共病对老年住院患者肌肉功能的影响

张泽正; 卞爱琳

doi:10.16766/j.cnki.issn.1674-4152.003329

共病对老年住院患者肌肉功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.003329

张泽正,
卞爱琳^,

天津市第一中心医院全科医学科，天津 300000

基金项目:

天津市卫健委科技项目 ZC20220

天津市卫健委科技项目 ZC20159

详细信息

通讯作者:
卞爱琳，E-mail：bianallen@sina.com

中图分类号: R592 R685
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- 被引次数: 0
出版历程
- 收稿日期: 2023-07-25
- 网络出版日期: 2024-03-09

Effect of comorbidities on muscle function in elderly hospitalized patients

ZHANG Zezheng,
BIAN Ailin^,

General Medicine Department, Tianjin First Central Hospital, Tianjin 300000, China

摘要

摘要: 目的本研究通过检测受试者骨骼肌质量、骨骼肌指数、握力，推算运动代谢当量METs值来评估老年人肌肉功能情况，进而探讨共病状态对老年住院患者肌肉功能的影响。方法选取2021年9—12月于天津市第一中心医院全科医学科住院的88例老年患者(年龄≥65岁)作为研究对象。收集患者一般资料，包括性别、年龄、入院主诉症状、疾病诊断、长期用药情况；利用生物电阻抗法测定骨骼肌质量(SMM)、骨骼肌指数(SMI)等，利用握力计测量优势手的握力来评价肌力，利用运动代谢当量METs值评价日常运动水平。评估老年患者共病状态，计算查尔森共病指数(CCI)；根据肌肉质量和运动功能进行肌少症的筛查；分析研究对象的共病情况与肌少症、运动能力的相关性。结果老年住院患者共病患病率为100.0%(88例)，入院主诉症状以头部不适、心前区不适、心悸为主，肌少症患病率为10.2%(9例)，且握力在不同年龄组比较差异均有统计学意义(P < 0.05)。经Spearman相关分析发现，握力与CCI、年龄、体脂率均呈负相关关系(P < 0.05)；METs值与年龄呈负相关关系(P < 0.05)。肌少症患者肿瘤的检出率高于无肌少症患者(P < 0.001)。结论全科医学科住院的老年患者共病情况严重。随着共病状态的加重，肌肉功能下降，且在握力上表现更明显。握力的测量比骨骼肌含量和骨骼肌指数的测量更为便捷，重复性好，适合大规模的现况调查，提示握力在老年人综合评估中有重要的作用。老年女性比男性的日常运动水平高，提示在老年男性患者健康管理时更应该提醒其养成运动习惯。
- 多病共存 /
- 肌肉减少症 /
- 住院患者 /
- 相关性分析
Abstract: Objective To evaluate the muscle function of elderly patients by measuring their skeletal muscle mass, skeletal muscle index, grip strength, and exercise metabolic equivalent METs values, and further explore the impact of comorbidity on muscle function in elderly hospitalized patients. Methods Elderly patients (aged ≥ 65 years) hospitalized in the General Medicine Department of Tianjin First Central Hospital from September 2021 to December 2021 were selected as the study subjects. The following general information for the enrolled cases were collected: gender, age, admission symptoms, disease diagnosis, and long-term medication status. The bioelectrical impedance method was used to measure the skeletal muscle mass (SMM, kg), skeletal muscle index (SMI), etc. The grip strength of the dominant hand was measured by the grip strength meter to evaluate the muscle strength, and the exercise metabolic equivalent of task METs value was used to evaluate the daily exercise level. Comorbidity status in elderly patients was evaluated, the Charlson comorbidity index (CCI) was calculated. Sarcopenia was screened based on muscle mass and motor function. The correlation between comorbidities, sarcopenia, and motor ability of the study subjects was analyzed. Results The prevalence of comorbidities in this study was 100.0% (88 cases), with the main symptoms of admission complaints being head discomfort, precordial discomfort, and palpitations. Among the enrolled cases, the incidence of sarcopenia was 10.2% (9 cases), and there was a statistically significant difference in grip strength among different age groups (P < 0.05). Spearman correlation analysis revealed a negative correlation between grip strength and CCI, age, and body fat rate (P < 0.05). The values of METs were negatively correlated with age (P < 0.05). The detection rate of tumors in patients with sarcopenia was significantly higher than that in patients without sarcopenia (P < 0.001). Conclusion The comorbidities of elderly patients admitted to the general practice department are severe. As comorbidities worsen, muscle function decreases, and the performance in grip strength is more pronounced. The measurement of grip strength is more convenient and reproducible than the measurement of skeletal muscle content and skeletal muscle index, making it suitable for large-scale cross-sectional surveys. This suggests that grip strength plays an important role in the comprehensive evaluation of elderly people. Older women have a higher level of daily exercise than men, suggesting that we should remind older male patients to develop exercise habits when managing their health.
- Multiple chronic conditions /
- Sarcopenia /
- Inpatient /
- Correlation analysis

