老年肌少症患者骨骼肌质量指数与肥胖、骨质疏松及肠道菌群的相关性研究

doi:10.3877/cma.j.issn.1674-6880.2018.06.001

中华危重症医学杂志(电子版) ›› 2018, Vol. 11 ›› Issue (06) : 361 -365. doi: 10.3877/cma.j.issn.1674-6880.2018.06.001

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论著

老年肌少症患者骨骼肌质量指数与肥胖、骨质疏松及肠道菌群的相关性研究

李姝敏¹, 汪晶美¹, 李晗宇¹, 吴月¹, 杨霁¹, 杨云梅¹^,^†(

)

^1. 310003　杭州，浙江大学医学院附属第一医院老年病科

收稿日期:2018-10-13 出版日期:2018-12-01
通信作者: 杨云梅
基金资助:
浙江省公益技术研究计划(LGF19H250001); 浙江省医药卫生科技计划项目(2018KY403); 浙江省医药卫生科技计划项目(2018KY372); 国家临床重点专科（老年病科）建设项目(国卫办医函[2013]544号)

Correlation between skeletal muscle index and obesity, osteoporosis, intestinal microflora in aged patients with sarcopenia

Shumin Li¹, Jingmei Wang¹, Hanyu Li¹, Yue Wu¹, Ji Yang¹, Yunmei Yang¹^,^†()

^1. Department of Geriatrics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China

Received:2018-10-13 Published:2018-12-01
Corresponding author: Yunmei Yang
About author:
Corresponding author: Yang Yunmei, Email: 1194070@zju.edu.cn

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引用本文：

李姝敏, 汪晶美, 李晗宇, 吴月, 杨霁, 杨云梅. 老年肌少症患者骨骼肌质量指数与肥胖、骨质疏松及肠道菌群的相关性研究[J/OL]. 中华危重症医学杂志(电子版), 2018, 11(06): 361-365.

Shumin Li, Jingmei Wang, Hanyu Li, Yue Wu, Ji Yang, Yunmei Yang. Correlation between skeletal muscle index and obesity, osteoporosis, intestinal microflora in aged patients with sarcopenia[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2018, 11(06): 361-365.

目的

探讨老年肌少症患者骨骼肌质量指数（SMI）与肥胖、骨质疏松的相关性，并分析不同SMI老年肌少症患者肠道菌群分布情况。

方法

将103例老年肌少症患者根据入选者SMI的均值（男5.1 kg / m²，女4.3 kg /m²）分为低SMI组（男38例，女11例）与极低SMI组（男43例，女11例）。对不同性别两组肌少症患者SMI、体质量指数（BMI）、全身脂肪百分比、髋关节密度及股骨颈密度进行比较，并采用Pearson检验分析SMI与上述指标间的相关性。同时，采用PCR技术检测患者肠道菌群的含量。

结果

在老年男性患者中，极低SMI组的SMI[（4.4 ± 0.5）kg / m² vs.（5.8 ± 0.5）kg / m²]与BMI[（21.6 ± 2.9）kg / m² vs.（24.8 ± 3.1）kg / m²]显著低于低SMI组（t = 12.062，P < 0.001；t = 4.740，P < 0.001）。在老年女性中，极低SMI组的SMI显著低于低SMI组[（3.8 ± 0.3）kg / m² vs.（4.8 ± 0.8）kg / m²，t = 7.065，P < 0.001]。同时，在老年男性中，SMI与BMI成正相关（r = 0.521，P < 0.001），普拉梭菌[2.87（0.42，10.86）× 10⁶拷贝数/ g vs. 9.57（1.33，36.04）× 10⁶拷贝数/ g]、梭菌属Ⅰ族[3.03（0.39，20.47）× 10⁴拷贝数/ g vs. 15.94（3.57，48.88）× 10⁴拷贝数/ g]在极低SMI组的含量均显著少于低SMI组（Z = 1.987，P = 0.047；Z = 2.943，P = 0.003）。在老年女性中，SMI与全身脂肪百分比成负相关（r = -0.447，P = 0.029）；与低SMI组比较，极低SMI组患者肠球菌含量显著减少[2.56（0.20，54.82）× 10⁴拷贝数/ g vs. 0.28（0.01，1.55）× 10⁴拷贝数/ g，Z = 2.068，P = 0.040]，梭菌属Ⅰ族含量显著增加[1.18（0.37，11.73）× 10⁴拷贝数/ g vs. 16.88（5.22，66.79）× 10⁴拷贝数/ g，Z = 2.134，P = 0.034]。

