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ENGLISH ABSTRACT
脑梗死合并肌少症患者的临床特征及相关影响因素研究
王建华
冯玫
乔爱春
何志强
李丽琪
王晓旭
作者及单位信息
·
DOI： 10.3760/cma.j.cn114798-20200207-00086
Effects of sarcopenia on neurological function and quality of life in patients with cerebral infarction and its risk factors
Wang Jianhua
Feng Mei
Qiao Aichun
He Zhiqiang
Li Liqi
Wang Xiaoxu
Authors Info & Affiliations
Wang Jianhua
Department of General Practice, Shanxi Bethune Hospital, Taiyuan 030021, China
Feng Mei
Department of General Practice, Shanxi Bethune Hospital, Taiyuan 030021, China
Qiao Aichun
Department of General Practice, Shanxi Bethune Hospital, Taiyuan 030021, China
He Zhiqiang
Department of General Practice, Shanxi Bethune Hospital, Taiyuan 030021, China
Li Liqi
Department of General Practice, Shanxi Bethune Hospital, Taiyuan 030021, China
Wang Xiaoxu
Department of General Practice, Shanxi Bethune Hospital, Taiyuan 030021, China
·
DOI： 10.3760/cma.j.cn114798-20200207-00086
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摘要

目的观察肌少症对脑梗死患者神经功能缺损和生活能力的影响及相关危险因素。

方法选取2017年1月至2019年1月在山西白求恩医院全科医学科住院治疗的急性脑梗死合并肌少症患者70例为观察组，另外选取同期年龄、性别均与观察组相匹配的非肌少症的急性脑梗死患者70例为对照组。比较两组患者入院时一般临床资料（如吸烟史、饮酒史、生化指标、合并疾病情况、营养情况等）、去脂体重指数（FFMI）、美国国立卫生研究院卒中量表（NIHSS）评分（用于评估神经功能缺损程度）、日常生活能力（ADL）评分，并比较两组患者出院3个月后NIHSS、ADL评分及脑卒中影响量表（SIS）评分（用于评估社会回归能力）。对肌少症可能存在的影响因素进行logistic回归分析。

结果入院时，观察组患者FFMI[（17.70±0.36）比（17.90±0.26）kg/m 2， t=3.751]及NIHSS[（15.00±3.51）比（12.17±3.21）分， t=-4.947]、ADL评分[（28.64±6.70）比（37.14±6.68）分， t=7.518]均较对照组低（均 P<0.05）。两组患者出院3个月后与入院时比较，NIHSS、ADL评分均有好转，但观察组患者NIHSS[（-1.99±1.17）比（-3.93±1.47）分， t=8.651， P<0.05]、ADL[（6.64±4.32）比（15.50±5.05）分， t=-11.158， P<0.05]恢复幅度较对照组低；而且观察组患者SIS评分较对照组低[（64.59±5.48）比（74.51±4.58）分， t=-11.639， P<0.05]。多因素logistic回归显示，体重下降（ OR=5.094）、骨质疏松（ OR=2.856）、激素水平异常（ OR=1.885）及合并疾病>3种（ OR=2.045）均为脑梗死患者合并肌少症的危险因素（均 P<0.05）。

结论合并肌少症的急性脑梗死患者神经功能缺损严重、日常生活能力下降明显，且恢复期神经功能缺损、日常生活能力改善情况及社会回归能力均低于未合并肌少症的脑梗死患者。体重下降、骨质疏松、激素水平异常及合并疾病>3种均为脑梗死患者合并肌少症的危险因素。

脑梗死;肌少症;危险因素;神经功能缺损;日常生活能力
ABSTRACT

ObjectiveTo investigate the effects of sarcopenia on neurological function and quality of life in patients with cerebral infarction and its risk factors.

MethodsSeventy acute cerebral infarction patients with sarcopenia (study group) and 70 age and gender-matched acute cerebral infarction patients without sarcopenia (control group) admitted in Shanxi Bethune Hospital from January 2017 to January 2019 were enrolled in the study. The fat free mass index (FFMI), National Institute of Health Stroke Scale (NIHSS), activity of daily living (ADL) and other related indexes were assessed at the admission and compared between the two groups. Three months after discharge, the neurological impairment, improvement of daily living ability and social regression ability were compared between two groups. Logistic regression analysis was conducted for the risk factors of sarcopenia.

ResultsThe FFMI [(17.70±0.36) vs. (17.90±0.26)kg/m 2, t=3.751, P<0.05], NIHSS9[ (15.00±3.51) vs. (12.17±3.21), t=-4.947, P<0.05] and ADL scores[ (28.64±6.70) vs. (37.14±6.68), t=7.518, P<0.05] of the study group were lower than those of the control group at the admission. NIHSS and ADL scores of the two groups were improved three months after discharge. However, the degree of improvement in NIHSS and ADL of the study group was lower than that of the control group[ (-1.99±1.17) vs. (-3.93±1.47), t=8.651, P<0.05; (6.64±4.32) vs. (15.50±5.05), t=-11.158, P<0.05, respectively]. Meanwhile, the social regression score (SIS) of the study group was lower than that of the control group [ (64.59±5.48) vs.(74.51±4.58), t=-11.639, P<0.05]. Multivariate logistic regression showed that weight loss ( OR=5.094), osteoporosis ( OR=2.856), abnormal hormone levels ( OR=1.885) and comorbid diseases>3 ( OR=2.045) were risk factors of sarcopenia (all P<0.05).

ConclusionAcute cerebral infarction patients with sarcopenia have severe neurological function impairments and decreased activities of daily living. Weight loss, osteoporosis, abnormal hormone levels, and comorbid diseases>3 are risk factors for sarcopenia in cerebral infarction patients.

Cerebral infarction;Sarcopenia;Risk factor;Neurological impairment;Ability of daily living
Feng Mei, Email: mocdef.qabq8073007471
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引用本文

王建华,冯玫,乔爱春,等. 脑梗死合并肌少症患者的临床特征及相关影响因素研究[J]. 中华全科医师杂志,2020,19(09)：824-828.

DOI:10.3760/cma.j.cn114798-20200207-00086

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脑梗死是临床的常见病、多发病，发病率和死亡率随着年龄的增加而逐渐升高，据统计，患病人数在60~65岁以后迅速增加 [ 1 ]。肌少症也是一种老年性疾病，随着年龄增加，主要表现为肌肉质量减少、肌肉力量下降或者活动能力减弱。脑梗死患者可出现不同程度的神经功能缺损，在合并肌少症的情况下可能使神经功能缺损进一步加重，影响脑梗死患者的生命质量及预后，而脑梗死患者肢体神经功能缺损后可使活动时间、强度、耐量等均下降，从而加速肌少症的进程，两者之间相互影响，形成恶性循环。目前研究发现，肌少症与代谢综合征密切相关 [ 2 ]，可使糖尿病、血脂异常的发病率升高，有关肌少症危险因素的研究也较多。本研究旨在比较急性脑梗死伴或不伴肌少症患者的去脂体重指数、身体神经功能缺损、日常生活能力等指标，评估肌少症对脑梗死患者神经功能缺损及生命质量的影响、筛查肌少症危险因素。
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