老年肌少症患者血清硬骨素和n-3脂肪酸表达水平及临床价值研究

Study on the expression level and clinical value of serum sclerostin and n-3 fatty acid in elderly sarcopenia patients

目的探讨血清硬骨素、n-3脂肪酸在老年肌少症患者中的表达水平及临床意义。方法收集2021年5月—2023年5月新疆医科大学第五附属医院老年病科收治的老年肌少症患者118例为病例组,根据病情程度分为肌少症前期(n=39)、肌少症期(n=46)和重度肌少症期(n=33),选取同期医院健康体检者60例为健康对照组。酶联免疫吸附法检测血清硬骨素,气相色谱法检测n-3脂肪酸水平;人体成分分析仪和生物电阻抗体法检测体脂百分比、上臂围、内脏脂肪面积、蛋白质质量;6M步行法测量步速,Jamar握力计测量双手握力,双能X线吸收仪测量全身及四肢骨骼肌质量,计算相对四肢骨骼肌质量指数(RSMI);硬骨素和n-3脂肪酸与病情严重程度及上述指标的相关性用Pearson积矩相关或Spearman秩相关分析;采用Logistic回归分析老年肌少症的影响因素,ROC曲线评估血清硬骨素和n-3脂肪酸对老年肌少症的诊断价值。结果病例组患者血清硬骨素、n-3脂肪酸水平低于健康对照组(t/P=13.342/<0.001、13.116/<0.001);血清硬骨素、n-3脂肪酸水平比较,肌少症前期>肌少症期>重度肌少症期(F/P=59.138/<0.001、79.217/<0.001);病例组患者体脂百分比、内脏脂肪面积大于健康对照组(t/P=8.732/<0.001、5.124/<0.001),上臂围、蛋白质质量、步速、握力、全身骨骼肌质量、四肢骨骼肌质量、RSMI水平低于健康对照组(t/P=3.859/<0.001、8.459/<0.001、5.758/<0.001、12.492/<0.001、7.006/<0.001、10.334/<0.001、11.813/<0.001);老年肌少症患者血清硬骨素、n-3脂肪酸与体脂百分比、内脏脂肪面积呈负相关(硬骨素:r/P=-0.537/<0.001、-0.612/<0.001;n-3脂肪酸:r/P=-0.498/<0.001、-0.523/<0.001),与上臂围、蛋白质质量、步速、握力、全身骨骼肌质量、四肢骨骼肌质量、RSMI呈正相关(硬骨素:r/P=0.593/<0.001、0.624/<0.001、0.639/<0.001、0.597/<0.001、0.601/<0.001、0.607/<0.001、0.638/<0.001;n-3脂肪酸:r/P=0.569/<0.001、0.611/<0.001、0.570/<0.001、0.592/<0.001、0.549/<0.001、0.534/<0.001、0.587/<0.001);年龄、体脂百分比、内脏脂肪面积升高是老年肌少症危险因素[OR(95%CI)=1.702(1.115~2.600)、1.551(1.052~2.287)、1.387(1.006~1.913)],BMI、上臂围、蛋白质质量、步速、握力、全身骨骼肌质量、四肢骨骼肌质量、RSMI、硬骨素、n-3脂肪酸升高是老年肌少症的保护因素[OR(95%CI)=0.728(0.539~0.982)、0.768(0.593~0.995)、0.845(0.723~0.986)、0.815(0.668~0.995)、0.585(0.382~0.897)、0.746(0.573~0.972)、0.733(0.559~0.964)、0.713(0.541~0.940)、0.822(0.695~0.973)、0.803(0.664~0.971)];血清硬骨素、n-3脂肪酸及二者联合诊断老年肌少症的AUC分别为0.822、0.818、0.894,二者联合诊断老年肌少症的AUC大于其各自单独诊断(Z=2.205、2.328,P=0.002、0.001)。结论老年肌少症患者血清硬骨素和n-3脂肪酸降低,两指标与病情严重程度密切相关,早期联合检测可辅助临床诊断老年肌少症。

