老年肌力减少症与肌肉衰减症患者身体成分的比较

A comparative study of body composition in elderly patients with dynapenia and sarcopenia

目的比较老年肌力减少症与肌肉衰减症患者的身体成分特征。方法采用横断面调查研究方法,于2020年1月至8月招募泸州市401名60岁及以上社区老年人进行肌肉衰减症的筛查,应用Inbody770人体成分分析仪测定身体成分,然后根据2019年亚洲肌肉衰减症工作组(asian worKing group for sarcopenia,AWGS2019)的诊断标准分为正常组(n=118,29.93%),肌力减少症组(n=150,36.91%),肌肉衰减症前期组(n=27,6.98%)和肌肉衰减症组(n=106,26.18%),采用多元方差分析比较4组各项身体成分指标的差异。结果在男性中,肌力减少症组的下肢体脂肪高于肌肉衰减症组(P<0.05),肌力减少症组的下肢细胞外水分与细胞内水分比值(extracellular water to intracellular water ratio,ECW/ICW)高于正常组(P<0.05);但正常组、肌力减少症、肌肉衰减症前期、肌肉衰减症组上肢ECW/ICW两两比较,差异均无统计学意义(P>0.05);下肢体脂肪与去脂体重比值(body fat mass to fat free mass ratio,BFM/FFM)与步速(r=-0.141,P=0.048)呈负相关。在女性中,同样肌力减少症组的下肢体脂肪高于肌肉衰减症组;肌肉衰减症组的上肢ECW/ICW高于肌肉衰减症前期组;肌肉衰减症组和肌力减少症组的下肢ECW/ICW高于正常组(P均<0.05);上肢ECW/ICW与握力(r=-0.234,P=0.001)呈负相关;下肢ECW/ICW与骨骼肌质量指数(skeletal muscle mass index,SMI)(r=-0.247,P<0.001)、握力(r=-0.334,P<0.001)和步速(r=-0.380,P<0.001)呈负相关。结论无论男女,肌力减少症患者的下肢体脂肪均高于肌肉衰减症患者。在老年女性中,肌力减少症和肌肉衰减症患者的下肢ECW/ICW均高于健康老人。此外,男性下肢BFM/FFM增加和女性下肢ECW/ICW升高均与肌肉质量减少、肌肉力量下降及躯体功能减退密切相关。因此,应将身体成分的评估和监测纳入老年人健康管理的范畴,作为预防和治疗肌肉衰减症的重要策略。

Objective To compare the differences in whole-body or regional body composition between elderly patients with dy-napenia and sarcopenia.Methods Using the cross-sectional survey research method,we recruited 401 community-dwelling older adults aged 60 years or older who participated in a sarcopenia screening program as study participants from January to August 2020 in Luzhou City.Body composition parameters were measured by Inbody770 body composition analyzer,and then,according to diagnostic criteria of Asian WorKing Group for Sarcopenia(AWGS)in 2019,participants were categorized into the robust group(n=118,29.93%),the dynapenia group(n=150,36.91%),the presarcopenia group(n=27,6.98%),and the sarcopenia group(n=106,26.18%).The differences of each body composition indicator among the four groups were compared applying Multivariate analysis of variance(MANOVA).Results In men,dynapenia group had significantly more body fat mass in the leg than the sarcopenia group(P<0.05).The ECW/ICW ratio in the leg of the dynapenia group was higher than that of the robust group(P<0.05).However,no signifi-cant differences in the arm ECW/ICW ratio was detected between the robust,dynapenia,presarcopenia,and sarcopenia groups(all P>0.05).The BFM/FFM ratio in the leg was negatively correlated with gait speed(r=-0.141,P=0.048).In women,similarly body fat mass in the leg was higher in the dynapenia group compared to the sarcopenia group.The ECW/ICW ratio of the sarcopenia group in the arm was higher than that of the presarcopenia group,and ECW/ICW ratio was higher in the leg in the dynapenia and sarcopenia group compared to the robust group(all P<0.05).Pearson correlation analysis showed that ECW/ICW ratio in the arm was negatively corre-lated with handgrip strength(r=-0.234,P=0.001)and ECW/ICW ratio in the leg was negatively correlated with SMI(r=-0.247,P<0.001),handgrip strength(r=-0.334,P<0.001),and gait speed(r=-0.380,P<0.001).Conclusions Regardless of men and women,patients with dynapenia exhibited higher body fat mass in the leg compared to patients with sarcopenia.Especially in elderly women,ECW/ICW ratios in the leg were higher in both patients with dynapenia and sarcopenia than in normal people.In addition,el-evated BFM/FFM of lower limbs in males and increased ECW/ICW ratios of lower limbs in females were strongly associated with de-creased muscle strength and impaired physical performance.Therefore,monitoring and assessment of body composition should be incor-porated in the health management of older adults as an important strategy for the prevention and treatment of sarcopenia.