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Article(id=1190669170607013893, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1190669163988398295, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.1458.2024.0521, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1699286400000, receivedDateStr=2023-11-07, revisedDate=null, revisedDateStr=null, acceptedDate=1703692800000, acceptedDateStr=2023-12-28, onlineDate=1761807251835, onlineDateStr=2025-10-30, pubDate=1745769600000, pubDateStr=2025-04-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1761807251835, onlineIssueDateStr=2025-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1761807251835, creator=13701087609, updateTime=1761807251835, updator=13701087609, issue=Issue{id=1190669163988398295, tenantId=1146029695717560320, journalId=1189873630562394117, year='2025', volume='50', issue='4', pageStart='367', pageEnd='503', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1761807250258, creator=13701087609, updateTime=1761807667423, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1190670913772339410, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1190669163988398295, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1190670913772339411, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1190669163988398295, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=444, endPage=451, ext={EN=ArticleExt(id=1190669170925781000, articleId=1190669170607013893, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Correlation between hemoglobin, anemia and sarcopenia in the elderly population, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To analyze the correlation between hemoglobin (Hb), anemia, and sarcopenia in the elderly population in Chongqing communities. Methods A cross-sectional study was conducted on elderly individuals who underwent healthy examinations at 5 community health service centers in Chongqing from March to August 2023. Demographic characteristics, social factors, body composition measurement, grip strength, 6-meter gait speed and blood tests were assessed. Receiver operating characteristic (ROC) curve was utilized to evaluate the accuracy of Hb in predicting sarcopenia, and the Youden index was employed to determine the optimal Hb cut-off value for diagnosing sarcopenia and its components. Both unadjusted and adjusted logistic regression analyses were performed to examine the relationship between Hb and anemia with sarcopenia and its components. Results A total of 531 elderly populations were included, with an average age of (71.1±6.5) years. The overall prevalence of sarcopenia was 13.6% (72/531), including 29 males (40.3%) and 43 females (59.7%). Unadjusted analyses showed that Hb was correlated with sarcopenia, decreased muscle mass, slower gait speed, and reduced grip strength (P<0.05). After adjusting for all potential risk factors, Hb was still significantly associated with sarcopenia and reduced grip strength (P<0.05). For every 10 g/L increase in Hb, the risk of sarcopenia decreased by 2.3%, and the risk of reduced grip strength decreased by 1.7% (P<0.05). Anemia was correlated with sarcopenia, reduced muscle mass, and decreased grip strength in unadjusted analyses (P<0.05), while the correlation between anemia and reduced grip strength remained significant after adjustment for all potential risk factors (P<0.05). The optimal Hb cut-off value for diagnosing sarcopenia in males and females were 148 g/L and 128 g/L, respectively. Conclusions Hb is an independent risk factor for sarcopenia and reduced grip strength. Anemia is associated with sarcopenia, but is not an independent risk factor for sarcopenia.

, correspAuthors=Li Xia, authorNote=null, correspAuthorsNote=
E-mail:
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目的 分析重庆市社区老年人血红蛋白(Hb)、贫血与肌少症的相关性。方法 本研究为横断面研究。对2023年3-8月前往重庆市5个社区卫生服务中心体检的老年人群进行人口信息、社会因素调查、人体成分测量、握力、6 m步行速度和血液分析。采用受试者操作特征(ROC)曲线评价Hb预测肌少症的准确性，约登指数确定诊断肌少症及其组成成分的最佳Hb临界值。采用未经调整和调整后的logistic回归分析Hb、贫血与肌少症及其组成成分的关系。结果 共纳入531名老年人，年龄(71.1±6.5)岁。肌少症患病率为13.6%(72/531)，其中男性29例(40.3%)，女性43例(59.7%)。未经调整时Hb与肌少症、肌肉量减少、步速减慢、握力降低相关(P<0.05)，调整可能的混杂因素后Hb仍与肌少症、握力降低明显相关(P<0.05)。Hb每升高10 g/L，肌少症患病率降低2.3%，握力降低的风险降低1.7%(P<0.05)。未经调整时贫血与肌少症、肌肉量减少、握力降低相关(P<0.05)，调整可能的混杂因素后贫血与握力降低明显相关(P<0.05)。诊断男性肌少症的最佳Hb临界值为148 g/L，女性为128 g/L。结论 Hb是肌少症与握力降低的独立危险因素。贫血与肌少症相关，但不是肌少症的独立危险因素。

, correspAuthors=夏丽, authorNote=null, correspAuthorsNote=
夏丽，E-mail：
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陈鸿桢，硕士研究生，主要从事肌少症及慢性病社区管理等方面的研究

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陈鸿桢，硕士研究生，主要从事肌少症及慢性病社区管理等方面的研究

