0.103	0.449	0.200	0.097
饮酒史	0.010	0.551	0.017	0.357	0.118	0.055	0.401	0.047
CoP平均速度	0.013	0.207	0.019	0.187	0.048	0.093	0.686	0.011
ML移动距离	0.026	0.211	0.039	0.199	0.079	0.222	0.697	0.004
过去1年内跌倒史	0.334	0.057	0.337	0.051	0.562	0.023	0.657	0.013
平衡功能受损	0.403	0.046	0.469	0.041	0.675	0.010	0.731	< 0.001
反应下降	0.437	0.044	0.479	0.040	0.692	0.007	0.751	< 0.001
下肢肌力减退	0.463	0.042	0.511	0.039	0.690	0.008	0.744	< 0.001
BMI	0.388	0.049	-0.359	0.047	-0.493	0.038	-0.695	0.003
MFES评分	0.167	0.053	0.266	0.051	0.481	0.039	-0.734	< 0.001

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