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Article(id=1220689487634551486, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1220689483859677846, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2025.19.008, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1722960000000, receivedDateStr=2024-08-07, revisedDate=1757347200000, revisedDateStr=2025-09-09, acceptedDate=null, acceptedDateStr=null, onlineDate=1768964653165, onlineDateStr=2026-01-21, pubDate=1760025600000, pubDateStr=2025-10-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1768964653165, onlineIssueDateStr=2026-01-21, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1768964653165, creator=13701087609, updateTime=1768964653165, updator=13701087609, issue=Issue{id=1220689483859677846, tenantId=1146029695717560320, journalId=1220038315760373764, year='2025', volume='39', issue='19', pageStart='3201', pageEnd='3376', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1768964652266, creator=13701087609, updateTime=1768965013333, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1220690998338961744, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1220689483859677846, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1220690998338961745, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1220689483859677846, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3256, endPage=3262, ext={EN=ArticleExt(id=1220689487961707212, articleId=1220689487634551486, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Relationship between grip strength change trajectory and cognitive function among community⁃dwelling elderly people, columnId=1220689487877821128, journalTitle=Chinese Nursing Research, columnName=Interdisciplinary Nursing Study, runingTitle=null, highlight=null, articleAbstract=

Objective To explore grip strength change trajectory of community⁃dwelling elderly people and its relationship with cognitive function. Methods Based on the grip strength and cognitive function data of community⁃dwelling elderly people from the China Health and Retirement Longitudinal Study(CHARLS) in 2011,2013,and 2015,group⁃based trajectory model(GBTM) was used to establish the grip strength change trajectory of community-dwelling elderly people.Multiple linear regression was used to analyze the relationship between grip strength trajectory and cognitive function. Results A total of 1 245 community⁃dwelling elderly people were included.GBTM analysis results showed that there were four grip strength trajectories among community⁃dwelling elderly people:extremely low level group,low level group,medium level group,and high level group.Multiple linear regression analysis results showed that after adjusting for confounding factors,compared to the extremely low level group,the grip strength of elderly people in the low level group,medium level group,and high level group were positively correlated with their cognitive function;The area under the receiver operating characteristic curve for predicting cognitive function using grip strength trajectory was 0.622(95%CI 0.587⁃0.657). Conclusions The grip strength trajectory of community-dwelling elderly people could be divided into four categories:extremely low level group,low level group,medium level group,and high level group,which have certain predictive value for the cognitive function of community⁃dwelling elderly people.Low grip strength in the elderly is a risk factor for cognitive decline.Therefore,early identification of the development trajectory of grip strength in the elderly is particularly important.

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MA Qiuping, E⁃mail:
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目的 探讨社区老年人握力变化轨迹及其与认知功能的关系。 方法 基于中国健康与养老追踪调查（CHARLS）中2011年、2013年、2015年社区老年人的握力和认知功能数据，采用群组轨迹模型（GBTM）建立社区老年人握力的变化轨迹，采用多元线性回归分析握力轨迹与认知功能的关系。 结果 共纳入1 245名社区老年人。GBTM分析结果显示，社区老年人存在4种握力轨迹：极低水平组、低水平组、中水平组和高水平组。多元线性回归分析结果显示，校正混杂因素后，相对于极低水平组，低水平组、中水平组和高水平组老年人握力与认知功能呈正相关；使用握力轨迹预测认知功能的受试者工作特征曲线下面积为0.622［95%CI（0.587，0.657）］。 结论 社区老年人的握力轨迹可分为极低水平组、低水平组、中水平组和高水平组4类，该4类轨迹对社区老年人认知功能具有一定的预测价值。老年人握力低是认知功能下降的危险因素，因而早期识别老年人握力的发展轨迹尤为重要。

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马秋平，E⁃mail：
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黄明亮，主管护师，硕士研究生在读