结论

老年肌少症患者SMI与BMI及全身脂肪百分比显著相关，且肠道菌群在不同程度的SMI间有所差异。

关键词: 肌少症, 肌，骨骼, 老年人, 肥胖症, 骨质疏松, 肠道菌群

Objective

To investigate the correlation of skeletal muscle index (SMI) with obesity and osteoporosis, and to explore the changes of intestinal microflora in different SMI aged patients with sarcopenia.

Methods

Totally 103 aged patients with sarcopenia were divided into the low SMI group (38 males, 11 females) and very low SMI group (43 males, 11 females) according to the mean SMI (male: 5.1 kg / m², female: 4.3 kg / m²). The SMI, body mass index (BMI), total body fat percentage, hip density and femoral neck density were measured, and the correlation between SMI and above indicators was analyzed by the Pearson test. Mean-while, the intestinal microflora was detected by PCR.

Results

In aged male patients, the levels of SMI[(4.4 ± 0.5) kg / m² vs. (5.8 ± 0.5) kg / m²] and BMI [(21.6 ± 2.9) kg / m² vs. (24.8 ± 3.1) kg / m²] in the very low SMI group were much lower than those in the low SMI group (t = 12.062, P < 0.001; t = 4.740, P < 0.001). In aged female patients, only the SMI level in the very low SMI group was much lower than that in the low SMI group [(3.8 ± 0.3) kg / m² vs. (4.8 ± 0.8) kg / m², t = 7.065, P < 0.001]. Meanwhile, in aged male patients, the SMI was positively correlated with BMI (r = 0.521, P < 0.001), and the contents of Faecali-bacterium prausnitzii [2.87 (0.42, 10.86) × 10⁶ copies / g vs. 9.57 (1.33, 36.04) × 10⁶ copies / g] and Clostridium cluster I [3.03 (0.39, 20.47) × 10⁴ copies / g vs. 15.94 (3.57, 48.88) × 10⁴ copies / g] in the very low SMI group were much lower than those in the low SMI group (Z = 1.987, P = 0.047; Z = 2.943, P = 0.003). In aged female patients, the SMI was negatively correlated with total body fat percentage (r = -0.447, P = 0.029), and compared with the low SMI group, the content of Enterococcus decreased [2.56 (0.20, 54.82) × 10⁴ copies / g vs. 0.28 (0.01, 1.55) × 10⁴ copies / g, Z = 2.068, P = 0.040], and the content of Clostridium cluster I increased significantly [1.18 (0.37, 11.73) × 10⁴ copies / g vs. 16.88 (5.22, 66.79) × 10⁴ copies / g, Z = 2.134, P = 0.034].

Conclusion

The SMI is related to the BMI and total body fat percentage in elderly patients with sarcopenia, and the content of intestinal microflora varies with different SMI degrees.

Key words: Sarcopenia, Muscle, skeletal, Aged, Obesity, Osteoporosis, Intestinal microflora

表1 两组男性肌少症老年患者一般资料的比较（ ± s）

组别	例数	年龄（岁）	SMI(kg/m²)	BMI(kg/m²)	全身脂肪百分比(%)	股骨颈密度(g/cm³)	髋关节密度(g/cm³)
极低SMI组	43	85 ± 4	4.4 ± 0.5	21.6 ± 2.9	40 ± 8	0.63 ± 0.10	0.76 ± 0.13
低SMI组	38	83 ± 6	5.8 ± 0.5	24.8 ± 3.1	39 ± 7	0.67 ± 0.13	0.81 ± 0.15
t值	?	1.761	12.062	4.740	0.793	1.352	1.450
P值	?	0.082	< 0.001	< 0.001	0.430	0.182	0.151

