Correlation between homocysteine and sarcopenia in elderly inpatients
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摘要:
目的 探讨老年患者血浆同型半胱氨酸(Hcy)水平与肌少症及认知功能状况的相关性。 方法 连续入选2017年6月—2020年3月在南京医科大学附属老年医院住院的老年患者346例,采用步行速度、握力、四肢骨骼肌指数(ASMI)切点诊断肌少症,行简易精神状态量表(MMSE)评定认知功能。共入选老年患者346例,其中肌少症122例(35.3%),非肌少症224例(64.7%)。比较老年患者肌少症组、非肌少症组Hcy水平及认知功能差异,分析Hcy水平与肌少症严重程度及认知功能状况之间的关系,多因素分析肌少症相关因素。 结果 (1) 与非肌少症组相比,肌少症组人群的年龄更高(P < 0.001),BMI、白蛋白、MMSE评分、受教育程度更低(均P < 0.001),Hcy水平更高(P=0.011)。(2)Pearson相关分析显示男性、女性患者的Hcy水平和步速、四肢骨骼肌指数(ASMI)、MMSE评分均呈负相关关系(均P < 0.05)。(3)多因素logistic回归分析结果显示,年龄(OR=1.064,95% CI 1.023~1.106, P=0.002)、BMI(OR=0.658,95% CI 0.589~0.734, P < 0.001)、受教育程度(OR=0.519,95% CI 0.331~0.812, P=0.004)是肌少症的影响因素。对性别进行分层,受教育程度和BMI是男性肌少症患者的影响因素,Hcy水平、年龄、受教育程度、BMI是女性肌少症患者的影响因素。 结论 老年患者Hcy水平与肌少症之间存在相关性。高Hcy水平是老年女性肌少症的危险因素,受教育程度高和高BMI是肌少症人群的保护因素。Hcy可作为肌少症的一项监测指标, 对疾病的评估、预后预测均有一定的临床意义。 Abstract:Objective To explore the association of serum homocysteine (Hcy) levels with sarcopenia and cognitive function in elderly inpatients. Methods A total of 346 elderly patients hospitalized in The Affiliated Geriatric Hospital of Nanjing Medical University from June 2017 to March 2020 were selected, including 122 cases (35.3%) with sarcopenia and 224 cases (64.7%) without sarcopenia. Walking speed, grip strength and limb skeletal muscle index (ASMI) were used to diagnose sarcopenia, and MMSE was used to assess cognitive function. The differences in Hcy level and cognitive function between the sarcopenia group and the non-sarcopenia group were compared, the relationship between Hcy level and the severity and cognitive function of sarcopenia was analyzed, and the influencing factors related to sarcopenia were analyzed by multiple factors. Results (1) Compared with the non-sarcopenia group, the sarcopenia group was older and had lower body mass index (BMI), serum albumin level, MMSE score and education level (all P < 0.001) and higher Hcy level (P=0.011). (2) Pearson correlation analysis showed that high Hcy level was negatively correlated with low gait speed, low ASMI and low MMSE score (all P < 0.05). (3) Multivariate logistic regression analysis revealed that age, high BMI and high education level were related to sarcopenia in total subjects. High education level and high BMI in males and age, high Hcy level, high BMI and high education level in females were associated with the presence of sarcopenia. Conclusions The higher Hcy level in elderly patients with sarcopenia, the more severe the decline of ASMI, gait speed and cognitive function. High Hcy level is a risk factor for sarcopenia in elderly women. High education level and high BMI are protective factors for sarcopenia. Serum Hcy level may be used as a monitoring index for sarcopenia, which has a certain clinical significance in disease evaluation and prognosis prediction. -
Key words:
- Sarcopenia /
- Homocysteine /
- Hyperhomocysteinemia /
- The elderly /
- Cognitive function
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表 1 研究对象一般人口学特征和临床特征