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黄明亮，主管护师，硕士研究生在读

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volume=59, issue=3, pageStart=371, pageEnd=378, url=null, language=null, rfNumber=[34], rfOrder=33, authorNames=WEAVER J D, HUANG M H, ALBERT M, journalName=Neurology, refType=null, unstructuredReference=WEAVER J D, HUANG M H, ALBERT M,et al.Interleukin-6 and risk of cognitive decline:MacArthur studies of successful aging[J].Neurology,2002,59(3):371-378., articleTitle=Interleukin-6 and risk of cognitive decline:MacArthur studies of successful aging, refAbstract=null)], funds=[Fund(id=1220838937703141738, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689487634551486, awardId=2023BS055, language=CN, fundingSource=2023年广西中医药大学引进博士科研启动基金项目(2023BS055), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1220838932267323559, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689487634551486, xref=null, ext=[AuthorCompanyExt(id=1220838932275712168, tenantId=1146029695717560320, journalId=1220038315760373764, 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journalId=1220038315760373764, articleId=1220689487634551486, language=CN, label=图1, caption=社区老年人筛选流程及结果, figureFileSmall=73RpaZvAMbtHaxQEAugbxg==, figureFileBig=B79eE1FeHmYXsycGHKE2fg==, tableContent=null), ArticleFig(id=1220838936679731523, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689487634551486, language=EN, label=Figure 2, caption=Trajectory of grip strength in community⁃dwelling elderly people, figureFileSmall=8rgx9ctxnhPZtH/jkKBUXA==, figureFileBig=kpNkXrPpvNasn0PpkQR2DQ==, tableContent=null), ArticleFig(id=1220838936767811911, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689487634551486, language=CN, label=图2, caption=社区老年人握力轨迹, figureFileSmall=8rgx9ctxnhPZtH/jkKBUXA==, figureFileBig=kpNkXrPpvNasn0PpkQR2DQ==, tableContent=null), ArticleFig(id=1220838936860086603, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689487634551486, language=EN, label=Figure 3, caption=ROC curve of the predictive value of grip strength trajectory on cognitive function in community⁃dwelling elderly people, figureFileSmall=Ks5PbEZ14h52LBDK9b8kYg==, figureFileBig=OBglCD9yABUkuTjeobnWLA==, tableContent=null), ArticleFig(id=1220838936948166991, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689487634551486, language=CN, label=图3, caption=社区老年人握力轨迹对认知功能预测价值的ROC曲线, figureFileSmall=Ks5PbEZ14h52LBDK9b8kYg==, figureFileBig=OBglCD9yABUkuTjeobnWLA==, tableContent=null), ArticleFig(id=1220838937053024593, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689487634551486, language=EN, label=Table 1, caption=

Grouped iteration results of group-based trajectory modelling

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组数多项式函数类型BICAvePP
2线性函数/线性函数12 194.660.978/0.934
2线性函数/二次函数12 195.730.976/0.940
3线性函数/线性函数/线性函数12 104.000.890/0.814/0.914
3线性函数/线性函数/二次函数12 106.330.890/0.814/0.907
3线性函数/二次函数/线性函数12 093.910.889/0.816/0.927
3线性函数/二次函数/二次函数12 097.050.888/0.818/0.925
3二次函数/线性函数/线性函数12 102.630.895/0.819/0.905
3二次函数/二次函数/线性函数12 095.970.895/0.814/0.922
3二次函数/二次函数/二次函数12 099.060.894/0.815/0.919
3二次函数/二次函数/立方函数12 102.620.893/0.813/0.920
3二次函数/立方函数/立方函数12 106.190.895/0.814/0.917
3立方函数/立方函数/立方函数12 109.750.893/0.816/0.919
4线性函数/线性函数/线性函数/线性函数12 089.220.829/0.778/0.801/0.850
4二次函数/二次函数①/二次函数/二次函数12 086.780.838/0.783/0.801/0.853
4线性函数①/二次函数①/线性函数①/线性函数①12 077.440.842/0.784/0.797/0.852
4立方函数/立方函数/立方函数/立方函数12 101.030.838/0.783/0.801/0.853
), ArticleFig(id=1220838937132716374, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689487634551486, language=CN, label=表1, caption=

