老年住院患者肌肉衰减综合征对骨质疏松症的预测价值及模型构建  

Predictive value of sarcopenia for osteoporosis and model construction in elderly hospitalized patients

作　　者：朱烈烈 邵湘芝 夏健宁 吴登宠[1] ZHU Lie-lie;SHAO Xiang-zhi;XIA Jian-ning;WU Deng-chong(Department of Rehabilitation,Wenzhou Hospital of Tradiional Chinese Medicine,Wenzhou 325000,Zhejiang,China)

机构地区：[1]温州市中医院康复科,浙江温州325000

出　　处：《广东医学》2023年第5期623-630,共8页Guangdong Medical Journal

基　　金：温州市基础性科研项目(Y20220064)。

摘　　要：目的 研究老年住院患者的肌肉衰减与骨质疏松症之间的关系并探讨肌肉衰减综合征各维度指标对骨质疏松症发生的预测价值。方法 纳入康复科住院的老年患者377例,根据其是否合并骨质疏松症分为骨质疏松组(112例)和非骨质疏松组(265例),比较两组相关指标的差异。骨骼肌含量采用四肢肌肉含量(ASM)与身高(Ht)的平方之比(ASM/Ht2)表示。肌肉功能以握力(kg)和步速(m/s)来评定。采用Spearman偏相关分析上述指标与骨密度之间的相关性,采用logistic回归分析握力、步速、肌肉含量与骨质疏松的关系并构建预测模型,同时应用受试者工作特征(ROC)曲线评估上述指标对骨质疏松症的预测价值。结果 骨质疏松组女性比例、体质指数(BMI)、年龄校正的查尔森合并症指数(aCCI)分级评分均显著高于非骨质疏松组,而平均骨密度、步速、握力、ASM和ASM/Ht2均显著低于非骨质疏松组(均P<0.05)。校正年龄和BMI后,步速、握力和ASM/Ht2仍与平均骨密度呈正相关(均P<0.05)。多因素logistic回归分析发现,年龄、BMI、握力、步速和ASM/Ht2与骨质疏松的发生独立相关(P<0.05)。构建骨质疏松风险预测模型为:Logit(P)=1.354+0.128×年龄+0.107×BMI-0.382×握力-1.970×步速-0.261×ASM/Ht2。进一步性别分层发现,男性组握力、ASM/Ht2及女性组握力、步速与骨质疏松的发生呈负相关(OR值分别为0.716、0.717、0.646和0.069,均P<0.05),是骨质疏松发生的独立保护因素。用ROC分析显示,模型总的预测效能AUC为0.923(95%CI:0.891~0.948),对应的敏感度为81.25%,特异度为94.72%。在总人群组与女性组,与步速、ASM/Ht2和BMI相比,握力的AUC最高。握力预测男性和女性骨质疏松的最佳临界值分别为26.69和24.01,敏感度分别为90.00%和80.56%,特异度分别为67.92%和84.91%。结论 老年住院患者肌肉衰减与骨质疏松症的发生密切相关,握力、步速和ASM/Ht2作为肌肉衰减综合�Objective To study the relationship between sarcopenia and osteoporosis in elderly hospitalized patients,and to explore the predictive value of the assessment-indicators of sarcopenia for osteoporosis.Methods The clinical data of 377 elderly hospitalized patients admitted to the rehabilitation department were divided into osteoporosis group(112 cases)and non-osteoporosis group(265 cases).Skeletal muscle mass was evaluated by the ratio of appendicular skeletal muscle mass(ASM)to height(Ht)squared(ASM/Ht^(2)).Muscle function was evaluated by grip strength(kg)and gait speed(m/s).Spearman partial correlation was used to analyze the correlation between the above indexes and bone mineral density(BMD).Logistic regression was used to analyze the relationship between grip strength,usual gait speed,muscle mass and osteoporosis.ROC curve was used to evaluate the predictive value of the above indexes for osteoporosis.Results Compared with the non-osteoporosis group,the proportion of women and the scores of BMI and aCCI in the osteoporosis group were significantly higher,while the average BMD,usual gait speed,grip strength,ASM,and ASM/Ht^(2)were significantly lower in the osteoporosis group(all P<0.05).After adjusting for age and BMI,usual gait speed,grip strength,and ASM/Ht’were still positively correlated with average BMD(all P<0.05).Multivariate logistic regression analysis showed that age,BMI,grip strength,gait speed and ASM/Ht^(2)were independently correlated with osteoporosis.The model for predicting the risk of osteoporosis was established as follows,Logit(P)=1.354+0.128×age+0.107×BMI-0.382×grip strength-1.970×usual gait speed-0.261×ASM/Ht^(2).Further gender stratification showed that grip strength,ASM/Ht in male group and grip strength,gait speed in female group were negatively correlated with the osteoporosis(0R=0.716,0.717,0.646,and 0.069 respectively,all P<0.05),which were independent protective factors for osteoporosis.The total prediction efficiency of the model was analyzed by ROC curve,and its AUC was 0.

关 键 词：肌肉衰减综合征 握力 步速 四肢肌肉含量 骨质疏松症 预测 

分 类 号：R592[医药卫生—老年医学] R493[医药卫生—内科学]