表1 两组男性肌少症老年患者一般资料的比较（ ± s）

组别	例数	年龄（岁）	SMI(kg/m²)	BMI(kg/m²)	全身脂肪百分比(%)	股骨颈密度(g/cm³)	髋关节密度(g/cm³)
极低SMI组	43	85 ± 4	4.4 ± 0.5	21.6 ± 2.9	40 ± 8	0.63 ± 0.10	0.76 ± 0.13
低SMI组	38	83 ± 6	5.8 ± 0.5	24.8 ± 3.1	39 ± 7	0.67 ± 0.13	0.81 ± 0.15
t值	?	1.761	12.062	4.740	0.793	1.352	1.450
P值	?	0.082	< 0.001	< 0.001	0.430	0.182	0.151

表2 两组女性肌少症老年患者一般资料的比较（ ± s）

组别	例数	年龄（岁）	SMI(kg/m²)	BMI(kg/m²)	全身脂肪百分比(%)	股骨颈密度(g/cm³)	髋关节密度(g/cm³)
极低SMI组	11	81 ± 8	3.8 ± 0.3	22.1 ± 3.4	50 ± 8	0.58 ± 0.17	0.70 ± 0.21
低SMI组	11	83 ± 4	4.8 ± 0.8	23.7 ± 3.1	46 ± 6	0.50 ± 0.19	0.65 ± 0.13
t值	?	0.785	7.065	1.183	0.953	0.837	0.631
P值	?	0.442	< 0.001	0.251	0.352	0.415	0.537

表2 两组女性肌少症老年患者一般资料的比较（ ± s）

组别	例数	年龄（岁）	SMI(kg/m²)	BMI(kg/m²)	全身脂肪百分比(%)	股骨颈密度(g/cm³)	髋关节密度(g/cm³)
极低SMI组	11	81 ± 8	3.8 ± 0.3	22.1 ± 3.4	50 ± 8	0.58 ± 0.17	0.70 ± 0.21
低SMI组	11	83 ± 4	4.8 ± 0.8	23.7 ± 3.1	46 ± 6	0.50 ± 0.19	0.65 ± 0.13
t值	?	0.785	7.065	1.183	0.953	0.837	0.631
P值	?	0.442	< 0.001	0.251	0.352	0.415	0.537

表3 两组男性肌少症老年患者各肠道细菌的比较[拷贝数/ g，M（P₂₅，P₇₅）]

组别	例数	普拉梭菌(× 10⁶)	肠球菌(× 10⁴)	普氏菌属(× 10⁷)	乳酸菌(× 10⁵)	双歧杆菌(× 10⁴)
极低SMI组	43	2.87(0.42,10.86)	1.21(0.30,14.93)	5.30(0.84,21.39)	1.25(0.18,87.64)	9.06(0.14,28.95)
低SMI组	38	9.57(1.33,36.04)	0.68(0.13,6.71)	9.20(1.68,13.17)	0.89(0.19,15.58)	28.44(2.79,340.22)
Z值	?	1.987	1.391	0.793	0.634	0.416
P值	?	0.047	0.164	0.430	0.526	0.677
组别	例数	梭菌属Ⅳ族(× 10⁷)	梭菌属Ⅰ族(× 10⁴)	直肠真杆菌(× 10⁴)	奇异菌属(× 10⁵)	肠杆菌(× 10⁵)
极低SMI组	43	1.08(0.13,2.93)	3.03(0.39,20.47)	2.38(0.11,40.77)	1.01(0.16,7.97)	4.16(1.08,26.68)
低SMI组	38	2.03(0.27,6.35)	15.94(3.57,48.88)	11.15(1.59,12.66)	0.87(0.25,5.41)	12.75(1.52,111.35)
Z值	?	1.628	2.943	1.845	0.454	1.182
P值	?	0.104	0.003	0.065	0.650	0.237

表3 两组男性肌少症老年患者各肠道细菌的比较[拷贝数/ g，M（P₂₅，P₇₅）]