群组轨迹模型分组迭代结果

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组数多项式函数类型BICAvePP
2线性函数/线性函数12 194.660.978/0.934
2线性函数/二次函数12 195.730.976/0.940
3线性函数/线性函数/线性函数12 104.000.890/0.814/0.914
3线性函数/线性函数/二次函数12 106.330.890/0.814/0.907
3线性函数/二次函数/线性函数12 093.910.889/0.816/0.927
3线性函数/二次函数/二次函数12 097.050.888/0.818/0.925
3二次函数/线性函数/线性函数12 102.630.895/0.819/0.905
3二次函数/二次函数/线性函数12 095.970.895/0.814/0.922
3二次函数/二次函数/二次函数12 099.060.894/0.815/0.919
3二次函数/二次函数/立方函数12 102.620.893/0.813/0.920
3二次函数/立方函数/立方函数12 106.190.895/0.814/0.917
3立方函数/立方函数/立方函数12 109.750.893/0.816/0.919
4线性函数/线性函数/线性函数/线性函数12 089.220.829/0.778/0.801/0.850
4二次函数/二次函数①/二次函数/二次函数12 086.780.838/0.783/0.801/0.853
4线性函数①/二次函数①/线性函数①/线性函数①12 077.440.842/0.784/0.797/0.852
4立方函数/立方函数/立方函数/立方函数12 101.030.838/0.783/0.801/0.853
), ArticleFig(id=1220838937229185370, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689487634551486, language=EN, label=Table 2, caption=

Univariate analysis results on factors influencing the grip strength trajectory in community⁃dwelling elderly people

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项目分类极低水平组（n=551）低水平组（n=499）中水平组（n=133）高水平组（n=62）P
年龄68.10±6.5366.20±6.0967.10±6.2166.50±5.27<0.001
体质指数（kg/m2）23.70±4.1224.40±4.5225.00±3.6624.60±3.490.004
血小板计数（×109/L）212.0±71.4210.0±75.5197.0±60.8190.0±49.90.025
三酰甘油（mmol/L）1.66±0881.59±0.871.59±0.851.50±0.960.380
高密度脂蛋白胆固醇（mmol/L）1.37±0.271.37±0.261.32±0.271.30±0.260.073
低密度脂蛋白胆固醇（mmol/L）2.80±0.722.84±0.742.68±0.742.56±0.580.009
C反应蛋白（mg/L）2.84±5.092.74±5.212.34±1.852.97±4.930.743
三酰甘油葡萄糖指数3.83±0.243.80±0.243.80±0.253.75±0.280.046
认知功能评分（分）8.15±4.349.62±4.1410.50±4.2312.10±3.63<0.001
性别[人（%）]女537（97.5)430（86.2)43（32.3)1（1.6)<0.001
男14（2.5)69（13.8)90（67.7)61（98.4)
婚姻状况[人（%）]已婚408（74.0)416（83.4)117（88.0)59（95.2)<0.001
未婚143（26.0)83（16.6)16（12.0)3（4.8)
高血压[人（%）]无337（61.2)317（63.5)68（51.1)37（59.7）0.077
有214（38.8)182（36.5)65（48.9)25（40.3）
糖尿病[人（%）]无542（98.4)493（98.8)131（98.5)62（100.0）0.840
有9（1.6）6（1.2）2（1.5)0（0.0）
脑卒中史[人（%）]无534（96.9）489（98.0）122（91.7)59（95.2）0.006
有17（3.1）10（2.0）11（8.3）3（4.8）
饮酒[人（%）]无485（88.0）424（85.0）87（65.4）33（53.2）<0.001
有66（12.0）75（15.0）46（34.6）29（46.8）
吸烟[人（%）]无539（97.8）485（97.2）119（89.5）49（79.0）<0.001
有12（2.2）14（2.8）14（10.5）13（21.0）
抑郁[人（%）]无288（52.3）286（57.3）95（71.4）49（79.0）<0.001
有263（47.7）213（42.7）38（28.6）13（21.0）
受教育程度[人（%）]大学及以上2（0.4）3（0.6）5（3.7）3（4.8）<0.001
初中、高中60（10.9）67（13.4）37（27.8）17（27.4）
小学233（42.3）242（48.5）61（45.9）37（59.7）
文盲256（46.5）187（37.5）30（22.6）5（8.1）
), ArticleFig(id=1220838937325654364, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689487634551486, language=CN, label=表2, caption=

