鄭熙 李淑梅 方圓
摘 要 目的:探討老年人的營養(yǎng)狀況與骨質(zhì)疏松癥(OP)和肌肉減少癥篩查結(jié)果之間的關(guān)系。方法:以2018年6月15日-2019年7月15日在上海市虹口區(qū)江灣鎮(zhèn)社區(qū)衛(wèi)生服務(wù)中心自愿參加體檢的954名60歲及以上的老年人為研究對象,其中男性441人,女性513人。應(yīng)用微型營養(yǎng)評估簡表(MNA-SF)對受試者進(jìn)行營養(yǎng)評估,使用跟骨定量超聲儀測量跟骨的骨密度(T值),通過測量握力(HS)和4米步態(tài)速度(GS)來評估肌肉力量與功能。結(jié)果:共發(fā)現(xiàn)營養(yǎng)不良及營養(yǎng)不良風(fēng)險者174例(18.2%)。不同營養(yǎng)狀況的OP風(fēng)險分布差異具有統(tǒng)計(jì)學(xué)意義(P<0.001)。營養(yǎng)狀況與GS(r=0.113,P<0.001)、HS(r=0.087,P=0.007)和T值(r=0.185,P<0.001)有顯著相關(guān)性。結(jié)論:營養(yǎng)不良的老年人骨質(zhì)疏松癥和肌肉減少癥的易患風(fēng)險較高,應(yīng)盡早對該類人群進(jìn)行高危篩查和確診檢查。
關(guān)鍵詞 骨質(zhì)疏松癥;肌肉減少癥;老年人;營養(yǎng)狀況;篩查
中圖分類號:R681 文獻(xiàn)標(biāo)志碼:A 文章編號:1006-1533(2020)18-0041-06
The relationship between nutritional status and the risk of osteoporosis and sarcopenia of the elderly in the community
ZHENG Xi1, LI Shumei2, FANG Yuan1(1. General Practice Department of Jiangwan Community Health Service Center, Shanghai 200434, China; 2. Department of Endocrinology of Shanghai Fourth Peoples Hospital, Shanghai 200081, China)
ABSTRACT Objective: To investigate the relationship between nutritional status and screening results of osteoporosis(OP) and sarcopenia in the elderly. Methods: From June 15, 2018 to July 15, 2019 954 elderly persons aged 60 and above who voluntarily participated in medical examinations were taken as the research objects in Jiangwan Community, Shanghai, including 441 males and 513 females. Mini nutritional assessment-short form(MNA-SF) was used to evaluate the nutritional status of the subjects, the bone mineral density(T value) of calcaneus was measured by calcaneal quantitative ultrasound, and muscle strength and function were evaluated by measuring grip strength(HS) and gait speed(GS) of 4 meters. Results: There were 174 cases(18.2%) with malnutrition and malnutrition risk found. The difference in OP risk distribution between different nutritional statuses was statistically significant(P<0.001). Nutritional status was significantly correlated with GS(r=0.113, P<0.001), HS(r=0.087, P=0.007) and T value(r=0.185, P<0.001). Conclusion: Elderly people with malnutrition have a higher risk of osteoporosis and sarcopenia, and high-risk screening and definitive diagnosis should be conducted for this group of people as early as possible.
KEY WORDS osteoporosis; sarcopenia; elderly people; nutritional status; screening
根據(jù)國家統(tǒng)計(jì)局第六次全國人口普查,2011年60歲及以上人口約為1.8億,老齡化問題日益嚴(yán)重[1]。營養(yǎng)不良往往會對老年人健康造成嚴(yán)重影響[2]。目前已被證實(shí),營養(yǎng)不良與社區(qū)老年人身體機(jī)能下降有關(guān)[3],如造成骨骼結(jié)構(gòu)和強(qiáng)度的破壞,甚至是肌肉的萎縮[4],最終導(dǎo)致骨質(zhì)疏松癥(Osteoporosis,OP)和肌肉減少癥(以下簡稱“肌少癥”)。
OP患者因骨強(qiáng)度下降,和/或肌少癥因肌肉力量和活動能力減弱,導(dǎo)致平衡能力下降而跌倒,兩者均被認(rèn)為容易并發(fā)脆性骨折,漸已成為全球性健康問題,會給老齡化社會帶來沉重的經(jīng)濟(jì)負(fù)擔(dān)[5-7]。而且OP和肌少癥存在共同的病理生理因素[8]。但目前我國居民對這兩種疾病的重視度不夠,檢查率不高,一旦發(fā)生脆性骨折,將嚴(yán)重降低患者的生活質(zhì)量[9]。因此,評估老年人營養(yǎng)狀況是篩查OP和肌少癥的重要環(huán)節(jié)。本文旨在探討老年人營養(yǎng)狀況與OP和肌少癥篩查結(jié)果的相關(guān)性。
OP曾被認(rèn)為是衰老的自然結(jié)果,但它卻是一種由于骨量流失而被忽視的疾病[28]。2016年的一項(xiàng)研究顯示,我國大陸50歲及以上人群的OP患病率已上升至27.96%[29]。本研究結(jié)果顯示,83.6%的老年人屬于OP中風(fēng)險和高風(fēng)險,但年齡與T值無相關(guān)性。然而,一項(xiàng)年齡跨度為28歲至90歲的研究表明,無論男性還是女性,隨著年齡增長,跟骨超聲聲速檢測會降低[30]??赡茉蚴悄挲g跨度較大,涵蓋了一部分年齡小于60歲的人群。
本研究發(fā)現(xiàn),T值與HS和GS呈正相關(guān)。相關(guān)研究也提示肌少癥可能與低骨量和OP有關(guān)[31]。同時,Locquet等[32]的研究提示,患有肌損傷的老年人骨健康較差。2013年日本一項(xiàng)研究發(fā)現(xiàn),OP女性患者的肌少癥患病率達(dá)到29.7%[33]。因此,需要對老年人進(jìn)行常規(guī)OP和肌少癥風(fēng)險篩查,以減少肌肉和骨量的損失[34],防止OP和肌少癥的發(fā)生。
肌少癥是與增齡相關(guān)的骨骼肌質(zhì)量減少,并出現(xiàn)肌肉強(qiáng)度下降的疾病,多發(fā)于老年人。本研究根據(jù)HS和GS的標(biāo)準(zhǔn),老年人患有肌少癥風(fēng)險的比例分別為16.4%和3.1%,均低于既往研究[35]??赡茉蛴校?)缺乏更多的篩選指標(biāo);(2)本地區(qū)經(jīng)濟(jì)條件較好;(3)本地區(qū)居民生活質(zhì)量較高,自我健康意識較強(qiáng)。
本研究發(fā)現(xiàn),HS和GS之間存在顯著正相關(guān)。有人開發(fā)了一種新的、簡單的肌少癥篩查工具[36],內(nèi)容僅包括年齡、小腿圍和HS,并未包含GS,可能是小腿圍可部分反映GS的緣故。
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