EWGSOP共识在上海市70～79岁社区老年女性肌肉衰减症研究中的应用

Application of EWGSOP Consensus in Evaluating Elderly Female Patients with Sarcopenia Ranging in age from 70 to 79 from Communities of Shanghai

目的:将欧洲老年人肌肉衰减症工作组(EWGSOP)提出的肌肉质量、肌肉力量和身体活动能力三维度综合评定法应用于上海市70~79岁社区老年女性肌肉衰减症的筛检研究中,以了解其检测方法及代表性指标是否适用于中国老年人群。方法:以上海市22位健康老年女性作为研究对象(老年组),另以10位青年女性作为参照对象(青年组),分别采用3D人体扫描法、生物电阻抗(BIA)法和双能X射线(DEXA)法,在获取四肢围度的同时,以相对骨骼肌质量指数(RASM)和骨骼肌指数(SMI)这两项国际通用指标对肌肉质量进行考量;采用握力计、Contrex等动训练仪对上、下肢肌肉力量进行测评;采用10 m步速、功能性伸展测试(FRT)、计时起立行走(TUG)、Berg平衡量表(BBS)、躯体简易功能量表(SPPB)等测试评定身体活动能力,最后参照EWGSOP共识就肌肉衰减症的检出率进行初步判定。结果:(1)老年组上臂围度和上肢脂肪量均较青年组显著上升(P<0.01),而上、下肢肌肉质量均未见显著变化(P>0.05);(2)BIA法和DEXA法检测结果显示,老年组RASM值均显著高于青年组(P<0.05),SMI值均显著低于青年组(P<0.01);(3)老年组握力、相对握力、下肢三关节伸肌和屈肌的各项肌肉力量指标均显著低于青年组(P<0.01),其中相对握力同下肢肌力多数指标间相关性较为显著;(4)老年组身体活动能力较青年组呈现显著衰退趋势(P<0.05),且除握力和步速间存在显著相关关系外,上肢肌力指标同其他身体活动能力指标间均未见显著相关关系;(5)经RASM指标评估肌肉质量维度时,BIA法和DEXA法所得检出率均为0,而经SMI指标评估肌肉质量维度时,相应的检出率分别为63.6%和45.4%。结论:本研究中EWGSOP共识应用于筛检肌肉衰减症时存在指标依赖性,建议在EWGSOP共识首推的"RASM+握力+步速"模式基础上,适当引入"SMI+相对握力+TUG/SPPB/Berg"模式进行综合判定,以避免对EWGSOP共识的简单照搬。

Objective To explore the feasibility of using the consensus of European Working Group on Sarcopenia in Older People（EWGSOP）to diagnose sarcopenia among community-dwelling womenaged from seventy to seventy-nine in Shanghai. Methods Twenty-two healthy community-dwelling women were recruited as the subject group（group S）,and another ten young girls were randomly selectedas the control group（group C）. The anthropometry,bioelectrical impedance analysis（BIA）and dual energy X-ray absorptionmetry（DEXA）were used to evaluate the circumferences of upper and lower limbs,and the dimension of muscle mass,according to relative appendicular skeletal mass（RASM）and skeletalmuscle index（SMI）. The grip dynamometer and isokinetic dynamometer were used to measure the muscle strength of upper and lower limbs. The ten meters gait speed,functional reach test,timed up andgo test,Berg balance scale and short physical performance battery were all applied to assess the physical performance. The criteria of EWGSOP consensus were applied to diagnose the situation of sarcopenia. Results Firstly,the average biceps circumference and fat mass of upper limbs in group S were significantly higher than group C（P〈0.01）,while no significant differences were observed in the musclemass（P〉0.05）. Secondly,RASM values gained from BIA and DEXA in S group were significantly higher than C group（P〈0.05）,while the SMI values of the former were significantly lower than the latter（P〈0.01）. Thirdly,absolute grip strength,relative grip strength and other biomechanical indexes of lowerlimbs in the s group were significantly lower than the C group（P〈0.01）;the relative grip strengthshowed significant correlation with most bio-mechanical indexes of lower limbs. Fourthly,the physicalperformance in group S declined significantly compared with that of the c group（P〈0.05）,and no significant correlation was found between muscle strength and physical performance of upper limbs exceptthe absolute grip strength and gait speed. The prevalence was 0% according to the RASM index,whilethe prevalence was 63.6% and 45.4% according to the BIA and DEXA respectively. Conclusion Theassessing pattern from EWGSOP consensus could not be simply copied to applying on Chinese old peo-ple due to serious difference between RASM and SMI. The combination of＂SMI＋relative grip strength＋TUG/SPPB/Berg＂may be better than the classical mode of ＂RASM＋absolute grip strength＋gait speed＂ in diagnosing sarcopenia.