Page 33 - 2022-35-中国全科医学

·4382· http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn

estimated that there will be about 200 million sarcopenia patients worldwide by the mid-21st century. Both essential hypertension
and sarcopenia are common in the elderly，but the correlation between them has been rarely studied in China. Objective To
examine the prevalence and risk factors of sarcopenia in middle-aged and elderly patients with essential hypertension，providing
a reference for secondary prevention and early delivery of intervention of sarcopenia in this group. Methods A total of 107
patients with essential hypertension aged ≥ 50 years who were hospitalized in Geriatric Department，the First People's Hospital
of Yunnan Province from December 2020 to December 2021 were enrolled. Sarcopenia was diagnosed by the recommendation from
Asian Working Group for Sarcopenia in 2019. Nutrition status was assessed using the Mini-Nutritional Assessment Scale-Short
Form（MNA-SF）. The general demographics，sarcopenia diagnostic indicators，laboratory indicators and MNA-SF assessment
results were collected. Binary Logistic regression analysis was used to explore the influencing factors of sarcopenia in essential
hypertension. The receiver operating characteristic（ROC） analysis was performed to explore the predictive value of body mass
index （BMI） for sarcopenia in essential hypertension. Results Among the 107 patients，53 （49.5%） were diagnosed with
sarcopenia，and other 54（50.5%） cases had no sarcopenia. The prevalence of sarcopenia in slightly underweight，normal
weight，overweight or obesity patients was 83.3%（5/6），64.2%（34/53），30.0%（12/40），25.0%（2/8），respectively.
2
The prevalence rate of sarcopenia decreased with the increase of BMI（χ trend =15.027，P=0.001）. Logistic regression analysis
showed that female〔OR=0.175，95%CI（0.059，0.518）〕，overweight〔OR=0.039，95%CI（0.003，0.513）〕，obesity〔OR=0.019，
95%CI（0.001，0.459）〕，higher 25-（OH）D〔OR=0.914，95%CI（0.843，0.991）〕，and higher MNA-SF score〔OR=0.832，
95%CI（0.697，0.992）〕 were associated with decreased risk of sarcopenia（P<0.05），while older age〔OR=1.139，95%CI
（1.073，1.209）〕，increased systolic blood pressure〔OR=1.038，95%CI（1.001，1.076）〕 and increased diastolic blood
pressure〔OR=1.095，95%CI（1.035，1.159）〕 were associated with increased risk of sarcopenia（P<0.05）. The area under
the ROC curve of BMI in predicting sarcopenia was 0.749〔95%CI（0.656，0.843）〕，with 52.8% sensitivity and 88.9%
2
specificity when 22.0 kg/m was determined as the optimal cut-off value. Conclusion The prevalence of sarcopenia was high in
middle-aged and elderly patients with essential hypertension，the risk of which was increased with advanced age，higher systolic
blood pressure and diastolic blood pressure，and declined with being female，overweight，obesity，higher vitamin D and good
nutrition. BMI may be a good predictor of sarcopenia in essential hypertension.
【Key words】 Essential hypertension；Sarcopenia；Body composition analysis；25-hydroxyvitamin D；Middle
aged；Aged

肌少症（Sarcopenia，SAR）是一种与年龄相关的老 供参考依据。
年综合征，表现为肌肉质量减少、肌力下降、身体机能 1 对象与方法
减退 ［1］ 。临床上会表现为肢体纤细无力、步态缓慢、 1.1 研究对象 收集 2020 年 12 月至 2021 年 12 月在
步态不稳，易出现跌倒、骨折，甚至造成残疾、死亡。 云南省第一人民医院老年医学科住院的≥ 50 岁 EH 患
从 40 岁以后，肌肉质量以平均每年 8% 的速度流失 ［2］ 。 者 107 例，其中男 62 例（58.0%），女 45 例（42.0%）；
60~70 岁的欧洲人群 SAR 患病率为 13%，80 岁以后可 年龄 50~96 岁，平均年龄（73.5±11.0）岁，<60 岁 13
达到 50% 左右 ［3］ 。中国的老年人群中，每年有接近 例（12.2%），60~75 岁 46 例（43.0%），>75 岁 48 例
4000 万人因 SAR 导致跌倒并出现严重损伤 ［4］ 。原发性 （44.8%）。根据 EH 患者是否合并 SAR，将其分为
高血压（essential hypertension，EH）是常见的慢性病之一， SAR 组和非 SAR 组。本研究经云南省第一人民医院伦
主要表现为体循环动脉压升高。EH 与 SAR 是老年人的 理委员会批准（KMUST-MEC-151），患者均签署知情
常见疾病。SAR 发病机制包括增龄、营养不良、运动减 同意书。
少、维生素 D 缺乏、胰岛素抵抗、慢性炎症、线粒体 1.1.1 纳入标准 （1）符合 EH 的诊断标准 ［5］ ；（2）
功能失调与氧化应激、肾素 - 血管紧张素 - 醛固酮系统 ≥ 50 岁；（3）能够正确表达自己的感受和意愿；（4）
（renin-angiotensin aldosterone system，RAAS）的激活等。 病历资料完整。
这些病理状态也与 EH 的发病有关。尽管公众对 EH 有 1.1.2 排除标准 （1）<50 岁；（2）近 3 个月内使用
了很多认识，但是 EH 合并 SAR 给患者带来的体成分 过影响体成分的药物（如营养制剂、维生素 D、钙磷制
改变及日常生活的影响并没有引起公众足够的认识。本 剂等）；（3）严重肝肾功能不全、恶性肿瘤、慢性消
研究目的是了解 SAR 在中老年 EH 患者中的患病率， 化道疾病、严重感染性疾病；（4）认知功能障碍、生
探索二者的相关性，明确 EH 患者发生 SAR 的危险因素， 活不能自理；（5）肢体残疾、躯体活动障碍；（6）临
为中老年 EH 患者发生 SAR 的二级预防和早期干预提 床病历资料不完善，依从性差、不愿进行配合的患者或