小腿围在上海老年人肌肉减少症评估诊断中的作用研究

Role of calf circumference in the evaluation and diagnosis of sarcopenia in the elderly in Shanghai

目的探讨上海老年人小腿围和四肢骨骼肌指数、握力、步速之间的关系。进一步研究小腿围与低骨骼肌肌量、力量和功能的诊断界值,验证小腿围在肌肉减少症评估诊断中的作用。方法选择复旦大学附属华东医院体检中心、上海4个社区招募2294例老年人,其中男性954例,女性1340例,平均年龄(71.6±8.7)岁,采用体成分仪检测四肢骨骼肌肌量(ASM)、上肢骨骼肌肌量(UMM)和下肢骨骼肌肌量(LMM),计算四肢骨骼肌指数(四肢骨骼肌指数=ASM/身高2)。测量步速,并用握力器测量握力。测量受试者的身高和体重,右小腿围和腰围。结果不同性别老年人年龄、体重指数(BMI)、腰围、步速差异无统计学意义;男性的身高、体重、ASM、四肢骨骼肌肌量/身高2、UMM、LMM、握力、小腿围明显高于女性(P<0.05)。≥80岁老年人小腿围明显低于70~79岁年龄组和60~69岁年龄组(P<0.05)。≥80岁老年女性小腿围明显低于70~79岁年龄组和60~69岁年龄组(P<0.05)。小腿围与年龄呈负相关(P<0.01),与身高、体重、BMI、握力、UMM、LMM、四肢骨骼肌肌量/身高2呈正相关(P<0.01),小腿围与步速没有相关性(P>0.05)。在小腿围与低四肢骨骼肌肌量/身高2的受试者工作特征曲线中,男性小腿围截断值为35.1 cm(特异度为0.721,敏感度为0.803,曲线下面积为0.809);女性小腿围截断值为33.6 cm(特异度为0.774,敏感度为0.778,曲线下面积为0.827)。结论老年人小腿围随着年龄的增加逐渐下降。小腿围与低骨骼肌肌量的截断值为男性35.1 cm、女性33.6 cm。应重视小腿围在肌肉减少症中评估和诊断的重要性。

Objective To investigate the relationship between calf circumference and appendicular skeletal muscle mass (ASM) index, handgrip strength and gait speed in the elderly in Shanghai, and to explore the optimal cut-off point of calf circumference as a simple proxy marker of skeletal muscle mass, strength and function.Methods A total of 2 294 participants were recruited from physical examination centers in Huadong Hospital Affiliated to Fudan University and 4 communities (954 males and 1 340 females) with an average age of (71.6±8.7) years. Appendicular skeletal muscle mass (ASM), Upper (UMM) and lower (LMM) limbs skeletal muscle mass were measured by bioelectrical impedance analysis (BIA). The ASM index (ASM/height2) were calculated.Gait speed was measured.Muscle strength was measured by handgrip strength using an electronic hand dynamometer.Height, weight, right calf circumference and waist circumference were measured.Results The age, body mass index (BMI), waist circumference and gait speed were not statistically different (all P>0.05) between both genders. Height, weight, ASM, ASM/height2, UMM, LMM, handgrip strength, calf circumference were significantly higher in men than in women (all P<0.05). The calf circumference of the elderly with age ≥ 80 was significantly lower than that of the 70-79 age group and 60-69 age group (P<0.05). The calf circumference of older women (age≥80) was significantly lower than that of the elderly women in the 70-79 age group and 60-69 age group (P<0.05). Calf circumference was correlated negatively with age(P<0.01) and positively with ASM/height2, height, weight, BMI, handgrip strength, UMM and LMM(P<0.01). There was no correlation between calf circumference and gait speed (P>0.05). In the receiver operating characteristic curve (ROC), the cut-off value of calf circumference for low muscle mass was 35.1 cm for male(specificity, 0.721;sensitivity, 0.803, ROC, 0.809) and 33.6 cm for female(specificity, 0.774;sensitivity, 0.778;ROC, 0.827).Conclusions Calf circumference decreases with ageing in the elderly. The optimal cut-off value of calf circumference for low muscle mass is 35.1 cm for males and 33.6 cm for females. We should pay attention to the importance of calf circumference in evaluation and diagnosis of sarcopenia.