两种肌肉衰减症的国际共识在上海社区老年女性研究中的应用

Study on Application of EWGSOP & AWGS Consensus for Sarcopenia in Elderly Community Dwelling Women from Shanghai

目的:参照两种肌肉衰减症国际共识,从肌肉质量、肌肉力量和身体活动能力等3个维度上对上海市老年女性肌肉衰减状况进行层层分析。方法:以上海市60~69岁之间的健康老年女性作为研究对象(E组),分别采用3D人体形态测量法、生物电阻抗法(BIA)、双能X射线吸收法(DEXA)以RASM和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等动训练器对受试者上、下肢肌肉力量进行测评;采用10 m步速、FRT、TUG、Berg平衡量表、SPPB测试等进行身体活动能力评定,最后分别参照两种国际共识就肌肉衰减症的检出率进行初步判定。结果:1)无论是采用BIA法,还是DEXA法测量,E组SMI值均随增龄呈现显著下降(P<0.001),而RASM值未见显著变化(P>0.05);2)E组握力、相对握力、下肢各关节伸肌和屈肌的各项力学指标也均随增龄显著下降(P<0.001),且相对握力同下肢肌力多数指标间相关性较为显著;3)E组步速、FRT、BBS得分、SPPB得分等均随增龄显著下降(P<0.05),并伴有TUG耗时显著上升(P<0.05),其中,SPPB测试不仅同握力和相对握力间呈现显著正相关,而且同TUG和BBS测试也具有显著相关性(P<0.05);4)两种共识标准下,采用RASM指标时肌肉衰减症检出率均较低,仅介于0%~3.5%,而采用SMI指标时相应检出率均为12.3%。结论:步入60岁以后,老年女性在3个维度均呈现显著下降;当参照两种共识进行肌肉衰减症判定时,SMI指标较RASM指标的检出效果更为稳定;建议今后将RASM和SMI两指标综合考量,并将相对握力和SPPB分别作为肌肉力量维度和身体活动能力维度的首选指标。总之,早日建立中国共识将有助于今后运动干预研究的开展。

Objective： By using the criteria of EWGSOP ＆ AWGS to analyze more details on elderly community dwelling women from Shanghai in three dimensions during diagnosing sarcopenia. Method： Healthy community dwelling women aged from sixty to sixty-nine were recruited from Yangpu district. Then, anthropometry, bioelectrical impedance analysis and dual energy X-ray absorptionmetry methods were used to evaluate the dimension of muscle mass, especially the indexes such as RASM ＆ SMI. Besides, grip dynamometer and isokinetic dynamometer were used to detect the muscle strength from upper and lower limbs. Furthermore, 10 meters gait speed, functional reach test, timed up and go test, Berg balance scale and short physical performance battery were all used to assess the dimension of physical performance. At last, the criteria of EWGSOP ＆ AWGS consensus were applied to diagnose the situation of sarcopenia. Results： 1 ） the value of SMI in elderly group declined significantly either by BIA or DEXA index with aging. 2 ） absolute grip strength, relative grip strength and other bio-mechanical indexes from lower limbs showed significantly decreasing, moreover, relative grip strength correlated significantly with most bio-mechanical indexes from lower limbs. 3 ） the value of gait speed, FRT, BBS, SPPB in the elderly women declined significant- ly, while TUG rose obviously. Meanwhile, the correlation between SPPB and absolute/relative grip strength remained significantly, let alone TUG and BBS. 4） the prevalence in this study were 3.5% and 12.3% according to RASM and SMI respectively. Conclusion： Muscle mass, muscle strength and physical performance in the elderly women declined significantly together after sixty years old. SMI showed more stability than RASM during using the criteria from EWGSOP ＆ AWGS. Therefore, combining the RASM with SMI will be better to understand the dimension of muscle mass, what＇ s more, this study also showed that relative grip strength and SPPB should be recommended as the first choice in future study. In a word, the consensus from China mainland is needed urgently for exercise intervention.