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陈鸿桢，硕士研究生，主要从事肌少症及慢性病社区管理等方面的研究

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J Endocrinol, 2016, 229(2): R67-81., articleTitle=Insulin resistance and sarcopenia: mechanistic links between common co-morbidities, refAbstract=null), Reference(id=1190669220628283680, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190669170607013893, doi=null, pmid=null, pmcid=null, year=1990, volume=68, issue=5, pageStart=2047, pageEnd=2053, url=null, language=null, rfNumber=[40], rfOrder=39, authorNames=Gutierrez G, Marini C, Acero AL, journalName=J Appl Physiol, refType=null, unstructuredReference=Gutierrez G, Marini C, Acero AL, et al. Skeletal muscle PO2 during hypoxemia and isovolemic anemia[J]. J Appl Physiol (1985), 1990, 68(5): 2047-2053., articleTitle=Skeletal muscle PO2 during hypoxemia and isovolemic anemia, refAbstract=null), Reference(id=1190669220678615329, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190669170607013893, doi=null, pmid=null, pmcid=null, year=1981, volume=22, issue=3, pageStart=308, pageEnd=323, url=null, language=null, rfNumber=[41], rfOrder=40, authorNames=Homer LD, Weathersby PK, Kiesow LA, journalName=Microvasc Res, refType=null, unstructuredReference=Homer LD, Weathersby PK, Kiesow LA. Oxygen gradients between red blood cells in the microcirculation[J]. 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J Nutr, 1983, 113(9): 1811-1818., articleTitle=Effects of dietary iron deficiency on muscle fiber characteristics and whole-body distribution of hemoglobin in mice, refAbstract=null), Reference(id=1190669220884136228, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190669170607013893, doi=null, pmid=null, pmcid=null, year=1986, volume=261, issue=29, pageStart=13827, pageEnd=13832, url=null, language=null, rfNumber=[44], rfOrder=43, authorNames=Cartier LJ, Ohira Y, Chen M, journalName=J Biol Chem, refType=null, unstructuredReference=Cartier LJ, Ohira Y, Chen M, et al. Perturbation of mitochondrial composition in muscle by iron deficiency. Implications regarding regulation of mitochondrial assembly[J]. J Biol Chem, 1986, 261(29): 13827-13832., articleTitle=Perturbation of mitochondrial composition in muscle by iron deficiency. Implications regarding regulation of mitochondrial assembly, refAbstract=null), Reference(id=1190669220988993829, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190669170607013893, doi=null, pmid=null, pmcid=null, year=2009, volume=1793, issue=1, pageStart=5, pageEnd=19, url=null, language=null, rfNumber=[45], rfOrder=44, authorNames=Zick M, Rabl R, Reichert AS, journalName=Biochim Biophys Acta, refType=null, unstructuredReference=Zick M, Rabl R, Reichert AS. Cristae formation-linking ultrastructure and function of mitochondria[J]. Biochim Biophys Acta, 2009, 1793(1): 5-19., articleTitle=Cristae formation-linking ultrastructure and function of mitochondria, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1190669213598630022, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190669170607013893, xref=null, ext=[AuthorCompanyExt(id=1190669213607018631, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190669170607013893, companyId=1190669213598630022, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of General Practice, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China), AuthorCompanyExt(id=1190669213615407240, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190669170607013893, companyId=1190669213598630022, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=重庆医科大学附属第一医院全科医学科，重庆 400016)])], figs=[ArticleFig(id=1190669215918080198, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190669170607013893, language=EN, label=Fig.1, caption=Receiver operating characteristic (ROC) curve to discriminate sarcopenia and its components in elderly populations according to hemoglobin level, figureFileSmall=W0bH0M7QFszQwknARbZ/DA==, figureFileBig=VvlteBp4DarqiACqetgnMA==, tableContent=null), ArticleFig(id=1190669215972606152, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190669170607013893, language=CN, label=图1, caption=Hb诊断老年人肌少症及其组成成分的ROC曲线

Hb. 血红蛋白；AUC. 曲线下面积；●示所有人的诊断临界值；■示女性的诊断临界值；▲示男性的诊断临界值

, figureFileSmall=W0bH0M7QFszQwknARbZ/DA==, figureFileBig=VvlteBp4DarqiACqetgnMA==, tableContent=null), ArticleFig(id=1190669216232653005, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190669170607013893, language=EN, label=Tab.1, caption=

