上臂围和小腿围在社区老年肌少症患者筛查诊断中的应用

doi:10.3969/j.issn.1006-9771.2021.08.015

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (8): 982-992.doi: 10.3969/j.issn.1006-9771.2021.08.015

• 社区康复 • 上一篇

上臂围和小腿围在社区老年肌少症患者筛查诊断中的应用

黎梦丽¹,刘闵敬¹,周思美¹,张庆²,王丽¹()

1.苏州大学医学部护理学院,江苏苏州市 215006
2.苏州大学体育学院,江苏苏州市215006

收稿日期:2020-08-10 修回日期:2021-05-31 出版日期:2021-08-25 发布日期:2021-08-25
通讯作者: 王丽 E-mail:li-wang-1@suda.edu.cn
作者简介:黎梦丽(1995-),女,汉族,河南驻马店市人,硕士研究生,主要研究方向：慢病康复、社区护理。|王丽(1979-),女,汉族,安徽合肥市人,博士,教授,博士生导师,主要研究方向：慢病康复、社区护理。
基金资助:
江苏省产学研合作项目(BY2018179)

Application of Upper Arm Circumference and Calf Circumference in Screening and Diagnosis of Sarcopenia for Old Adults in Community

LI Meng-li¹,LIU Min-jing¹,ZHOU Si-mei¹,ZHANG Qing²,WANG Li¹()

1. School of Nursing, Medical College, Soochow University, Suzhou, Jiangsu 215006, China
2. School of Physical Education, Soochow University, Suzhou, Jiangsu 215006, China

Received:2020-08-10 Revised:2021-05-31 Published:2021-08-25 Online:2021-08-25
Contact: WANG Li E-mail:li-wang-1@suda.edu.cn
Supported by:
Jiangsu Province Industry-University-Research Cooperation Project(BY2018179)

摘要/Abstract

摘要：

目的探讨上臂围和小腿围与肌肉量的相关关系及其对肌量减少和肌少症的筛查诊断效果和最佳诊断截断值。方法 2020年3月至8月,方便抽取831例社区老年人(≥ 60岁)作为研究对象,采用身体成分测试仪检测肌肉量等指标,同时进行上臂围和小腿围的测量,握力及步速测试。上臂围、小腿围与肌肉量等指标的相关性行Pearson相关分析,受试者操作特征(ROC)曲线分析上臂围和小腿围对肌量减少和肌少症的诊断效果,并利用约登指数(YI)确定最佳诊断截断值。结果上臂围和小腿围与四肢骨骼肌含量(ASM)和骨骼肌质量指数(SMI)呈显著正相关(r = 0.6~0.8, P < 0.001)。上臂围诊断肌量减少的ROC曲线下面积(AUC)是男性0.888、女性0.787,小腿围是男性0.933、女性0.854;上臂围最佳截断值男性和女性均为26 cm,小腿围男性34 cm、女性33 cm。上臂围诊断肌少症的AUC是男性0.902、女性0.744,小腿围是男性0.923、女性0.832;其最佳截断值无性别差异,分别是26 cm和33 cm。在社区老年男性和女性中,年龄、上臂围、小腿围、握力和步速等多指标对肌量减少和肌少症联合诊断的AUC均大于0.85。结论社区老年人中,上臂围和小腿围均与肌肉量呈正相关,且对肌量减少和肌少症具有较好的诊断效果;多指标的联合诊断可显著提高上臂围在女性中的诊断效果。

关键词: 肌少症, 上臂围, 小腿围, 筛查, 受试者工作特征曲线

Abstract:

Objective To explore the correlation of upper arm circumference and calf circumference with muscle mass, and the screening effect and the cut-off values for low muscle mass and sarcopenia. Methods From March to August, 2020, a total of 831 community-dwelling old people (≥ 60 years old) were recruited by using convenience sampling. Muscle mass and other body composition indicators were tested by body composition tester. The upper arm circumference, calf circumference, grip strength and gait speed were measured at the same day. Pearson cofficient was used to analyze the correlation of upper arm circumference and calf circumference with muscle mass, and receiver operation characteristic (ROC) curve was used to analyze the diagnostic effect of upper arm circumference and calf circumference on low muscle mass and sarcopenia, and the Youden index (YI) was used to determine the cut-off values. Results Upper arm circumference and calf circumference were positively correlated with appendicular skeletal muscle mass (ASM) and skeletal mass index (SMI) (r = 0.6 to 0.8, P < 0.001). For diagnosing low muscle mass, the areas under the ROC curve (AUC) of upper arm circumference were 0.888 for male, 0.787 for female; and that of calf circumference were 0.933 for male, 0.854 for female, respectively. The cut-off values of upper arm circumference for low muscle mass were 26 cm for both male and female; and that of calf circumference were 34 cm for male and 33 cm for female, respectively. For diagnosing sarcopenia, the AUC of upper arm circumference was 0.902 for male, 0.744 for female; and that of calf circumference was 0.923 for male, 0.832 for female, respectively. The cut-off values of upper arm circumference and calf circumference for sarcopenia were 26 cm and 33 cm for both male and female. The AUC of combined diagnosis with age, upper arm circumference, calf circumference, grip strength and gait speed for low muscle mass and sarcopenia in males and females was all greater than 0.85. Conclusion In the community old adults, upper arm circumference and calf circumference are positively correlated with muscle mass, and both indices can be used to diagnose low muscle mass and sarcopenia. multi-indices combination can improve the diagnosis effect of upper arm circumference in females.