社区老年人握力轨迹影响因素的单因素分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类极低水平组（n=551）低水平组（n=499）中水平组（n=133）高水平组（n=62）P
年龄68.10±6.5366.20±6.0967.10±6.2166.50±5.27<0.001
体质指数（kg/m2）23.70±4.1224.40±4.5225.00±3.6624.60±3.490.004
血小板计数（×109/L）212.0±71.4210.0±75.5197.0±60.8190.0±49.90.025
三酰甘油（mmol/L）1.66±0881.59±0.871.59±0.851.50±0.960.380
高密度脂蛋白胆固醇（mmol/L）1.37±0.271.37±0.261.32±0.271.30±0.260.073
低密度脂蛋白胆固醇（mmol/L）2.80±0.722.84±0.742.68±0.742.56±0.580.009
C反应蛋白（mg/L）2.84±5.092.74±5.212.34±1.852.97±4.930.743
三酰甘油葡萄糖指数3.83±0.243.80±0.243.80±0.253.75±0.280.046
认知功能评分（分）8.15±4.349.62±4.1410.50±4.2312.10±3.63<0.001
性别[人（%）]女537（97.5)430（86.2)43（32.3)1（1.6)<0.001
男14（2.5)69（13.8)90（67.7)61（98.4)
婚姻状况[人（%）]已婚408（74.0)416（83.4)117（88.0)59（95.2)<0.001
未婚143（26.0)83（16.6)16（12.0)3（4.8)
高血压[人（%）]无337（61.2)317（63.5)68（51.1)37（59.7）0.077
有214（38.8)182（36.5)65（48.9)25（40.3）
糖尿病[人（%）]无542（98.4)493（98.8)131（98.5)62（100.0）0.840
有9（1.6）6（1.2）2（1.5)0（0.0）
脑卒中史[人（%）]无534（96.9）489（98.0）122（91.7)59（95.2）0.006
有17（3.1）10（2.0）11（8.3）3（4.8）
饮酒[人（%）]无485（88.0）424（85.0）87（65.4）33（53.2）<0.001
有66（12.0）75（15.0）46（34.6）29（46.8）
吸烟[人（%）]无539（97.8）485（97.2）119（89.5）49（79.0）<0.001
有12（2.2）14（2.8）14（10.5）13（21.0）
抑郁[人（%）]无288（52.3）286（57.3）95（71.4）49（79.0）<0.001
有263（47.7）213（42.7）38（28.6）13（21.0）
受教育程度[人（%）]大学及以上2（0.4）3（0.6）5（3.7）3（4.8）<0.001
初中、高中60（10.9）67（13.4）37（27.8）17（27.4）
小学233（42.3）242（48.5）61（45.9）37（59.7）
文盲256（46.5）187（37.5）30（22.6）5（8.1）
), ArticleFig(id=1220838937401151839, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689487634551486, language=EN, label=Table 3, caption=

Multiple⁃linear regression analysis results of grip strength trajectory and cognitive function in community⁃dwelling elderly people

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模型组别回归系数标准误标准化回归系数P
模型1低水平组1.470.260.17<0.05
中水平组2.380.410.17<0.05
高水平组3.970.570.20<0.05
模型2低水平组0.970.260.11<0.05
中水平组1.060.490.080.030
高水平组2.140.690.110.002
), ArticleFig(id=1220838937497620834, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689487634551486, language=CN, label=表3, caption=

