肌少症指数在老年COPD合并肌少症患者中的预测价值

王安秀 杨明莹 杨耀鹏 周红坚 林明 刘芳 段玉琼

【摘要】 目的：通过分析老年COPD患者的肌少症指数（SI，血清肌酐/血清胱抑素），寻找最佳SI的诊断切点。方法：前瞻性研究2018年1月-2019年1月本院老年病科所收治的124例老年COPD患者。收集入院时监测的各项生命体征、年龄、性别、身高、四肢肌肉质量指数（SMI）、血清肌酐、血清胱抑素、1年内临床预后等资料，并计算SI，比较不同性别的资料，分析SI对不同性别COPD患者合并肌少症的预测效果;分析SMI、SI和住院天数、机械通气、住院次数的相关性。结果：本次共收集124例患者，其中男72例，男性肌少症60例，女52例，女性肌少症41例。ROC曲线分析结果显示，SI预测老年男性COPD合并肌少症的ROC曲线下面积为0.878，老年女性ROC曲线下面积为0.860;老年男性和老年女性患者的SI切点分别为87.915（灵敏度为0.833，特异度为0.833）和80.295（灵敏度为0.750，特异度为0.925）。SMI、SI与1年内住院天数、住院次数有相关性（P<0.05）。结论：SI是一种简便的识别肌少症的指标，低SI与患者住院天数有关。

【关键词】 血清肌酐 血清胱抑素 肌少症 COPD 双能X线吸收测量法

[Abstract] Objective： To find the best cut-off point of sarcopenia index （SI， serum creatinine / serum cystatin） by analyzing the SI in elderly patients with COPD. Method： A prospective study was conducted on 124 elderly patients with COPD admitted to the geriatric department of our hospital from January 2018 to January 2019. The data of vital signs， age， sex， height， limb muscle mass index （SMI）， serum creatinine， serum cystatin， and clinical prognosis within 1 year were collected. The SI was calculated， and the data of different genders were compared， the predictive effect of SI in COPD patients with sarcopenia of different genders was analyzed， The correlation between SMI， SI and length of stay， mechanical ventilation and number of stays was analyzed. Result： A total of 124 patients were collected， including 72 males， 60 males with sarcopenia， 52 females， and 41 females with sarcopenia. The ROC curve analysis showed that， SI predicted area under the ROC curve of COPD combined with sarcopenia in elderly men was 0.878， the area under the ROC curve of elderly women was 0.860; the SI cut points for identifying sarcopenia in elderly men and elderly women were 87.915 （sensitivity was 0.833， specificity was 0.833） and 80.295 （sensitivity was 0.750， specificity was 0.925）， respectively. SMI and SI were correlated with hospitalization days and hospitalization times within 1 year （P<0.05）. Conclusion： SI is a simple index to identify sarcopenia， low SI is related to the length of hospital stay.

[Key words] Serum creatinine Serum cystatin Sarcopenia COPD Dual-energy X-ray absorptiometry

First-author’s address： The Sixth Affiliated Hospital of Kunming Medical University， Yuxi 653100， China

doi：10.3969/j.issn.1674-4985.2021.25.034

肌少癥（sarcopenia）由Rosenberg于1989年第一次提出，定义为一种随着年龄的增加骨骼肌肌肉质量减少及功能下降的疾病，即年龄相关性肌少症[1]。研究发现65岁以上老年人肌少症患病率为5%～10%，80岁以上老年人患病率高达31.6%[2]。肌少症的发生随着年龄的增加而增加，研究发现肌少症与许多影响公共健康的疾病有关，如伴随着年龄增加相关的骨量丢失，出现肌少症合并骨质疏松症，致使老年人易发生跌倒和骨折，继而成为老年人群致残、致死的主要原因之一，这已成为老年医学领域研究热点。……