项目 总体(346例) 非肌少症组(224例) 肌少症组(122例) 统计量 P值 男性[例(%)] 222(64.2) 145(64.7) 77(63.1) 0.090a 0.764 年龄(x±s,岁) 82.11±9.38 80.25±9.93 83.78±5.36 4.621b < 0.001 BMI(x±s) 24.33±2.84 25.90±3.08 22.77±2.61 8.852b < 0.001 吸烟[例(%)] 80(23.1) 47(21.0) 33(27.0) 1.310a 0.252 饮酒[例(%)] 101(29.2) 65(29.0) 36(29.5) 0.004a 0.952 受教育程度[例(%)] 4.161c < 0.001 小学及以下 27(7.8) 8(3.6) 19(15.6) 初中、高中 161(46.5) 102(45.5) 59(48.4) 大学及以上 158(45.7) 114(50.9) 44(36.1) 收缩压(x±s,mm Hg) 134.49±15.74 133.87±15.17 135.63±16.76 0.994b 0.321 舒张压(x±s,mm Hg) 72.20±8.87 72.45±8.97 71.75±8.72 0.693b 0.489 AST[M(P25, P75),U/L] 18(15, 22) 18(15, 22) 17(15, 21) 1.147c 0.157 尿素氮[M(P25, P75),mmol/L] 5.60(4.74, 6.80) 5.59(4.63, 6.62) 5.78(4.89, 7.03) 1.192c 0.233 肌酐[M(P25, P75),μmol/L] 76.8(64.2, 89.0) 75.9(64.8, 86.2) 78.0(62.7, 98.5) 0.814c 0.416 尿酸[M(P25, P75),μmol/L] 330(269,391) 330(275, 392) 330(264, 391) 0.310c 0.757 血钾[M(P25, P75),mmol/L] 3.9(3.6, 4.1) 3.9(3.7, 4.1) 3.8(3.6, 4.1) 0.557c 0.578 HbA1c[M(P25, P75),%] 6.1(5.8, 6.7) 6.2(5.8, 6.7) 6.0(5.7, 6.8) 1.262c 0.207 总胆固醇(x±s,mmol/L) 4.11±1.02 4.08±0.99 4.17±1.08 0.722b 0.471 TG[M(P25, P75),mmol/L] 1.07(0.79, 1.52) 1.12(0.80, 1.62) 1.05(0.77, 1.36) 1.911c 0.056 低密度脂蛋白胆固醇[M(P25, P75),mmol/L] 2.26(1.69, 2.84) 2.31(1.66, 2.85) 2.16(1.73, 2.82) 0.097c 0.923 TSH[M(P25, P75),uIU/ml] 2.03(1.33, 2.81) 1.91(1.34, 2.69) 2.18(1.32, 2.96) 0.836c 0.403 超敏CRP[M(P25, P75),mg/L] 1.35(0.60, 2.92) 1.10(0.53, 2.65) 1.70(0.67, 3.18) 1.825c 0.053 Hcy[M(P25, P75),μmol/L] 12.5(10.5, 15.4) 12.3(10.1, 15.6) 13.2(11.5, 15.2) 2.531c 0.011 白蛋白(x±s,g/L) 38.26±4.55 38.85±4.29 37.19±4.84 3.279b 0.001 总蛋白(x±s,g/L) 67.25±7.10 67.48±6.93 66.82±7.42 0.832b 0.406 心脏彩超EF[M(P25, P75),%] 65.7(63.6, 68.5) 65.7(63.6, 68.5) 65.8(63.6, 68.6) 0.387c 0.699 ASMI(x±s) 6.97±1.28 7.54±1.11 5.92±0.83 14.068b < 0.001 小腿围[M(P25, P75),cm] 33(31, 35) 34(33, 36) 31(30, 33) 9.751c < 0.001 最大握力值[M(P25, P75),kg] 22.7(18.2, 29.7) 25.8(20.1, 30.8) 19.2(15.1, 24.1) 7.118c < 0.001 男性 26.1(21.2, 31.0) 28.8(24.2, 33.3) 22.0(18.4, 26.2) 5.888c < 0.001 女性 18.5(15.0, 22.1) 20.2(17.0, 24.6) 15.1(13.5, 18.2) 5.581c < 0.001 6米步速(x±s,m/s) 0.69±0.24 0.75±0.24 0.58±0.23 6.385b < 0.001 MMSE[M(P25, P75),分] 27(24, 29) 27(25, 29) 25(20, 27) 6.182c < 0.001 认知功能障碍[例(%)] 75(21.7) 28(12.5) 47(38.5) 31.510a < 0.001 注:a为χ2值,b为t值,c为Z值。1 mm Hg=0.133 kPa。 表 2 住院老年患者肌少症影响因素的logistic回归分析
项目 类别 B SE Wald χ2 P值 OR值 95% CI 总人群(346例) Hcy(μmol/L) 0.021 0.027 0.618 0.432 1.021 0.969~1.077 性别 -0.050 0.294 0.000 0.987 0.995 0.559~1.771 年龄(岁) 0.062 0.020 9.551 0.002 1.064 1.023~1.106 白蛋白(g/L) -0.017 0.036 0.236 0.627 0.983 0.916~1.054 BMI -0.419 0.056 56.089 < 0.001 0.658 0.589~0.734 受教育程度 -0.656 0.229 8.250 0.004 0.519 0.331~0.812 男性(222例) Hcy(μmol/L) -0.007 0.033 0.047 0.828 0.993 0.930~1.060 年龄(岁) 0.039 0.023 2.832 0.092 1.040 0.994~1.089 受教育程度 -0.625 0.283 4.872 0.027 0.535 0.307~0.932 白蛋白(g/L) 0.006 0.042 0.018 0.894 1.006 0.926~1.092 BMI -0.454 0.076 35.964 < 0.001 0.635 0.548~0.737 女性(124例) Hcy(μmol/L) 0.114 0.050 5.149 0.023 1.120 1.016~1.236 年龄(岁) 0.147 0.046 10.321 0.001 1.158 1.059~1.267 受教育程度 -0.988 0.446 4.901 0.027 0.372 0.155~0.893 白蛋白(g/L) -0.066 0.079 0.701 0.402 0.936 0.803~1.092 BMI -0.490 0.107 20.908 < 0.001 0.613 0.497~0.756 -
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