社区老年人握力轨迹与认知功能的多元线性回归分析结果

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模型组别回归系数标准误标准化回归系数P
模型1低水平组1.470.260.17<0.05
中水平组2.380.410.17<0.05
高水平组3.970.570.20<0.05
模型2低水平组0.970.260.11<0.05
中水平组1.060.490.080.030
高水平组2.140.690.110.002
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社区老年人握力变化轨迹与认知功能的关系
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黄明亮 , 杨春晓 , 饶丽丽 , 刘笑言 , 马秋平
护理研究 | 交叉护理学研究 2025,39(19): 3256-3262
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护理研究 | 交叉护理学研究 2025, 39(19): 3256-3262
社区老年人握力变化轨迹与认知功能的关系
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黄明亮, 杨春晓, 饶丽丽, 刘笑言, 马秋平
作者信息
  • 广西中医药大学护理学院，广西 530022

    • 黄明亮，主管护师，硕士研究生在读

通讯作者:

马秋平，E⁃mail：
Relationship between grip strength change trajectory and cognitive function among community⁃dwelling elderly people
Mingliang HUANG, Chunxiao YANG, Lili RAO, Xiaoyan LIU, Qiuping MA
Affiliations
  • School of Nursing, Guangxi University of Chinese Medicine, Guangxi 530022 China
出版时间: 2025-10-10 doi: 10.12102/j.issn.1009-6493.2025.19.008
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摘要
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目的 探讨社区老年人握力变化轨迹及其与认知功能的关系。 方法 基于中国健康与养老追踪调查（CHARLS）中2011年、2013年、2015年社区老年人的握力和认知功能数据，采用群组轨迹模型（GBTM）建立社区老年人握力的变化轨迹，采用多元线性回归分析握力轨迹与认知功能的关系。 结果 共纳入1 245名社区老年人。GBTM分析结果显示，社区老年人存在4种握力轨迹：极低水平组、低水平组、中水平组和高水平组。多元线性回归分析结果显示，校正混杂因素后，相对于极低水平组，低水平组、中水平组和高水平组老年人握力与认知功能呈正相关；使用握力轨迹预测认知功能的受试者工作特征曲线下面积为0.622［95%CI（0.587，0.657）］。 结论 社区老年人的握力轨迹可分为极低水平组、低水平组、中水平组和高水平组4类，该4类轨迹对社区老年人认知功能具有一定的预测价值。老年人握力低是认知功能下降的危险因素，因而早期识别老年人握力的发展轨迹尤为重要。

握力  /  认知功能  /  社区  /  老年人  /  轨迹  /  群组轨迹模型  /  相关性

Objective To explore grip strength change trajectory of community⁃dwelling elderly people and its relationship with cognitive function. Methods Based on the grip strength and cognitive function data of community⁃dwelling elderly people from the China Health and Retirement Longitudinal Study(CHARLS) in 2011,2013,and 2015,group⁃based trajectory model(GBTM) was used to establish the grip strength change trajectory of community-dwelling elderly people.Multiple linear regression was used to analyze the relationship between grip strength trajectory and cognitive function. Results A total of 1 245 community⁃dwelling elderly people were included.GBTM analysis results showed that there were four grip strength trajectories among community⁃dwelling elderly people:extremely low level group,low level group,medium level group,and high level group.Multiple linear regression analysis results showed that after adjusting for confounding factors,compared to the extremely low level group,the grip strength of elderly people in the low level group,medium level group,and high level group were positively correlated with their cognitive function;The area under the receiver operating characteristic curve for predicting cognitive function using grip strength trajectory was 0.622(95%CI 0.587⁃0.657). Conclusions The grip strength trajectory of community-dwelling elderly people could be divided into four categories:extremely low level group,low level group,medium level group,and high level group,which have certain predictive value for the cognitive function of community⁃dwelling elderly people.Low grip strength in the elderly is a risk factor for cognitive decline.Therefore,early identification of the development trajectory of grip strength in the elderly is particularly important.