组别	例数	普拉梭菌(× 10⁶)	肠球菌(× 10⁴)	普氏菌属(× 10⁷)	乳酸菌(× 10⁵)	双歧杆菌(× 10⁴)
极低SMI组	43	2.87(0.42,10.86)	1.21(0.30,14.93)	5.30(0.84,21.39)	1.25(0.18,87.64)	9.06(0.14,28.95)
低SMI组	38	9.57(1.33,36.04)	0.68(0.13,6.71)	9.20(1.68,13.17)	0.89(0.19,15.58)	28.44(2.79,340.22)
Z值	?	1.987	1.391	0.793	0.634	0.416
P值	?	0.047	0.164	0.430	0.526	0.677
组别	例数	梭菌属Ⅳ族(× 10⁷)	梭菌属Ⅰ族(× 10⁴)	直肠真杆菌(× 10⁴)	奇异菌属(× 10⁵)	肠杆菌(× 10⁵)
极低SMI组	43	1.08(0.13,2.93)	3.03(0.39,20.47)	2.38(0.11,40.77)	1.01(0.16,7.97)	4.16(1.08,26.68)
低SMI组	38	2.03(0.27,6.35)	15.94(3.57,48.88)	11.15(1.59,12.66)	0.87(0.25,5.41)	12.75(1.52,111.35)
Z值	?	1.628	2.943	1.845	0.454	1.182
P值	?	0.104	0.003	0.065	0.650	0.237

表4 两组女性肌少症老年患者各肠道细菌的比较[拷贝数/ g，M（P₂₅，P₇₅）]

组别	例数	普拉梭菌(× 10⁶)	肠球菌(× 10⁴)	普氏菌属(× 10⁷)	乳酸菌(× 10⁵)	双歧杆菌(× 10⁴)
极低SMI组	11	4.64(1.53,12.11)	0.28(0.01,1.55)	8.10(5.40,24.58)	0.06(0.02,25.75)	5.25(0.43,260.83)
低SMI组	11	5.26(0.50,6.70)	2.56(0.20,54.82)	13.57(2.34,51.50)	0.45(0.20,21.46)	6.95(0.34,55.69)
Z值	?	0.492	2.068	0.164	1.477	0.164
P值	?	0.652	0.040	0.898	0.151	0.898
组别	例数	梭菌属Ⅳ族(× 10⁷)	梭菌属Ⅰ族(× 10⁴)	直肠真杆菌(× 10⁴)	奇异菌属(× 10⁵)	肠杆菌(× 10⁵)
极低SMI组	11	1.46(0.33,3.22)	16.88(5.22,66.79)	3.25(0.07,110.73)	3.16(1.88,9.23)	5.78(1.62,76.92)
低SMI组	11	1.35(0.18,2.41)	1.18(0.37,11.73)	7.25(0.41,42.25)	2.53(0.16,6.33)	2.76(0.58,22.56)
Z值	?	0.295	2.134	0.230	0.755	0.755
P值	?	0.797	0.034	0.847	0.478	0.478

表4 两组女性肌少症老年患者各肠道细菌的比较[拷贝数/ g，M（P₂₅，P₇₅）]

组别	例数	普拉梭菌(× 10⁶)	肠球菌(× 10⁴)	普氏菌属(× 10⁷)	乳酸菌(× 10⁵)	双歧杆菌(× 10⁴)
极低SMI组	11	4.64(1.53,12.11)	0.28(0.01,1.55)	8.10(5.40,24.58)	0.06(0.02,25.75)	5.25(0.43,260.83)
低SMI组	11	5.26(0.50,6.70)	2.56(0.20,54.82)	13.57(2.34,51.50)	0.45(0.20,21.46)	6.95(0.34,55.69)
Z值	?	0.492	2.068	0.164	1.477	0.164
P值	?	0.652	0.040	0.898	0.151	0.898
组别	例数	梭菌属Ⅳ族(× 10⁷)	梭菌属Ⅰ族(× 10⁴)	直肠真杆菌(× 10⁴)	奇异菌属(× 10⁵)	肠杆菌(× 10⁵)
极低SMI组	11	1.46(0.33,3.22)	16.88(5.22,66.79)	3.25(0.07,110.73)	3.16(1.88,9.23)	5.78(1.62,76.92)
低SMI组	11	1.35(0.18,2.41)	1.18(0.37,11.73)	7.25(0.41,42.25)	2.53(0.16,6.33)	2.76(0.58,22.56)
Z值	?	0.295	2.134	0.230	0.755	0.755
P值	?	0.797	0.034	0.847	0.478	0.478

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Correlation between skeletal muscle index and obesity, osteoporosis, intestinal microflora in aged patients with sarcopenia

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Correlation between skeletal muscle index and obesity, osteoporosis, intestinal microflora in aged patients with sarcopenia