利用DXA评估系统性红斑狼疮患者中肌少症的现患率

Assessment of sarcopenia prevalence in patients with systemic lupus erythematosus using DXA

目的评估系统性红斑狼疮(systemic lupus erythematosus,SLE)患者中肌少症的现患率,分析SLE共病肌少症患者的体成分变化,探讨SLE患者肌少症发生的危险因素。方法共纳入114例SLE患者(病例组)和114例健康对照者(对照组)。采用双能X线吸收法(dual energy X-ray absorptiometry,DXA)测量两组的肌肉质量,通过握力和步速分别评估患者的肌力和体能。根据欧洲老年人肌少症工作组及亚洲肌少症工作组诊断标准对SLE患者进行肌少症诊断及分期,将SLE患者分为肌少症组及非肌少症组,比较组间患者的体成分及骨密度等指标的差异,分析SLE患者共病肌少症的影响因素。结果SLE患者的平均病程为(79.6±72.8)个月。45.6%(n=52)的SLE患者共病肌少症,其中22.8%(n=26)的患者为肌少症前期,16.7%(n=19)的患者为肌少症期,6.1%(n=7)的患者为严重肌少症期。肌少症组患者的体重、体质指数、脂肪质量指数、全身瘦组织含量、瘦质量指数、全身去脂体重、去脂体重指数均低于非肌少症组和对照组。肌少症组的骨矿物质含量、腰椎和股骨骨密度明显低于对照组。多因素回归分析显示,体质指数(OR=0.61,P<0.001,95%CI:0.49~0.75)和职业劳动强度(OR=2.0,P=0.009,95%CI:1.19~3.34)是SLE患者共病肌少症的影响因素。结论SLE患者中约半数共病肌少症,共病肌少症SLE患者的脂肪、肌肉含量和重要部位骨密度下降,其中体质指数和职业劳动强度是SLE患者出现肌少症的影响因素。

Objective To evaluate the prevalence of sarcopenia in patients with systemic lupus erythematosus(SLE),analyze changes in body composition in patients with SLE comorbid with sarcopenia,and explore the risk factors for sarcopenia in SLE patients.Methods A total of 114 patients with SLE and 114 healthy volunteers were included.Dual-energy X-ray absorptiometry(DXA)was used to measure muscle mass in both groups.Grip strength and gait speed were assessed to evaluate muscle strength and physical performance in patients.Sarcopenia diagnosis and staging were performed according to the criteria of the European Working Group on Sarcopenia in Older People and the Asian Working Group for Sarcopenia.Patients with SLE were divided into sarcopenia and non-sarcopenia groups,and differences in body composition and bone density between the groups were compared.Factors influencing sarcopenia comorbidity in SLE patients were analyzed.Results The mean duration of SLE was(79.6±72.8)months.45.6%(n=52)of SLE patients had comorbid sarcopenia,among which 22.8%(n=26)were in the pre-sarcopenia stage,16.7%(n=19)were in the sarcopenia stage,and 6.1%(n=7)were in the severe sarcopenia stage.Patients with sarcopenia comorbidity in the SLE group had lower body weight,body mass index,fat mass index,whole-body lean tissue content,lean mass index,whole-body lean mass,and lean mass index compared to non-sarcopenia SLE patients and healthy controls.Bone mineral content,lumbar spine,and femoral bone density in sarcopenia subgroups were significantly lower than those in healthy controls.Multivariate regression analysis showed that body mass index(OR=0.61,P<0.001,95%CI:0.49-0.75)and occupational labor intensity(OR=2.0,P=0.009,95%CI:1.19-3.34)were factors influencing sarcopenia comorbidity in SLE patients.Conclusion Approximately half of SLE patients have comorbid sarcopenia,with decreased fat,muscle content,and bone density at important sites in sarcopenia comorbid SLE patients.Body mass index and occupational labor intensity are factors influencing the occurrence of sarcopenia in SLE patients.