grip strength  /  cognitive function  /  community  /  elderly people  /  trajectory  /  group⁃based trajectory model  /  correlation
黄明亮, 杨春晓, 饶丽丽, 刘笑言, 马秋平. 社区老年人握力变化轨迹与认知功能的关系. 护理研究, 2025 , 39 (19) : 3256 -3262 . DOI: 10.12102/j.issn.1009-6493.2025.19.008
Mingliang HUANG, Chunxiao YANG, Lili RAO, Xiaoyan LIU, Qiuping MA. Relationship between grip strength change trajectory and cognitive function among community⁃dwelling elderly people[J]. Chinese Nursing Research, 2025 , 39 (19) : 3256 -3262 . DOI: 10.12102/j.issn.1009-6493.2025.19.008
正文
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经济的快速增长带来了人口老龄化，引发了公众的健康担忧。预期寿命的增加使得与衰老相关的认知问题变得越来越明显。研究表明，老年人的认知功能普遍随着年龄的增长而下降，并且与认知功能障碍、阿尔兹海默病（Alzheimer's disease，AD）、痴呆症和死亡的风险增高密切相关[1⁃3]。因此，确定与认知功能下降的相关因素，并采取措施预防这些风险因素可能是防治认知功能衰退的一个重要途径。目前，已有研究证明握力与认知功能的关系，但多为横断面研究，握力的纵向变化与认知功能的研究较少[4⁃7]。群组轨迹模型（GBTM）是一种对存在异质性的总体进行追踪性分析的方法，可以探究并明确总体中各亚组的发展轨迹趋势及轨迹特征。本研究基于群组轨迹模型，旨在识别社区老年人握力发展轨迹，并探讨其与认知功能的关系。
1 对象与方法
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1.1　研究对象
基于中国健康与养老追踪调查（CHARLS）的数据，该项目通过北京大学生物医学伦理委员会的批准（审批号：IRB0000105211015)，网址为http：//CHARLS.pku.edu.cn。本研究收集了2011年、2013年、2015年社区老年人的握力及认知功能数据，并以2015年CHARLS数据作为随访结局进行分析。排除标准：1）年龄<60岁；2）缺失认知功能评分数据的个体；3）握力数据缺失的个体；4）缺失关键协变量（吸烟、饮酒、文化程度等）的个体。最终纳入1 245名社区老年人，筛选流程及结果详见图1。
1.2　研究方法
1.2.1　握力评估
收集2011年、2013年、2015年社区老年人的握力数据。在CHARLS中，每位受试者均进行双手直角（90°）握力计测试。如果其中1只手由于某种原因无法测量，则记录另1只手的最大值。每名参与者的左手和右手均被测量2次，本研究以4个测量值的最大值作为连续变量进行统计分析[8⁃9]。
1.2.2　认知功能评估
以2015年社区老年人的认知功能为随访结局（因变量），涉及定向力、注意力、情景记忆和视觉空间能力4个维度。1）采用电话访谈认知状态量表⁃10（Telephone Interview for Cognitive Status，TICS⁃10）评价定向力和注意力，得分为0~10分[10]。2）采用减法任务评估注意力，该任务要求参与者依次从100减去7，共减5次。3）通过询问日期（年、月、日)、星期几和季节评估定向力。4）采用即刻回忆和延迟回忆评估情景记忆[11]。即刻回忆要求参与者在听到汉语名词后立即回忆尽可能多的名词，而延迟回忆要求参与者在4~10 min后回忆同样的名词，情景记忆评分由即刻回忆和延迟回忆平均数计算[12]。5）采用图形绘制评估视觉空间能力，呈现给参与者一张图片，并指导参与者绘制相同的图片，成功完成绘画任务计1分，无法完成绘画任务计0分[12]。认知功能总分为TICS⁃10得分、情景记忆得分和图形绘制得分之和，为0~21分，得分越高表明受试者认知功能越好[13]。