Objective To investigate the expression level and clinical significance of serum sclerostin and n-3 fatty acid in elderly patients with sarcopenia.Methods One hundred and eighteen elderly patients with sarcopenia admitted to the Department of Geriatrics,the Fifth Affiliated Hospital of Xinjiang Medical University from May 2021 to May 2023 were collected as the case group,according to the severity of the disease,the patients were divided into pre-sarcopenia(n=39),sarcopenia(n=46)and severe sarcopenia(n=33),and 60 healthy subjects were selected as the control group.Serum sclerostin was detected by enzyme-linked immunosorbent assay,and n-3 fatty acid level was detected by gas chromatography.Body composition analyzer and bioelectrical resistance antibody method were used to detect body fat percentage,upper arm circumference,visceral fat area and protein mass,the walking speed was measured by 6 m walking method,the grip strength of both hands was measured by Jamar grip strength meter,and the skeletal muscle mass of the whole body and limbs was measured by dual energy X-ray absorptiometry,and the relative skeletal muscle mass index(RSMI)of the limbs was calculated;the correlation of sclerostin and n-3 fatty acids with disease severity and body fat percentage,upper arm circumference,visceral fat area,protein mass,walking speed,grip strength,skeletal muscle mass and RASM was analyzed by Pearson product moment correlation or Spearman rank correlation;Logistic regression analysis was used to analyze the influencing factors of sarcopenia in the elderly.The diagnostic value of serum sclerostin and n-3 fatty acids for sarcopenia in the elderly was evaluated by ROC curve.Results Serum sclerostin and n-3 fatty acid levels in case group were less than those in control group(t/P=13.342/<0.001,13.116/<0.001).Serum sclerostin and n-3 fatty acid levels in pre-sarcopenia stage were higher than those in sarcopenia stage and severe sarcopenia stage(F/P=59.138/<0.001,79.217/<0.001).Percentage of body fat,and visceral fat area in case group were greater than those in control group(t/P=8.732/<0.001,5.124/<0.001),upper arm circumference,protein mass,walking speed,grip strength,skeletal muscle mass of the whole body and limbs,RSMI in case group were less than those in control group(t/P=3.859/<0.001,8.459/<0.001,5.758/<0.001,12.492/<0.001,7.006/<0.001,10.334/<0.001,11.813/<0.001).Serum sclerostin and n-3 fatty acid levels were negative associated with percentage of body fat,and visceral fat area(r/P=-0.537/<0.001,-0.612/<0.001;-0.498/<0.001,-0.523/<0.001),and positive associated with upper arm circumference,protein mass,walking speed,grip strength,skeletal muscle mass of the whole body and limbs,RSMI(r/P=0.593/<0.001,0.624/<0.001,0.639/<0.001,0.597/<0.001,0.601/<0.001,0.607/<0.001,0.638/<0.001;0.569/<0.001,0.611/<0.001,0.570/<0.001,0.592/<0.001,0.549/<0.001,0.534/<0.001,0.587/<0.001).Age,body fat percentage,and increased visceral fat area are risk factors for sarcopenia in the elderly[OR(95%CI)=1.702(1.115-2.600),1.551(1.052-2.287),1.387(1.006-1.913)],while BMI,upper arm circumference,protein mass,pace,grip strength,whole-body skeletal muscle mass,limb skeletal muscle mass,RSMI,osteocalcin,and n-3 fatty acids are protective factors for sarcopenia in the elderly[OR(95%CI)=0.728(0.539-0.982)、0.768(0.593-0.995)、0.845(0.723-0.986)、0.815(0.668-0.995)、0.585(0.382-0.897)、0.746(0.573-0.972)、0.733(0.559-0.964)、0.713(0.541-0.940)、0.822(0.695-0.973)、0.803(0.664-0.971)];The AUC of serum osteocalcin,n-3 fatty acids,and their combined diagnosis of sarcopenia in the elderly were 0.822,0.818,and 0.894,respectively.The AUC of their combined diagnosis of sarcopenia in the elderly was greater than that of their individual diagnosis(Z=2.205,2.328,P=0.002,0.001).Conclusion Serum sclerostin and n-3 fatty acids decrease in elderly sarcopenia patients,which are related to disease progression.Early testing of two indicators can be used as biochemical indicators in clinical diagnosis of elderly sarcopenia patients.