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表 1 Charlson共病指数评分方法

Table 1. Charlson comorbidity index scoring method

共病情况	Charlson共病分数(分)	共病情况	Charlson共病分数(分)
冠状动脉疾病	1	偏瘫	2
充血性心力衰竭	1	中度至重度肾病	2
慢性肺疾病	1	糖尿病伴终末器官损害	2
消化性溃疡疾病	1	5年内患有肿瘤	2
周围性血管疾病	1	白血病	2
轻度肝脏疾病	1	淋巴瘤	2
脑血管疾病	1	中重度肝病	3
结缔组织疾病	1	转移性肿瘤	6
糖尿病	1	艾滋病	6
痴呆	1
注：根据年龄调整计分，自50~59岁开始计1分，每增加10岁计分增加1分。将所患疾病类型的分数相加并根据年龄增加相应的分数，总分即为Charlsen共病指数。

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表 2 老年共病患者共病数量分布情况

Table 2. Distribution of the number of comorbidity in elderly patients with comorbidity

慢性病数量(个)	例数(%)	男性(例)	女性(例)
2	3(3.4)	1	2
3	4(4.5)	2	2
4	5(5.7)	4	1
5	15(17.0)	6	9
6	14(15.9)	6	8
7	11(12.5)	6	5
8	13(14.8)	11	2
9	10(11.4)	8	2
10	8(9.1)	4	4
11	3(3.4)	2	1
12	2(2.3)	2	0

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表 3 老年共病患者各项疾病患病情况

Table 3. Diseases of senile comorbidities

疾病种类	例数(%)	疾病种类	例数(%)
冠状动脉疾病	64(72.7)	偏瘫	12(13.6)
充血性心力衰竭	35(40.0)	中度至重度肾病	13(14.8)
慢性肺疾病	8(9.1)	糖尿病伴终末器官损害	7(8.0)
消化性溃疡疾病	2(2.3)	5年内患有肿瘤	16(18.2)
周围性血管疾病	18(20.5)	白血病	0
轻度肝脏疾病	16(18.2)	淋巴瘤	0
脑血管疾病	57(64.8)	中重度肝病	1(1.1)
结缔组织疾病	3(3.5)	中重度肝病	8(9.1)
糖尿病	25(28.4)	艾滋病	0
痴呆	3(3.5)

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表 4 不同性别、年龄老年住院患者肌少症相关指标比较

Table 4. Comparison of indicators related to sarcopenia in patients of different genders and ages

年龄(岁)	例数	握力(x±s, kg)		统计量	P值	骨骼肌质量(x±s, kg)		统计量	P值
年龄(岁)	例数	男性	女性	统计量	P值	男性	女性	统计量	P值
65~79	62	26.5±9.8	17.1±4.0	5.057^a	< 0.001	28.1±5.4	21.4±3.1	6.172^a	< 0.001
80~92	26	13.9±8.2	9.6±6.8	1.199^a	0.243	25.9±5.7	20.7±2.8	2.590^a	0.016
统计量		4.581^a	3.593^a			1.325^a	0.572^a
P值		< 0.001	0.001			0.191	0.571