1.2.3　协变量
包括性别、年龄、教育程度、婚姻状况、饮酒、吸烟、高血压、糖尿病、脑卒中、抑郁、体质指数。考虑机体炎症与骨骼肌萎缩、力量损失和功能障碍增加有关[14⁃15]。握力作为上半身肌肉力量的敏感指标，从另一方面反映出机体对氧化应激及炎症的抵抗和修复[16]，是整体健康状况的预测因素[17]。同时，研究指出，握力与心血管疾病生物标志物存在一定关联[18]。因此，本研究将C反应蛋白[6]、血小板计数[19]、三酰甘油[20]、低密度脂蛋白胆固醇[20]、高密度脂蛋白胆固醇[20]和三酰甘油葡萄糖指数[21]等标志物也纳入研究。采用流行病学调查中心抑郁自评量表（CES⁃D）评价受试者个体的抑郁程度，该量表在我国人群中具有较高的信度和效度，由10个条目组成，总分为30分，得分>10分表明存在潜在的抑郁[22]。
1.2.4　统计学方法
使用R Studio和Stata 15.0软件进行统计分析。定性资料以频数、百分比（%）表示，进行χ²检验或Fisher确切概率法。服从正态分布的定量资料以均数±标准差（$\bar{x}\pm s$）表示。采用群组轨迹模型识别具有相似轨迹的潜在簇[23]。构建群组轨迹模型时首先确定最佳分组数，之后确定多项式阶次。根据贝叶斯信息准则（Bayesian information criterion，BIC）确定群组轨迹模型的亚组数（2~4组）及各亚组函数模型。研究指出，BIC绝对值最小，越接近0，表示模型拟合越好[24]。另外，平均验后分组概率（AvePP）反映根据轨迹分组后的亚组内成员与该轨迹的符合程度，当平均验后分组概率>0.70时，表明模型的拟合效果良好，同时结合每组样本量合理、符合理论解释的模型即最优模型[25]。确定群组轨迹模型分组后，采用χ²检验或方差分析比较不同轨迹组的差异。采用多元线性回归分析不同握力轨迹与认知功能的关联。以P<0.05为差异有统计学意义。
2 结果
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2.1　社区老年人握力变化轨迹
采用群组轨迹模型进行模型拟合，综合BIC等评价指标发现，随着组别数由2~4依次迭代，BIC值逐渐减小，详见表1。因此，本研究确定最佳组数为4组，分别为：极低水平组（44.3%，AvePP=0.842）、低水平组（40.0%，AvePP=0.784）、中水平组（10.7%，AvePP=0.797）和高水平组（5%，AvePP=0.852），社区老年人握力变化轨迹见图2。
2.2　社区老年人握力轨迹影响因素的单因素分析
结果显示，社区老年人不同性别、年龄、体质指数、婚姻状况、脑卒中史、饮酒、吸烟、抑郁、学教育程度、血小板、低密度脂蛋白胆固醇水平、三酰甘油葡萄糖指数和认知功能评分握力轨迹不同，差异有统计学意义（P<0.05）。详见表2。
2.3　老年握力轨迹分组与认知功能的多元线性回归分析
采用多元线性回归分析握力轨迹与认知功能的关系，以极低水平组握力轨迹为参照，结果显示，在未调整任何协变量的模型1中，低水平组、中水平组和高水平组与认知功能均呈正相关（P<0.05）。在调整性别、年龄、高血压、糖尿病、脑卒中、饮酒、吸烟、抑郁、教育程度等协变量后，低水平组、中水平组和高水平组仍与认知功能相关（P<0.05）。详见表3。
2.4　社区老年人握力轨迹对认知功能的预测价值
本研究中，如果参与者的认知功能评分低于研究人群平均认知功能评分的1个标准差或更多，则被归类为认知功能障碍[7,26]。结果显示，社区老年人握力轨迹预测认知功能的受试者工作特征（ROC）曲线下面积（AUC）为0.622[95%CI（0.587，0.657）]，表明握力轨迹对社区老年人认知功能具有一定的预测效果，但预测效能相对较低。详见图3。
3 讨论
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3.1　握力与认知功能的关系
