机会性定量CT分析老年人群骨肌健康特征

Analysis of bone and muscle health characteristics of elderly population by means of opportunistic quantitative computed tomo-graphy

中文关键词: 老年  定量CT  骨质疏松症  肌少症  体积骨密度

英文关键词: elderly  quantitative computed tomography  osteoporosis  sarcopenia  volumetric bone mineral density

中文摘要:

      目的 通过机会性定量CT(QCT)分析老年人骨肌质量.方法 选取2021年5月-2022年9月于同济大学附属第十人民医院行低剂量胸部CT平扫的老年(≥60岁)体检人群221例.通过QCT检测受试者L1、L2椎体平均体积骨密度(vBMD)、骨骼肌面积(SMA)、肌间隙脂肪组织(IMAT)面积和骨骼肌质量指数(SMI).依据SMI、握力和6 m步速测试诊断肌少症.比较骨量正常组、骨量减少组和骨质疏松(OP)组患者肌群参数和握力差异,分析肌群参数与vBMD的相关性.结果 221例老年人共检出50例OP,19例肌少症.女性OP检出率高于男性(28.95％vs 15.89％,P=0.020),不同性别人群肌少症检出率差异无统计学意义(P=0.565).老年男性中,与骨量正常组相比,骨量减少组SMIL2和SMI椎旁肌降低,OP组SMIL2降低(P＜0.05);骨量减少组IMATL2、IMAT椎旁肌、IMAT/SMAL2和IMAT/SMA椎旁肌升高;OP组IMATL2、IMAT腹壁肌、IMAT椎旁肌、IMAT/SMAL2、IMAT/SMA腹壁肌和IMAT/SMA椎旁肌升高,握力降低,差异有统计学意义(P＜0.05).老年女性中,与骨量正常组相比,OP组IMATL2、IMAT腹壁肌、IMAT/SMAL2和IMAT/SMA腹壁肌升高,握力降低,差异有统计学意义(P＜0.05);与骨量减少组相比,OP组IMAT腹壁肌和IMAT/SMA腹壁肌升高,差异有统计学意义(P＜0.05).SMI椎旁肌与vBMD呈弱正相关,但校正年龄因素后相关性消失(男性:r=0.067,P=0.538;女性:r=0.136,P=0.176).各肌群IMAT、IMAT/SMA与vBMD间均存在负相关(P＜0.05).校正年龄因素后,IMAT椎旁肌仍与vBMD呈负相关(男性:r=-0.258,P=0.011;女性:r=-0.212,P=0.030).结论 老年人骨量降低伴随着椎旁肌肉质量降低、IMAT增多及握力下降,肌肉健康损害可能促进了OP的发生.

英文摘要:

      Objective To analyze bone and muscle mass of elderly population by means of opportunistic quantitative computed tomography(QCT).Methods 221 elderly volunteers(≥ 60 years old)who underwent low-dose chest CT plain scan physical examination in Tenth Peoples Hospital Affiliated to Tongji University from May 2021 to September 2022 were en-rolled.QCT was used to measure the average volumetric bone mineral density(vBMD)of L1/L2 vertebral bodies,skeletal mus-cle area(SMA),intermuscular adipose tissue(IMAT)area,and skeletal muscle mass index(SMI).Sarcopenia was diagnosed based on SMI,grip strength,and 6-meter gait speed.The differences in muscle parameters and grip strength were compared among the normal bone mass group,osteopenia group and osteoporosis(OP)group,and the correlation between muscle parame-ters and vBMD were analyzed.Results Among 221 volunteers,50 ones were diagnosed with OP and 19 ones with sarcopenia.The detection rate of OP in females was higher than that in males(28.95％vs 15.89％,P=0.020),while there was no statisti-cally significant difference in the detection rate of sarcopenia between different genders(P=0.565).Among elderly males,com-pared with the normal bone mass group,the SMI L2 and SMIparaspinal muscle decreased in the osteopenia group,and SML2 decreased in the OP group(P＜0.05);IMATL2,IMATparaspinal muscle,IMAT/SMIL2,and IMAT/SMAparaspinal muscle increased in the osteopenia group;IMATL2,IMATabdominal wall muscle,IMATparaspinal muscle,IMAT/SMIL2,IMAT/SMAabdominal wall muscle,and IMAT/SMAparaspinal muscle increased in the OP group,while grip strength decreased,with statistically significant differences(P＜0.05).Among elderly women,compared with the normal bone mass group,the OP group showed an increase in IM ATL2,IMATabdominal wall muscle,IMAT/SMIL2 and IMAT/SMAabdominal wall muscle,and a decrease in grip strength,with statistical significance(P＜0.05).Com-pared with the osteopenia group,the IMATabdominal wall muscle and IMAT/SMAabdominal wall muscle in the OP group increased significantly(P＜0.05).There is a weak positive correlation between SMIparaspinal muscle and vBMD,but the correlation disappears after adjus-ting for age factor(male:r=0.067,P=0.538;female:r=0.136,P=0.176).There was a negative correlation(P＜0.05)between IMAT,IMAT/SMA,and vBMD in all groups.After adjusting for age factor,IMATparaspinal muscle remained nega-tively correlated with vBMD(male:r=-0.258,P=0.011;female:r=-0.212,P=0.030).Conclusion Decreased bone mass in the elderly is accompanied by decreased paraspinal muscle mass,increased IMAT and decreased grip strength.Muscle health impairment may promote the occurrence of OP.