住院老年患者血浆同型半胱氨酸水平与肌少症的相关性研究

陆冰; 刘晔; 陈吉海; 顾刘宝; 樊垚; 欧阳晓俊

doi:10.16766/j.cnki.issn.1674-4152.002175

住院老年患者血浆同型半胱氨酸水平与肌少症的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.002175

1.
南京医科大学附属老年医院老年医学科，江苏南京 210024
2.
南京医科大学附属老年医院临床流行病学研究室，江苏南京 210024

基金项目:

江苏省卫生健康委保健局科研项目 BJ16025

江苏省卫生健康委科研项目 H2019038

南京医科大学科技发展基金 NMUB2020186

详细信息

通讯作者:
欧阳晓俊，E-mail: xiaojun_ouyang@aliyun.com

中图分类号: R563 R-332
计量
- 文章访问数: 141
- HTML全文浏览量: 103
- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2020-10-22

Correlation between homocysteine and sarcopenia in elderly inpatients

1.
Department of Geriatrics, Geriatric Hospital of Nanjing MedicalUniversity, Nanjing, Jiangsu 210024, China

摘要

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。
- 肌少症 /
- 同型半胱氨酸 /
- 高同型半胱氨酸血症 /
- 老年人 /
- 认知功能
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.
- Sarcopenia /
- Homocysteine /
- Hyperhomocysteinemia /
- The elderly /
- Cognitive function
利益冲突 无

HTML全文

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)	0.090^a	0.764
年龄(x±s，岁)	82.11±9.38	80.25±9.93	83.78±5.36	4.621^b	< 0.001
BMI(x±s)	24.33±2.84	25.90±3.08	22.77±2.61	8.852^b	< 0.001
吸烟[例(%)]	80(23.1)	47(21.0)	33(27.0)	1.310^a	0.252
饮酒[例(%)]	101(29.2)	65(29.0)	36(29.5)	0.004^a	0.952
受教育程度[例(%)]				4.161^c	< 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	0.994^b	0.321
舒张压(x±s，mm Hg)	72.20±8.87	72.45±8.97	71.75±8.72	0.693^b	0.489
AST[M(P₂₅, P₇₅)，U/L]	18(15, 22)	18(15, 22)	17(15, 21)	1.147^c	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)	1.192^c	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)	0.814^c	0.416
尿酸[M(P₂₅, P₇₅)，μmol/L]	330(269，391)	330(275, 392)	330(264, 391)	0.310^c	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)	0.557^c	0.578
HbA1c[M(P₂₅, P₇₅)，%]	6.1(5.8, 6.7)	6.2(5.8, 6.7)	6.0(5.7, 6.8)	1.262^c	0.207
总胆固醇(x±s，mmol/L)	4.11±1.02	4.08±0.99	4.17±1.08	0.722^b	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)	1.911^c	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)	0.097^c	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)	0.836^c	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)	1.825^c	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)	2.531^c	0.011
白蛋白(x±s，g/L)	38.26±4.55	38.85±4.29	37.19±4.84	3.279^b	0.001
总蛋白(x±s，g/L)	67.25±7.10	67.48±6.93	66.82±7.42	0.832^b	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)	0.387^c	0.699
ASMI(x±s)	6.97±1.28	7.54±1.11	5.92±0.83	14.068^b	< 0.001
小腿围[M(P₂₅, P₇₅)，cm]	33(31, 35)	34(33, 36)	31(30, 33)	9.751^c	< 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)	7.118^c	< 0.001
男性	26.1(21.2, 31.0)	28.8(24.2, 33.3)	22.0(18.4, 26.2)	5.888^c	< 0.001
女性	18.5(15.0, 22.1)	20.2(17.0, 24.6)	15.1(13.5, 18.2)	5.581^c	< 0.001
6米步速(x±s，m/s)	0.69±0.24	0.75±0.24	0.58±0.23	6.385^b	< 0.001
MMSE[M(P₂₅, P₇₅)，分]	27(24, 29)	27(25, 29)	25(20, 27)	6.182^c	< 0.001
认知功能障碍[例(%)]	75(21.7)	28(12.5)	47(38.5)	31.510^a	< 0.001
注：^a为χ²值，^b为t值，^c为Z值。1 mm Hg=0.133 kPa。

下载: 导出CSV

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

下载: 导出CSV

参考文献(22)

