原发性高血压合并肌少症患病率及影响因素研究

Prevalence and Influencing Factors of Sarcopenia in Essential Hypertension

背景随着全球人口老龄化日益加剧,肌少症的发病率持续上升,预计到21世纪中叶全球将约有2亿肌少症患者。原发性高血压与肌少症均是老年人的常见病,而目前国内关于原发性高血压与肌少症相关性的研究相对较少。目的了解中老年原发性高血压患者肌少症的患病率,明确原发性高血压患者发生肌少症的危险因素,为中老年原发性高血压患者肌少症的二级预防和早期干预提供参考依据。方法收集2020年12月至2021年12月在云南省第一人民医院老年医学科住院的≥50岁原发性高血压患者107例,收集患者的一般资料、肌少症诊断指标、实验室指标,采用简易营养评估量表(MNA-SF)对患者进行营养评估。根据2019年亚洲肌少症工作组(AWGS)诊断标准,将患者分为肌少症组和非肌少症组。采用二元Logistic回归分析探讨原发性高血压患者发生肌少症的影响因素。绘制受试者工作特征(ROC)曲线探讨体质指数(BMI)对原发性高血压患者发生肌少症的预测价值。结果107例患者中,肌少症组53例(49.5%),非肌少症组54例(50.5%)。体形消瘦者、体质量正常者、超重者、肥胖者肌少症检出率分别为83.3%(5/6)、64.2%(34/53)、30.0%(12/40)、25.0%(2/8),随着BMI等级增加,肌少症检出率降低(χ_(趋势)^(2)=15.027,P=0.001)。二元Logistic回归分析结果显示,女性〔OR=0.175,95%CI(0.059,0.518)〕、超重〔OR=0.039,95%CI(0.003,0.513)〕、肥胖〔OR=0.019,95%CI(0.001,0.459)〕、MNA-SF评分升高〔OR=0.832,95%CI(0.697,0.992)〕、25-羟维生素D〔25-(OH)D〕水平升高〔OR=0.914,95%CI(0.843,0.991)〕是原发性高血压患者发生肌少症的保护因素(P<0.05),高龄〔OR=1.139,95%CI(1.073,1.209)〕、收缩压升高〔OR=1.038,95%CI(1.001,1.076)〕、舒张压升高〔OR=1.095,95%CI(1.035,1.159)〕是原发性高血压患者发生肌少症的危险因素(P<0.05)。BMI预测原发性高血压患者发生肌少症的ROC曲线下面积为0.749〔95%CI(0.656,0.843)〕,最佳截断值为22.0 kg/m^(2),灵敏度为52.8%,特异度为88.9%。结论中老年原发性高血压患者肌少症患病率高。高龄、较高的收缩压及舒张压是肌少症的危险因素,女性、超重、肥胖、较高的维生素D、营养良好是肌少症的保护因素。BMI对原发性高血压患者发生肌少症有很好的预测价值。

Background The prevalence of sarcopenia is rising along with global population aging,and it is estimated that there will be about 200 million sarcopenia patients worldwide by the mid-21st century.Both essential hypertension and sarcopenia are common in the elderly,but the correlation between them has been rarely studied in China.Objective To examine the prevalence and risk factors of sarcopenia in middle-aged and elderly patients with essential hypertension,providing a reference for secondary prevention and early delivery of intervention of sarcopenia in this group.Methods A total of 107 patients with essential hypertension aged ≥50 years who were hospitalized in Geriatric Department,the First People’s Hospital of Yunnan Province from December 2020 to December 2021 were enrolled.Sarcopenia was diagnosed by the recommendation from Asian Working Group for Sarcopenia in 2019.Nutrition status was assessed using the Mini-Nutritional Assessment Scale-Short Form(MNA-SF).The general demographics,sarcopenia diagnostic indicators,laboratory indicators and MNA-SF assessment results were collected.Binary Logistic regression analysis was used to explore the influencing factors of sarcopenia in essential hypertension.The receiver operating characteristic(ROC) analysis was performed to explore the predictive value of body mass index (BMI) for sarcopenia in essential hypertension.Results Among the 107 patients,53 (49.5%) were diagnosed with sarcopenia,and other 54(50.5%) cases had no sarcopenia.The prevalence of sarcopenia in slightly underweight,normal weight,overweight or obesity patients was 83.3%(5/6),64.2%(34/53),30.0%(12/40),25.0%(2/8),respectively.The prevalence rate of sarcopenia decreased with the increase of BMI(χ_(trend)^(2)=15.027,P=0.001).Logistic regression analysis showed that female〔OR=0.175,95%CI(0.059,0.518)〕,overweight〔OR=0.039,95%CI(0.003,0.513)〕,obesity〔OR=0.019,95%CI(0.001,0.459)〕,higher 25-(OH)D〔OR=0.914,95%CI(0.843,0.991)〕,and higher MNA-SF score〔OR=0.832,95%CI(0.697,0.992)〕were associated with decreased risk of sarcopenia(P<0.05),while older age〔OR=1.139,95%CI(1.073,1.209)〕,increased systolic blood pressure〔OR=1.038,95%CI(1.001,1.076)〕and increased diastolic blood pressure〔OR=1.095,95%CI(1.035,1.159)〕were associated with increased risk of sarcopenia(P<0.05).The area under the ROC curve of BMI in predicting sarcopenia was 0.749〔95%CI(0.656,0.843)〕,with 52.8% sensitivity and 88.9% specificity when 22.0 kg/m^(2) was determined as the optimal cut-off value.Conclusion The prevalence of sarcopenia was high in middle-aged and elderly patients with essential hypertension,the risk of which was increased with advanced age,higher systolic blood pressure and diastolic blood pressure,and declined with being female,overweight,obesity,higher vitamin D and good nutrition.BMI may be a good predictor of sarcopenia in essential hypertension.