Comparison of basic characteristics of two groups of elderly populations

, figureFileSmall=null, figureFileBig=null, tableContent=
项目肌少症组(n=72)非肌少症组(n=459)t/χ2P
年龄(岁, $\bar{x}±s$)75.9±6.970.3±6.1-7.128<0.001
年龄[例(%)]28.722<0.001
60~74岁33(45.8)352(76.7)
≥75岁39(54.2)107(23.3)
性别[例(%)]0.0800.777
男29(40.3)193(42.0)
女43(59.7)266(58.0)
BMI(kg/m2, $\bar{x}±s$)22.6±3.324.9±3.0-6.124<0.001
BMI[例(%)]
低体重4(5.6)3(0.7)45.617<0.001
正常体重52(72.2)174(37.9)
超重或肥胖16(22.2)282(61.4)
文化程度[例(%)]13.0190.001
小学及以下55(76.4)247(53.8)
中学12(16.7)140(30.5)
高中及以上5(6.9)72(15.7)
婚姻状况[例(%)]11.289<0.001
已婚46(63.9)373(81.3)
其他(未婚、丧偶等)26(36.1)86(18.7)
收入[例(%)]1.2040.273
不能承担日常生活15(20.8)72(15.7)
可以承担日常生活57(79.2)387(84.3)
吸烟[例(%)]1.7680.413
仍在吸烟10(13.9)80(17.4)
已戒烟11(15.3)91(19.8)
从未吸烟51(70.8)288(62.7)
饮酒[例(%)]3.6960.158
仍在饮酒9(12.5)103(22.4)
已戒酒13(18.1)74(16.1)
从不饮酒50(69.4)282(61.5)
高血压[例(%)]1.9930.158
有高血压45(62.5)246(53.6)
无高血压27(37.5)213(46.4)
糖尿病[例(%)]5.0290.025
有糖尿病28(38.9)120(26.1)
无糖尿病44(61.1)339(73.9)
日常生活能力[例(%)]16.967<0.001
正常58(80.6)433(94.3)
受损14(19.4)26(5.7)
营养状况[例(%)]13.646<0.001
营养良好58(80.6)429(93.5)
存在营养风险12(16.4)30(6.5)
WBC(×109/L, $\bar{x}±s$)6.2±1.66.1±1.9-0.3540.723
肌酐(mg/L, $\bar{x}±s$)8.8±2.69.2±6.30.5490.583
Hb(g/L, $\bar{x}±s$)127±13134±143.857<0.001
贫血[例(%)]8.7050.003
是23(31.9)79(17.2)
否49(68.1)380(82.8)
ASM/身高2[kg/m2, M(Q1, Q3)]5.6(5.4, 6.6)7.3(6.6, 8.2)-10.552<0.001
步速(m/s, $\bar{x}±s$)0.8±0.21.0±0.26.955<0.001
握力(kg, $\bar{x}±s$)20.2±6.124.6±7.7-4.389<0.001
), ArticleFig(id=1190669216366870734, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190669170607013893, language=CN, label=表1, caption=

两组老年人基本情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目肌少症组(n=72)非肌少症组(n=459)t/χ2P
年龄(岁, $\bar{x}±s$)75.9±6.970.3±6.1-7.128<0.001
年龄[例(%)]28.722<0.001
60~74岁33(45.8)352(76.7)
≥75岁39(54.2)107(23.3)
性别[例(%)]0.0800.777
男29(40.3)193(42.0)
女43(59.7)266(58.0)
BMI(kg/m2, $\bar{x}±s$)22.6±3.324.9±3.0-6.124<0.001
BMI[例(%)]
低体重4(5.6)3(0.7)45.617<0.001
正常体重52(72.2)174(37.9)
超重或肥胖16(22.2)282(61.4)
文化程度[例(%)]13.0190.001
小学及以下55(76.4)247(53.8)
中学12(16.7)140(30.5)
高中及以上5(6.9)72(15.7)
婚姻状况[例(%)]11.289<0.001
已婚46(63.9)373(81.3)
其他(未婚、丧偶等)26(36.1)86(18.7)
收入[例(%)]1.2040.273
不能承担日常生活15(20.8)72(15.7)
可以承担日常生活57(79.2)387(84.3)
吸烟[例(%)]1.7680.413
仍在吸烟10(13.9)80(17.4)
已戒烟11(15.3)91(19.8)
从未吸烟51(70.8)288(62.7)
饮酒[例(%)]3.6960.158
仍在饮酒9(12.5)103(22.4)
已戒酒13(18.1)74(16.1)
从不饮酒50(69.4)282(61.5)
高血压[例(%)]1.9930.158
有高血压45(62.5)246(53.6)
无高血压27(37.5)213(46.4)
糖尿病[例(%)]5.0290.025
有糖尿病28(38.9)120(26.1)
无糖尿病44(61.1)339(73.9)
日常生活能力[例(%)]16.967<0.001
正常58(80.6)433(94.3)
受损14(19.4)26(5.7)
营养状况[例(%)]13.646<0.001
营养良好58(80.6)429(93.5)
存在营养风险12(16.4)30(6.5)
WBC(×109/L, $\bar{x}±s$)6.2±1.66.1±1.9-0.3540.723
肌酐(mg/L, $\bar{x}±s$)8.8±2.69.2±6.30.5490.583
Hb(g/L, $\bar{x}±s$)127±13134±143.857<0.001
贫血[例(%)]8.7050.003
是23(31.9)79(17.2)
否49(68.1)380(82.8)
ASM/身高2[kg/m2, M(Q1, Q3)]5.6(5.4, 6.6)7.3(6.6, 8.2)-10.552<0.001
步速(m/s, $\bar{x}±s$)0.8±0.21.0±0.26.955<0.001
握力(kg, $\bar{x}±s$)20.2±6.124.6±7.7-4.389<0.001
), ArticleFig(id=1190669216471728336, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190669170607013893, language=EN, label=Tab.2, caption=