年龄(岁)	例数	骨骼肌指数(x±s, kg/m²)		统计量	P值	METs值[M(P₂₅, P₇₅)]		统计量	P值
年龄(岁)	例数	男性	女性	统计量	P值	男性	女性	统计量	P值
65~79	62	8.2±1.5	7.0±0.8	4.038^a	< 0.001	2.9(1.0, 4.0)	4.1(4.0，4.5)	-2.650^b	0.005
80~92	26	7.8±1.4	6.8±0.7	2.447^a	0.022	1.0(1.0, 4.0)	1.0(1.0, 4.0)	0.216^b	0.835
统计量		0.889^a	0.580^a			0.546^b	2.360^b
P值		0.378	0.566			0.564	0.013
注：^a为t值，^b为Z值。

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表 5 肌少症指标与一般资料及共病情况的相关性分析

Table 5. Correlation analysis of sarcopenia index with general data and comorbidities

项目	SMM		SMI		握力		METs值
项目	r_s值	P值	r_s值	P值	r_s值	P值	r_s值	P值
CCI	0.002	0.988	-0.017	0.877	-0.403	< 0.001	-0.139	0.199
共病数量	0.104	0.333	0.139	0.197	0.005	0.965	-0.025	0.819
累及系统数量	0.156	0.163	0.157	0.158	0.102	0.362	0.077	0.492
年龄	-0.178	0.096	-0.162	0.132	-0.523	< 0.001	-0.240	0.025
体重	0.787	< 0.001	0.802	< 0.001	0.340	0.002	-0.016	0.884
BMI	0.455	< 0.001	0.599	< 0.001	0.153	0.170	0.012	0.912
体脂率	-0.309	0.005	-0.175	0.117	-0.244	0.027	0.017	0.877
用药数量	0.162	0.147	0.177	0.111	0.215	0.053	-0.072	0.518

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表 6 有无肌少症老年住院患者疾病检出情况比较(例)

Table 6. Comparison of disease detection in elderly hospitalized patients with or without sarcopenia (case)

组别	例数	缺血性脑血管病	冠心病	高血压	心律失常	心功能不全	糖尿病	肿瘤	下肢动脉疾病
有肌少症	9	7	4	5	7	5	2	7	2
无肌少症	79	50	59	56	39	26	23	14	16
χ²值		0.743	2.298	0.318	2.614	0.959	0.013	16.039	< 0.001
P值		0.389	0.130	0.573	0.106	0.327	0.909	< 0.001	0.999

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参考文献(15)

