肌少症与慢性炎症作用

Sarcopenia and Chronic Inflammation

摘要: 目的：慢性炎症作用与慢性疾病和其他年龄相关的疾病有关，如肌肉萎缩和虚弱，甚至死亡。随着老龄化的发展，机体出现很多生理学的变化。肌少症主要表现为在老年人群中存在肌肉数量及力量逐渐减少的特征变化。多项研究表明肌少症与慢性炎症之间存在着某种联系。本文旨在观察肌少症人群中予以营养干预前后其体重、骨骼肌量、握力等体测指标及炎症指标的变化，探讨肌少症人群干预前后各项指标的变化、体重、骨骼肌量及握力之间的相关性及炎症反应与肌少症的相关性并探索其作用机制。方法：本研究从2017年5月至2017年12月通过对南京社区进行了一项随机分组、开放、平行及前后对照的临床观察性研究，对248例65~85岁社区人群根据低肌骨骼肌量的诊断标准(骨骼肌量低于生物电阻抗人体成分分析仪器InbodyS10根据受试者的身高推算出理想值的90%)筛选出目标人群，予以常规饮食及运动指导，并予以干预组加以口服全营养补充剂(雅培全安素) 53.8 g，一天二次，两餐之间口服，观察干预前后体测指标，如体重、握力及骨骼肌质量等、以及炎症指标(白介素-6，C反应蛋白)的变化。结果：本研究筛选248例65~85岁社区人群中，共78人符合低骨骼肌量的诊断标准，其中33人愿配合进行肌少症相关诊断的检查，并符合其诊断。其中男：女 = 19:14，平均年龄77.45 ± 6.52岁，最终完成研究的共20人(因故中途脱组/退出13人)，干预组10人，对照组10人。干预84 ± 7天后，干预组VS对照组体重变化平均值为：2.4 ± 1.69 kg VS 0.34 ± 1.95 kg；干预组VS对照组骨骼肌变化平均值为：0.21 ± 0.32 kg VS −0.23 ± 0.53 kg；干预组VS对照组白介素-6变化平均值为：15.27 ± 36.16 pg/ml VS 18.80 ± 38.21 pg/ml；干预组VS对照组C反应蛋白变化平均值为：1.05 ± 2.80 VS 0.70 ± 1.40；相关性分析：肌少症患者体重与握力的相关性分析p值 = 0.00 (<0.05)；肌少症患者握力与骨骼肌的相关性分析p值 = 0.011 (<0.05)；肌少症患者体重与骨骼肌的相关性分析p值 = 0.003 (<0.05)；统计结果显示体测指标及炎症指标的相关性分析无统计学意义，但研究结果显示干预后炎症指标有明显下降趋势，其中机制需进一步探索。结论：肌少症患者通过营养干预后，体测指标及炎症指标均有一定的变化；肌少症可能与慢性炎症反应有关，因此进一步探索炎症介质与肌少症之间的影响机制，对改善及治疗肌少症人群有一定的启发指导意义。

Abstract: Objective: Chronic inflammation is associated with chronic disease and other age-related diseases, such as muscle atrophy and weakness, and even death. As aging, there are many physiological changes in the body. Sarcopenia is characterized by the gradual reduction of muscle mass and strength in the elderly. Multiple studies have shown a link between sarcopenia and chronic inflammation. The purpose of this paper is to observe weight, skeletal muscle, grip strength, the change of inflammation index in sarcopenia; to investigate the relationship between inflammatory factor and sarcopenia and explore its action mechanism. Methods: From May 2017 to December 2017, this study conducted a randomized, open, parallel and compared clinical observational study in the Nanjing province community. It involves 248 cases in 65 - 85 years old community people according to the diagnostic criteria for low muscle (skeletal muscle quantity below human body composition analysis instrument InbodyS10 bioelectricity impedance calculated based on the height of the subjects of ideal value 90%), so we selected the target groups, gave guidance of diet and exercise, and then we gave the intervention group oral full nutritional supplements (53.8 g bid, Abbott Ensure complete), and then observed the change of skeletal muscle mass and inflammation index (Interleukin-6, C-reactive protein). Results: This study screened 248 cases, 65 - 85 years old community, 78 people in low quantity of skeletal muscle of diagnostic criteria, including 33 people cooperated to test for diagnosis of sarcopenia, and conformed to its diagnosis. The study showed Male: Female = 19:14; the mean age was 77.45 ± 6.52; and the total number of study participants was 20 (for the reason of dissection/withdrawal of 13 persons): 10 persons in the intervention group and 10 in the control group. After 84 ± 7 days, the average weight change of the intervention group VS the control group was 2.4 ± 1.69 kg VS 0.34 ± 1.95 kg. The mean value of skeletal muscle in the intervention group VS control group was 0.21 ± 0.32 kg VS −0.23 ± 0.53 kg. The mean value of Interleukinin-6 in the intervention group VS control group was 15.27 ± 36.16 pg/ml VS 18.80 ± 38.21 pg/ml. The mean value of C-reactive protein in the intervention group VS control group was 1.05 ± 2.80 VS 0.70 ± 1.40. Correlation analysis: Correlation analysis of body weight and grip strength of Sarcopenia p value = 0.00 (<0.05); Correlation analysis of grip strength and skeletal muscle in Sarcopenia p = 0.011 (<0.05); Correlation analysis of body weight and skeletal muscle in Sarcopenia p value = 0.003 (<0.05). Statistical results showed that there was no statistical significance in the correlation analysis of indicators and inflammatory markers, but the results showed that after intervention, the inflammation index has obvious downward trend, whose mechanism needs further exploration. Conclusion: Sarcopenia may be associated with chronic inflammation. Thus to further explore the influence mechanism between the inflammatory mediators and sarcopenia has certain enlightening significance for improving and treating sarcopenia.