张伟等[27]探讨了中老年脑卒中病人握力与认知功能的关系，结果表明，握力可提高认知功能，每增加5 kg握力，脑卒中病人能够正确画出图案的概率增加30%[95%CI（8%，57%），P=0.005]，同时，情节记忆增加0.15分（P=0.003），电话筛查认知功能增加0.30分（P=0.001），总认知得分增加0.60分（P<0.001）。李志强等[28]研究了北京市老年人握力与认知障碍的关联，结果表明，握力每增加1 kg，老年人认知障碍患病风险下降4%[OR=0.96，95%CI（0.95，0.97）]。此外，杨佳佳等[29]研究发现，调整社会人口学信息、生活方式因素和疾病史等协变量后，相比于握力Q1组（<18.6 kg），Q2组（18.6~24.1 kg）、Q3组（24.2~31.1 kg）和Q4组（>31.1 kg）的认知功能得分回归系数分别为0.45，0.40，1.19；认知障碍发生率的OR值分别为0.97，0.79，0.22，当以握力作为连续性变量进行分析时，其每增加1 kg，认知功能得分增加0.07分，认知障碍的发生风险降低6%。但上述研究均为横断面研究，无法阐述握力动态变化与随后认知功能的关系。
3.2　社区老年人握力变化的4个轨迹及其对认知功能的预测价值
本研究探讨了握力的发展轨迹与认知功能的关系。根据握力的动态变化模式，群组轨迹模型分析识别出4个不同的轨迹组：极低水平组（44.3%）、低水平组（40.0%）、中水平组（10.7%）和高水平组（5.0%）。回归分析结果显示，与极低水平组相比，低水平组、中水平组和高水平组展现出了较好的认知功能，这与Jane等[30⁃31]研究结果一致。此外，韩孝[32]研究使用握力作为预测因子构建了轻度认知障碍预测模型，取得良好的预测效果，但本研究结果显示，虽然握力轨迹与认知障碍的发生显著相关，但仅使用握力轨迹预测认知功能的效能有限（AUC值为0.622），后期可考虑将握力轨迹与其他变量联合，构建轻度认知障碍的风险预测模型。
3.3　握力对认知功能影响的相关机制
握力与认知功能的关系可以归结为多种机制。从生物学方面考虑，一定强度的运动训练在提升肌肉力量同时，对大脑也会产生刺激效应，有利于促进神经可塑性[33]。从炎症机制方面看，较高的握力可以反映神经肌肉系统的完整性和对氧化应激及炎症更好地抵抗[34]。一项对社区老年人的研究发现，体内有高浓度促炎细胞因子的老年人，其认知功能下降率更明显，肌肉量和握力值较低[16]。握力是衡量一个人整体肌肉力量的可靠指标，认知功能下降与握力之间的关系可能受神经元和运动复杂性的影响。
4 局限性与展望
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本研究描述了握力轨迹与认知功能之间的关系，但也存在一定的局限性。首先，握力与认知功能之间的机制较为复杂，CHARLS数据库仅在2011年、2013年、2015年提供了握力测试数据，时间点较少，本研究可能无法建立因果关系。其次，虽然本研究尽可能调整一系列潜在混杂因素，以确定握力变化轨迹与认知功能之间的相关性是可靠的，但仍不能排除其他混杂因素的影响。最后，本研究共纳入了19个研究变量，在筛选符合研究的人群时排除了变量存在缺失值的人群，可能会造成一定的选择偏倚。基于以上情况，建议未来的研究应使用更长期的纵向数据与时间设计或更强大的因果建模方法充分揭示握力与认知功能的关系。
基金
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  • 2023年广西中医药大学引进博士科研启动基金项目(2023BS055)
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2025年第39卷第19期
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doi: 10.12102/j.issn.1009-6493.2025.19.008
  • 接收时间：2024-08-07
  • 首发时间：2026-01-21
  • 出版时间：2025-10-10
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  • 收稿日期：2024-08-07
  • 修回日期：2025-09-09
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2023年广西中医药大学引进博士科研启动基金项目(2023BS055)
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    广西中医药大学护理学院，广西 530022

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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