Key words: sarcopenia, upper arm circumference, calf circumference, screening, receiver operator characteristic curve

黎梦丽,刘闵敬,周思美,张庆,王丽. 上臂围和小腿围在社区老年肌少症患者筛查诊断中的应用[J]. 《中国康复理论与实践》, 2021, 27(8): 982-992.

LI Meng-li,LIU Min-jing,ZHOU Si-mei,ZHANG Qing,WANG Li. Application of Upper Arm Circumference and Calf Circumference in Screening and Diagnosis of Sarcopenia for Old Adults in Community[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(8): 982-992.

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变量	总体(n = 831)	男性(n = 366)	女性(n = 465)	t值	P值
肌量减少(n)	150	48	102	-	-
肌少症(n)	113	35	78	-	-
年龄(岁)	72.67±5.81	72.52±5.60	72.80±5.97	-0.673	0.501
身高(m)	1.60±0.09	1.66±0.06	1.55±0.06	27.274	< 0.001
体质量(kg)	60.62±10.52	65.51±9.75	56.78±9.46	13.029	< 0.001
BMI(kg/m²)	23.67±3.32	23.60±2.97	23.74±3.56	-0.625	0.532
握力(kg)	24.82±8.22	31.11±7.34	19.85±4.72	25.442	< 0.001
步速(m/s)	0.96±0.211	1.01±0.21	0.92±0.21	6.509	< 0.001
上臂围(cm)	27.38±2.73	27.47±2.48	27.31±2.91	0.869	0.385
小腿围(cm)	34.31±2.83	35.14±2.60	33.66±2.84	7.740	< 0.001
去脂体质量(kg)	43.67±8.07	50.95±5.84	37.94±3.87	36.740	< 0.001
脂肪量(kg)	16.96±6.77	14.58±5.58	18.86±7.03	-9.782	< 0.001
肌肉量(kg)	41.29±7.69	48.30±5.55	35.78±3.53	37.545	< 0.001
体脂率(%)	27.56±8.60	21.64±5.98	32.21±7.40	-22.743	< 0.001
躯干肌肉量(kg)	23.65±3.69	26.69±2.83	21.07±1.97	31.051	< 0.001
左上肢肌肉量(kg)	2.10±0.53	2.57±0.37	1.74±0.29	34.931	< 0.001
左下肢肌肉量(kg)	6.73±1.65	8.19±1.26	5.59±0.79	34.702	< 0.001
右上肢肌肉量(kg)	2.25±0.66	2.72±0.49	1.88±0.53	23.455	< 0.001
右下肢肌肉量(kg)	6.79±1.65	8.26±1.27	5.64±0.77	34.744	< 0.001
ASM (kg)	17.88±4.30	21.73±3.17	14.85±2.06	36.021	< 0.001
SMI (kg/m²)	6.92±1.14	7.82±0.91	6.21±0.71	27.945	< 0.001

变量	总体				男性				女性
	上臂围		小腿围		上臂围		小腿围		上臂围		小腿围
	r值	P值	r值	P值	r值	P值	r值	P值	r值	P值	r值	P值
总肌肉量	0.367	< 0.001	0.594	< 0.001	0.703	<0.001	0.763	< 0.001	0.514	< 0.001	0.631	< 0.001
ASM	0.403	< 0.001	0.652	< 0.001	0.701	< 0.001	0.808	< 0.001	0.604	< 0.001	0.762	< 0.001
SMI	0.469	< 0.001	0.687	< 0.001	0.701	< 0.001	0.789	< 0.001	0.599	< 0.001	0.709	< 0.001
握力	0.188	< 0.001	0.388	< 0.001	0.354	< 0.001	0.371	< 0.001	0.132	0.005	0.247	< 0.001
步速	0.083	0.017	0.225	< 0.001	0.174	0.001	0.235	< 0.001	0.016	0.731	0.139	0.003

性别	变量	AUC	标准误	P值	AUC 95%CI		最佳截断值(cm)	YI	敏感性(%)	特异性(%)
性别	变量	AUC	标准误	P值	下限	上限	最佳截断值(cm)	YI	敏感性(%)	特异性(%)
男	上臂围	0.888	0.028	< 0.001	0.832	0.943	26	0.666	79.2	87.4
男	小腿围	0.933	0.021	< 0.001	0.893	0.974	34	0.711	87.5	83.6
女	上臂围	0.787	0.025	< 0.001	0.737	0.836	26	0.465	73.5	73.0
女	小腿围	0.854	0.019	< 0.001	0.817	0.891	33	0.555	83.3	72.2

性别	变量	AUC	标准误	P	AUC 95%CI		最佳截断值(cm)	YI	敏感性(%)	特异性(%)
性别	变量	AUC	标准误	P	下限	上限	最佳截断值(cm)	YI	敏感性(%)	特异性(%)
男	上臂围	0.902	0.031	< 0.001	0.840	0.963	26	0.712	85.7	85.5
男	小腿围	0.923	0.024	< 0.001	0.876	0.969	33	0.697	80.0	89.7
女	上臂围	0.744	0.030	< 0.001	0.685	0.803	26	0.398	62.8	77.0
女	小腿围	0.832	0.022	< 0.001	0.789	0.876	33	0.536	84.6	69.0

性别	AUC	标准误	P	95%CI
性别	AUC	标准误	P	下限	上限
男	0.951	0.015	< 0.001	0.923	0.980
女	0.900	0.015	< 0.001	0.870	0.929

上臂围和小腿围在社区老年肌少症患者筛查诊断中的应用

Application of Upper Arm Circumference and Calf Circumference in Screening and Diagnosis of Sarcopenia for Old Adults in Community

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