老年住院患者发生肌少症的影响因素及其体位性血压特征

Influencing factors for sarcopenia and orthostatic blood pressure characteristics in elderly hospitalized patients

    摘要
  • 摘要:
    目的 探讨老年住院患者发生肌少症的影响因素及其体位性血压特征。
    方法 连续纳入老年受试者271名，收集人口学、疾病史、用药情况、实验室、身体成分、握力、步速及卧立位血压和心率资料。依据亚洲肌少症工作组2019年诊断标准，将受试者分为肌少症组（n = 63）和非肌少症组（n = 208）。采用logistic回归分析肌少症的危险因素。采用t检验、χ2检验、Pearson相关、Spearman相关及偏相关分析肌少症与体位性血压变化之间的关系。
    结果 与非肌少症组比较，肌少症组患者年龄更大、男性占比更高，体重指数（BMI）、骨骼肌质量指数（SMI）、握力、步速及血红蛋白更低，营养风险及帕金森病比例更高（均P＜0.05）。多因素logistic回归分析显示：年龄（OR = 1.104，95%CI：1.054～1.156）、帕金森病（OR = 10.900，95%CI：2.537～46.836）增加肌少症风险，BMI（OR = 0.628，95%CI：0.543～0.727）、女性（OR = 0.264，95%CI：0.118～0.592）为保护因素（均P＜0.001）。肌少症组体位性低血压（OH）检出率高于非肌少症组（41.3%比26.4%，χ2 = 5.073，P = 0.024），站立后1 min和3 min收缩压、舒张压降幅更大，心率代偿性增快更明显（均P＜0.05）。Spearman相关性分析显示，OH与肌少症呈正相关（r = 0.137，P = 0.024）。偏相关分析显示，SMI与站立后1 min及3 min的舒张压变化值（ΔDBP）均呈正相关（r = 0.123，P = 0.044；r = 0.135，P = 0.027）；左、右手握力与站立后3 min的心率变化值（ΔHR）均呈负相关（左手握力：r = –0.180，P = 0.003；右手握力：r = –0.122，P = 0.046）。
    结论  年龄增长、帕金森病、男性及低BMI是发生肌少症的主要危险因素。老年住院肌少症患者表现为站立后收缩压和舒张压降幅更大，心率代偿性增快更明显，但代偿效果不足以维持血压稳定，OH风险显著增高。

     

    Abstract:
    Objective To investigate the influencing factors for sarcopenia and the orthostatic blood pressure characteristics in elderly hospitalized patients.
    Methods A total of 271 elderly participants were consecutively enrolled. Demographic data, medical history, medication use, laboratory indices, body composition, grip strength, gait speed, and supine-to-standing blood pressure and heart rate measurements were collected. According to the 2019 diagnostic criteria of the Asian Working Group for Sarcopenia, participants were divided into sarcopenia group (n = 63) and non-sarcopenia group (n = 208). Logistic regression analysis was performed to identify risk factors for sarcopenia. Independent-sample t-tests, chi-square tests, Pearson correlation, Spearman correlation, and partial correlation analysis were used to examine the relationship between sarcopenia indicators and orthostatic blood pressure changes.
    Results Compared with non-sarcopenic patients, those with sarcopenia were older, had a higher proportion of males, and exhibited lower body mass index (BMI), skeletal muscle mass index (SMI), grip strength, gait speed, and hemoglobin, along with higher nutritional risk and proportion of Parkinson's disease (all P ＜ 0.05). Multivariate logistic regression identified age (OR = 1.104, 95%CI: 1.054 to 1.156), Parkinson's disease (OR = 10.900, 95%CI: 2.537 to 46.836) were risk factors, while BMI (OR = 0.628, 95%CI: 0.543 to 0.727) and female sex (OR = 0.264, 95%CI: 0.118 to 0.592) were protective factors for sarcopenia (all P ＜ 0.001). The prevalence of orthostatic hypotension (OH) was higher in the sarcopenia group than in the non-sarcopenia group (41.3% vs. 26.4%, χ2 = 5.073, P = 0.024). Compared with non-sarcopenic patients, those with sarcopenia showed larger drops in systolic and diastolic blood pressure at 1 and 3 minutes after standing, along with a more pronounced compensatory increase in heart rate (all P ＜ 0.05). Spearman correlation analysis showed a significant positive correlation between OH and sarcopenia (r = 0.137, P = 0.024). Partial correlation analysis further revealed that SMI was significantly positively correlated with change in diastolic blood pressure (ΔDBP) at 1 min and 3 min after standing (r = 0.123, P = 0.044; r = 0.135, P = 0.027, respectively), and both left and right grip strength were significantly negatively correlated with change in heart rate (ΔHR) at 3 min after standing (left grip strength: r = –0.180, P = 0.003; right grip strength: r = –0.122, P = 0.046).
    Conclusions Advancing age, Parkinson's disease, male sex, and low BMI are major risk factors for sarcopenia. Elderly hospitalized patients with sarcopenia exhibit greater drops in systolic and diastolic blood pressure after standing, along with more pronounced compensatory heart rate increases that are insufficient to maintain blood pressure stability, resulting in a higher risk of OH.

     

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