[1]	WANG L, NIU H, ZHANG J. Homocysteine induces mitochondrial dysfunction and oxidative stress in myocardial ischemia/reperfusion injury through stimulating ROS production and the ERK1/2 signaling pathway[J]. Exp Ther Med, 2020, 20(2): 938-944. doi: 10.3892/etm.2020.8735
[2]	BONETTI F, BROMBO G, ZULIANI G. The relationship between hyperhomocysteinemia and neurodegeneration[J]. Neurodegener Dis Manag, 2016, 6(2): 133-145. doi: 10.2217/nmt-2015-0008
[3]	CHEN S, DONG Z, CHENG M, et al. Homocysteine exaggerates microglia activation and neuroinflammation through microglia localized STAT3 overactivation following ischemic stroke[J]. J Neuroinflammation, 2017, 14(1): 187. doi: 10.1186/s12974-017-0963-x
[4]	KOZAKOVA M, MORIZZO C, PENNO G, et al. Plasma Homocysteine and cardiovascular organ damage in a population with a high prevalence of risk factors[J]. J Clin Endocrinol Metab, 2020, 105(8): dgaa289. http://www.researchgate.net/publication/341657976_Plasma_Homocysteine_and_Cardiovascular_Organ_Damage_in_a_Population_with_a_High_Prevalence_of_Risk_Factors
[5]	XIE Y, FENG H, PENG S, et al. Association of plasma homocysteine, vitamin B12 and folate levels with cognitive function in Parkinson's disease: A meta-analysis[J]. Neurosci Lett, 2017, 636(1): 190-195. http://www.sciencedirect.com/science/article/pii/S0304394016308461
[6]	CRUZ-JENTOFT A J, BAHAT G, BAUER J, et al. Sarcopenia: Revised European consensus on definition and diagnosis[J]. Age Ageing, 2019, 48(1): 16-31. doi: 10.1093/ageing/afy169
[7]	VEERANKI S, LOMINADZE D, TYAGI S C. Hyperhomocysteinemia inhibits satellite cell regenerative capacity through p38 alpha/beta MAPK signaling[J]. Am J Physiol Heart Circ Physiol, 2015, 309(2): H325-334. doi: 10.1152/ajpheart.00099.2015
[8]	CHEN L K, WOO J, ASSANTACHAI P, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment[J]. J Am Med Dir Assoc, 2020, 21(3): 300-307. e2. doi: 10.1016/j.jamda.2019.12.012
[9]	LI H, JIA J, YANG Z. Mini-Mental state examination in elderly Chinese: A population-based normative study[J]. J Alzheimers Dis, 2016, 53(2): 487-496. doi: 10.3233/JAD-160119
[10]	CAMPOS F, ABRIGO J, AGUIRRE F, et al. Sarcopenia in a mice model of chronic liver disease: Role of the ubiquitin-proteasome system and oxidative stress[J]. Pflugers Arch, 2018, 470(10): 1503-1519. doi: 10.1007/s00424-018-2167-3
[11]	张宁, 朱文玲, 刘晓红, 等. 住院老年冠心病患者衰弱与肌肉功能评价的横断面分析[J]. 中华内科杂志, 2019, 58(4): 265-269.
[12]	KIM J, KIM H, ROH H, et al. Causes of hyperhomocysteinemia and its pathological significance[J]. Arch Pharm Res, 2018, 41(4): 372-383. doi: 10.1007/s12272-018-1016-4
[13]	INGENBLEEK Y. Lean body mass harbors sensing mechanisms that allow safeguarding of methionine homeostasis[J]. Nutrients, 2017, 9(9): 1035. doi: 10.3390/nu9091035
[14]	陈茉莉, 夏莉, 赵伟, 等. 血清同型半胱氨酸与原发性肝癌的相关性研究[J]. 中华全科医学, 2020, 18(9): 1443-1445, 1465. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202009004.htm
[15]	VIDONI M L, PETTEE GABRIEL K, LUO S T, et al. Relationship between homocysteine and muscle strength decline: The baltimore longitudinal study of aging[J]. J Gerontol A Biol Sci Med Sci, 2018, 73(4): 546-551. doi: 10.1093/gerona/glx161
[16]	DEGENS H, GAYAN-RAMIREZ G, VAN HEES H W. Smoking-induced skeletal muscle dysfunction: From evidence to mechanisms[J]. Am J Respir Crit Care Med, 2015, 191(6): 620-625. doi: 10.1164/rccm.201410-1830PP
[17]	LEE W J, PENG L N, LOH C H, et al. Sex-different associations between serum homocysteine, high-sensitivity C-reactive protein and sarcopenia: Results from I-Lan Longitudinal Aging Study[J]. Exp Gerontol, 2020, 132(4): 110832. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_PM31772093
[18]	PENG T C, CHEN W L, WU L W, et al. Sarcopenia and cognitive impairment: A systematic review and meta-analysis[J]. Clin Nutr, 2020, 39(9): 2695-2701. doi: 10.1016/j.clnu.2019.12.014
[19]	CHOU M Y, NISHITA Y, NAKAGAWA T, et al. Role of gait speed and grip strength in predicting 10-year cognitive decline among community-dwelling older people[J]. BMC Geriatr, 2019, 19(1): 186. doi: 10.1186/s12877-019-1199-7
[20]	SMITH A D, REFSUM H, BOTTIGLIERI T, et al. Homocysteine and dementia: An international consensus statement[J]. J Alzheimers Dis, 2018, 62(2): 561-570. doi: 10.3233/JAD-171042
[21]	陆冰, 潘晓东, 周林赟, 等. 老年高血压患者同型半胱氨酸水平与脑白质病变分级及认知功能的相关性研究[J]. 中华老年医学杂志, 2019, 38(3): 251-254.
[22]	SINK K M, ESPELAND M A, CASTRO C M, et al. Effect of a 24-Month physical activity intervention vs health education on cognitive outcomes in sedentary older adults: The LIFE randomized trial[J]. JAMA, 2015, 314(8): 781-790. doi: 10.1001/jama.2015.9617