除步速外的步态标记物在肌少症合并认知障碍筛查中的价值  

The value of gait markers other than gait speed in screening for sarcopenia with cognitive impairment

作　　者：王静 周哲平 周莉[3] 金玲娟 孙万飞 王月菊[1] Wang Jing;Zhou Zheping;Zhou Li;Jin Lingjuan;Sun Wanfei;Wang Yueju(Department of Geriatrics,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Geriatrics,The Affiliated Changshu No.2 People's Hospital of Nantong University,Changshu 215500,China;Department of Nutrition,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Suzhou Yiyang Nursing Home,Suzhou 215006,China;Department of Geriatrics,Taihe County People's Hospital,Fuyang 236600,China)

机构地区：[1]苏州大学附属第一医院老年医学科,苏州215006 [2]南通大学附属常熟第二人民医院老年医学科,常熟215500 [3]苏州大学附属第一医院临床营养科,苏州215006 [4]苏州市怡养护理院,苏州215006 [5]阜阳市太和县人民医院老年科,阜阳236600

出　　处：《中华老年医学杂志》2024年第10期1285-1291,共7页Chinese Journal of Geriatrics

基　　金：江苏省卫健委临床技术应用研究项目建设单位(LD2021024);江苏省老年医学临床技术应用研究项目带头人(LR2021006);苏州市医学重点学科项目(SZXK202101);肠道菌群调试对老年肌少症患者的干预效果研究(2020YFC2005604-5)。

摘　　要：目的老年肌少症患者合并认知障碍往往会带来更严重的不良事件。本研究旨在分析老年肌少症合并认知障碍患者的身体成分特点和步态特征,寻找老年肌少症合并认知障碍的敏感步态标记物。方法本研究邀请苏州地区3个不同护理院的200例老年人参与,使用北京版蒙特利尔认知量表(MoCA-BJ)评估总体认知功能,生物电阻抗法分析身体成分,可穿戴步态分析系统检测步态,筛选肌少症合并认知障碍的步态预测因子并构建预测模型。结果83名参与者被纳入分析并分为3组,肌少症合并轻度认知障碍(MCI)组24例,肌少症合并痴呆组24例,对照组(认知功能正常且无肌少症的老年人)35例。与对照组比较,肌少症合并MCI组的骨骼肌质量指数[(5.6±0.8)kg/m^(2)比(7.4±0.8)kg/m^(2)]、总蛋白[(6.7±1.1)kg比(8.9±1.5)kg]、上臂肌肉维度[(21.4±1.7)cm比(24.1±2.3)cm]更低(均P<0.05)。与对照组比较,肌少症合并痴呆组的步幅[(0.45±0.17)m比(0.65±0.22)m]更短、步速[(0.38±0.13)m/s比(0.55±0.18)m/s]更慢、转弯角速度[(89.8±23.4)度/s比(116.8±26.3)度/s]更小,转弯时间[(3.2±0.5)s比(2.8±0.3)s]更长(均P<0.05)。转弯时间对肌少症合并MCI有一定的预测能力(曲线下面积=0.673,灵敏度70.8%,特异度68.6%);年龄+转弯角速度的模型(曲线下面积=0.87,灵敏度83.3%,特异度85.7%)对于肌少症合并痴呆表现出较好的预测价值。结论与对照组比较,肌少症合并MCI组的肌肉力量、营养状态及步态表现更差。除步速外,本研究提出转弯相关的步态指标对肌少症合并认知障碍有较高预测价值,基于可穿戴设备的步态评估可能是筛查这类高危人群的新途径。Objective Elderly patients with sarcopenia and cognitive impairment are prone to experiencing more severe adverse events.This study aimed to analyze body composition and gait characteristics in this population,as well as to identify sensitive gait indicators of sarcopenia in individuals with cognitive impairment.Methods A total of 200 elderly individuals from 3 different nursing homes in Suzhou were recruited for this study.The participants'overall cognitive function was assessed using the Beijing version of the Montreal Cognitive Assessment(MoCA-BJ),body composition was evaluated through bioelectrical impedance analysis,and gait was assessed using a wearable gait analysis system.Gait predictors of sarcopenia with cognitive impairment were then identified and used to construct predictive models.Results The study encompassed 83 participants,divided into three groups:35 in the control group(cognitively normal,without sarcopenia),24 in the sarcopenia with mild cognitive impairment(MCI)group,and 24 in the sarcopenia with dementia group.When compared to the control group,individuals in the sarcopenia with MCI group exhibited lower Skeletal Muscle Mass Index[(5.6±0.8)kg/m^(2)vs.(7.4±0.8)kg/m^(2)],Total Protein[(6.7±1.1)kg vs.(8.9±1.5)kg],and Arm Muscle Circumference[(21.4±1.7)cm vs.(24.1±2.3)cm](all P<0.05).Similarly,in comparison to the control group,those in the sarcopenia with dementia group displayed a shorter stride length[(0.45±0.17)m vs.(0.65±0.22)m],slower gait speed[(0.38±0.13)m/s vs.(0.55±0.18)m/s],smaller turn velocity[(89.8±23.4)degrees/s vs.(116.8±26.3)degrees/s],and longer turn duration[(3.2±0.5)s vs.(2.8±0.3)s](all P<0.05).Notably,turn duration was identified as having predictive value for sarcopenia with MCI[Area under the curve(AUC)=0.673,sensitivity 70.8%,specificity 68.6%],while a model incorporating age and turn velocity demonstrated strong predictive power for sarcopenia with dementia(AUC=0.87,sensitivity 83.3%,specificity 85.7%).Conclusions Compared to the control group,the group wit

关 键 词：认知障碍 步态 肌少症 

分 类 号：R685[医药卫生—骨科学] R749.1[医药卫生—外科学]