高龄患者共病指数与肌少症的相关性研究

doi:10.3877/cma.j.issn.2096-0263.2019.06.005

目的

探讨高龄老年患者共病指数与肌少症的相关性。

方法

回顾性收集东部战区总医院干部病房2017年6月至2018年6月收治的65例年龄大于80岁的老年住院患者。利用胸部CT测量胸12椎体（T₁₂）椎弓根水平肌肉组织的横截面积（cm²）及肌肉密度（HU）。以T₁₂椎弓根水平肌肉横截面积除以患者身高计算得到胸部骨骼肌指数（TSMI）。分析肌少症和非肌少症组患者Charlson共病指数（CCI）、体重指数（BMI）及实验室指标的差异性，分析肌肉密度及面积在不同年龄、CCI分组及是否卧床患者中方面的差异，并通过多因素回归法分析TSMI与CCI、BMI及年龄的关系。

结果

65例高龄老年患者中，80~90岁组的肌肉密度高于90~100岁组，差异具有统计学意义（t=2.294，P<0.05），但肌肉面积的差异无统计学意义；男性和女性之间的肌肉密度差异无统计学意义，而肌肉面积差异有统计学意义（t=4.815，P<0.05）；CCI评分6~9分组肌肉密度及肌肉面积均大于评分为10~14分组，差异有统计学意义（t=3.108，P<0.05；t=3.468，P<0.05）。肌少症组与非肌少症组的CCI评分差异有统计学意义（t=7.754，P<0.05）。两组的BMI、血白蛋白、血肌酐、血红蛋白及肌红蛋白差异无统计学意义。TSMI与CCI呈线性相关关系（r=-0.534，P<0.05）。

结论

共病指数与高龄老年患者肌少症的发生密切相关。

关键词: 肌少症, 老年人，80以上, 共病评估工具

Objective

To explore the correlation between comorbidity index and sarcopenia in elderly patients.

Methods

Sixty-five elderly patients over 80 years old were included in this study. Chest CT was used to measure the cross-sectional area (cm²) and muscle density (HU) of the muscle tissue at the pedicle level of the 12 thoracic vertebral (T₁₂). The thoracic skeletal muscle index (TSMI) was calculated by dividing the cross sectional area of the T₁₂ pedicle level with the height of the patient. The difference of the Charlson comorbidity index (CCI), BMI and the laboratory indexes of patients with sarcopenia and non sarcopenia were analyzed by t test. The difference of muscle density and area between different age groups, CCI groups and bed rest groups were analyzed also by t test. The relationship between TSMI and CCI, BMI, age were analyzed using multivariate regression analysis.

Results

All 65 elderly patients were over 80 years old, the muscle density of the 80-90 year old group was higher than that of the 90-100 year old group, the difference was statistically significant (t=2.294, P<0.05), but the difference of muscle area was not statistically significant. The muscle density and muscle area of the patients in the male and female had not significance difference (t=4.815, P<0.05), and the CCI score 6-9 groups. Muscle density and muscle area were larger than those of the 10-14 groups, and the difference was statistically significant (t=3.108, P<0.05; t=3.468, P<0.05). There was a statistically significant difference in CCI score between sarcopenia group and non sarcopenia group (t=7.754, P<0.05). There was no significant difference in BMI, serum albumin, serum creatinine, hemoglobin and myoglobin between the two groups. The linear correlation between TSMI and CCI was statistically significant (r=-0.534, P<0.05).

Conclusion

The comorbidity index is closely related to the occurrence of sarcopenia in elderly patients.

Key words: Sarcopenia, Aged, 80 and over, Comorbidity assessment tool

表1 高龄肌少症患者不同亚组肌肉密度与肌肉面积的比较

项目	例数	肌肉密度（HU，±s）	肌肉面积（cm²，±s）
年龄（岁）
80～90	49	16±10	109±28
91～100	16	10±10	98±26
t值		2.294	1.639
P值		0.025	0.106
性别
男性	53	13±10	112±24
女性	12	19±13	75±22
t值		-1.471	4.815
P值		0.164	<0.001
CCI得分（分）
6～9	44	16±11	113±28
10～14	21	9±7	90±20
t值		3.108	3.468
P值		0.003	0.001

表1 高龄肌少症患者不同亚组肌肉密度与肌肉面积的比较

项目	例数	肌肉密度（HU，±s）	肌肉面积（cm²，±s）
年龄（岁）
80～90	49	16±10	109±28
91～100	16	10±10	98±26
t值		2.294	1.639
P值		0.025	0.106
性别
男性	53	13±10	112±24
女性	12	19±13	75±22
t值		-1.471	4.815
P值		0.164	<0.001
CCI得分（分）
6～9	44	16±11	113±28
10～14	21	9±7	90±20
t值		3.108	3.468
P值		0.003	0.001

表2 肌少症组与非肌少症组患者各项指标的比较

组别	例数	CCI	BMI（kg/m²，±s）	Alb（g/L，±s）	Scr（umol/L，±s）	Mb（g/L，±s）	Hb（g/L，±s）
肌少症组	47	9.2±2.4	24.2±2.8	34±4	98±44	75±28	116±17
非肌少症组	18	6.3±0.5	23.5±2.9	34±5	81±27	111±103	110±20
t值		7.754	0.89	0.019	1.515	-1.466	1.193
P值		<0.001	0.377	0.985	0.135	0.160	0.237

表2 肌少症组与非肌少症组患者各项指标的比较

组别	例数	CCI	BMI（kg/m²，±s）	Alb（g/L，±s）	Scr（umol/L，±s）	Mb（g/L，±s）	Hb（g/L，±s）
肌少症组	47	9.2±2.4	24.2±2.8	34±4	98±44	75±28	116±17
非肌少症组	18	6.3±0.5	23.5±2.9	34±5	81±27	111±103	110±20
t值		7.754	0.89	0.019	1.515	-1.466	1.193
P值		<0.001	0.377	0.985	0.135	0.160	0.237

图1 SMI与CCI直线相关关系散点图

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Correlation between comorbidity index and sarcopenia in elderly patients

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Correlation between comorbidity index and sarcopenia in elderly patients