[1]	XIA L, ZHAO R, WAN Q, et al. Sarcopenia and adverse health-related outcomes: an umbrella review of meta-analyses of observational studies[J]. Cancer Med, 2020, 9(21): 7964-7978. doi: 10.1002/cam4.3428
[2]	KOCHLIK B, FRANZ K, HENNING T, et al. Frailty is characterized by biomarker patterns reflecting inflammation or muscle catabolism in multi-morbid patients[J]. J Cachexia Sarcopenia Muscle, 2023, 14(1): 157-166. doi: 10.1002/jcsm.13118
[3]	LASKOU F, FUGGLE N R, PATEL H P, et al. Associations of osteoporosis and sarcopenia with frailty and multimorbidity among participants of the Hertfordshire Cohort Study[J]. J Cachexia Sarcopenia Muscle, 2022, 13(1): 220-229. doi: 10.1002/jcsm.12870
[4]	彭德荣, 陈晨, 喻梦珠, 等. 基于数据挖掘的社区高血压患者共病现状及关联规则分析[J]. 中华全科医学, 2023, 21(6): 907-910. doi: 10.16766/j.cnki.issn.1674-4152.003012 PENG D R, CHEN C, YU M Z, et al. Analysis of comorbidity status and association rules of community hypertension patients based on data mining[J]. Chinese Journal of General Practice, 2023, 21(6): 907-910. doi: 10.16766/j.cnki.issn.1674-4152.003012
[5]	王琴, 林萍, 任谦, 等. 肌肉减少症患者血清AMPK-αmRNA、SIRT1、GDF-8的水平及其临床意义[J]. 中华全科医学, 2022, 20(7): 1151-1154, 1229. doi: 10.16766/j.cnki.issn.1674-4152.002545 WANG Q, LIN P, REN Q, et al. The levels of AMPK-αmRNA, SIRT1 and GDF-8 in serum of patients with sarcopenia and their clinical significance[J]. Chinese Journal of General Practice, 2022, 20(7): 1151-1154, 1229. doi: 10.16766/j.cnki.issn.1674-4152.002545
[6]	贡歌, 万文辉, 刘新晖, 等. 高龄患者共病指数与肌少症的相关性研究[J]. 中华老年骨科与康复电子杂志, 2019, 5(6): 327-331. https://www.cnki.com.cn/Article/CJFDTOTAL-LNGK201906006.htm GONG G, WAN W H, LIU X H, et al. A study on the correlation between comorbidity index and sarcopenia in elderly patients[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2019, 5(6): 327-331. https://www.cnki.com.cn/Article/CJFDTOTAL-LNGK201906006.htm
[7]	GONG G, WAN W, ZHANG X, et al. Correlation between the Charlson comorbidity index and skeletal muscle mass/physical performance in hospitalized older people potentially suffering from sarcopenia[J]. BMC Geriatr, 2019, 19(1): 367. doi: 10.1186/s12877-019-1395-5
[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. doi: 10.1016/j.jamda.2019.12.012
[9]	PORTO J M, NAKAISHI A, CANGUSSU-OLIVEIRA L M, et al. Relationship between grip strength and global muscle strength in community-dwelling older people[J]. Arch Gerontol Geriatr, 2019, 82: 273-278. doi: 10.1016/j.archger.2019.03.005
[10]	温俏睿, 吴曼, 刘琪, 等. 中国成年人慢性病与肌肉重量、力量及质量的相关性分析[J]. 中华流行病学杂志, 2021, 42(11): 1948-1954. doi: 10.3760/cma.j.cn112338-20200910-01146 WEN Q R, WU M, LIU Q, et al. Correlation analysis between chronic diseases and muscle weight, strength and mass in Chinese adults[J]. Chinese Journal of Epidemiology, 2021, 42(11): 1948-1954. doi: 10.3760/cma.j.cn112338-20200910-01146
[11]	林伟权, 孙敏英, 刘览, 等. 广州市社区老年人慢性病共病与营养状况相关性研究[J]. 中华全科医学, 2022, 20(11): 1870-1873, 1929. doi: 10.16766/j.cnki.issn.1674-4152.002723 LIN W Q, SUN M Y, LIU L, et al. A study on the correlation between chronic disease comorbidities and nutritional status of elderly people in Guangzhou community[J]. Chinese Journal of General Practice, 2022, 20(11): 1870-1873, 1929. doi: 10.16766/j.cnki.issn.1674-4152.002723
[12]	董潇杨, 张琳洁, 顾冬红, 等. 中老年人握力与多重慢病共病关联的纵向研究[J]. 四川大学学报(医学版), 2021, 52(2): 267-273. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYK202102020.htm DONG X Y, ZHANG L J, GU D H, et al. Longitudinal study on the association between grip strength and multiple comorbidities in middle-aged and elderly people[J]. Journal of Sichuan University(Medical Science Edition), 2021, 52(2): 267-273. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYK202102020.htm
[13]	LIN M H, CHANG C Y, WU D M, et al. Relationship of multimorbidity, obesity status, and grip strength among older adults in Taiwan[J]. Int J Environ Res Public Health, 2021, 18(14): 7540. doi: 10.3390/ijerph18147540
[14]	AMASENE M, MEDRANO M, ECHEVERRIA I, et al. Malnutrition and poor physical function are associated with higher comorbidity index in hospitalized older adults[J]. Front Nutr, 2022, 9: 920485. DOI: 10.3389/fnut.2022.920485.
[15]	MATSUO Y, MITSUYOSHI T, SHINTANI T, et al. Impact of low skeletal muscle mass on non-lung cancer mortality after stereotactic body radiotherapy for patients with stage Ⅰ non-small cell lung cancer[J]. J Geriatr Oncol, 2018, 9(6): 589-593. doi: 10.1016/j.jgo.2018.05.003