Associations between hemoglobin (Hb) and anemia with sarcopenia components in elderly populations

, figureFileSmall=null, figureFileBig=null, tableContent=
指标肌肉量握力步速
正常减少P正常降低P正常减慢P
Hb(g/L, $\bar{x}±s$)134±14130±140.008134±13130±160.001135±13131±15<0.001
贫血[例(%)]0.039<0.0010.054
是77(17.6)25(26.9)50(13.8)52(30.8)41(15.8)61(22.4)
否361(82.4)68(73.1)312(86.2)117(69.2)218(84.2)211(77.6)
), ArticleFig(id=1190669216543031506, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190669170607013893, language=CN, label=表2, caption=

老年人Hb、贫血与肌少症组成成分的关系

, figureFileSmall=null, figureFileBig=null, tableContent=
指标肌肉量握力步速
正常减少P正常降低P正常减慢P
Hb(g/L, $\bar{x}±s$)134±14130±140.008134±13130±160.001135±13131±15<0.001
贫血[例(%)]0.039<0.0010.054
是77(17.6)25(26.9)50(13.8)52(30.8)41(15.8)61(22.4)
否361(82.4)68(73.1)312(86.2)117(69.2)218(84.2)211(77.6)
), ArticleFig(id=1190669216605946068, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190669170607013893, language=EN, label=Tab.3, caption=

Multivariable logistic regression for associations among hemoglobin (Hb) and anemia with sarcopenia and its components in elderly populations

, figureFileSmall=null, figureFileBig=null, tableContent=
指标模型1模型2模型3
OR(95%CI)POR(95%CI)POR(95%CI)P
Hb
肌少症0.967(0.951~0.984)<0.0010.970(0.951~0.988)0.0020.977(0.957~0.999)0.036
肌肉量减少0.979(0.964~0.995)0.0080.979(0.962~0.996)0.0160.993(0.973~1.013)0.469
步速减慢0.976(0.964~0.989)<0.0010.980(0.966~0.994)0.0060.988(0.974~1.003)0.126
握力降低0.979(0.966~0.992)0.0010.974(0.960~0.989)0.0010.983(0.968~0.998)0.030
贫血
肌少症2.258(1.301~3.919)0.0041.818(1.025~3.222)0.0411.103(0.575~2.116)0.769
肌肉量减少1.724(1.024~2.900)0.0401.434(0.836~2.461)0.1900.895(0.486~1.650)0.723
步速减慢1.537(0.991~2.384)0.0551.416(0.904~2.219)0.1291.125(0.701~1.805)0.626
握力降低2.773(1.782~4.317)<0.0012.410(1.526~3.805)<0.0011.967(1.220~3.172)0.005
), ArticleFig(id=1190669216660472022, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190669170607013893, language=CN, label=表3, caption=

未经调整和调整后Hb、贫血与老年人肌少症及其组成成分的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
指标模型1模型2模型3
OR(95%CI)POR(95%CI)POR(95%CI)P
Hb
肌少症0.967(0.951~0.984)<0.0010.970(0.951~0.988)0.0020.977(0.957~0.999)0.036
肌肉量减少0.979(0.964~0.995)0.0080.979(0.962~0.996)0.0160.993(0.973~1.013)0.469
步速减慢0.976(0.964~0.989)<0.0010.980(0.966~0.994)0.0060.988(0.974~1.003)0.126
握力降低0.979(0.966~0.992)0.0010.974(0.960~0.989)0.0010.983(0.968~0.998)0.030
贫血
肌少症2.258(1.301~3.919)0.0041.818(1.025~3.222)0.0411.103(0.575~2.116)0.769
肌肉量减少1.724(1.024~2.900)0.0401.434(0.836~2.461)0.1900.895(0.486~1.650)0.723
步速减慢1.537(0.991~2.384)0.0551.416(0.904~2.219)0.1291.125(0.701~1.805)0.626
握力降低2.773(1.782~4.317)<0.0012.410(1.526~3.805)<0.0011.967(1.220~3.172)0.005
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老年人血红蛋白、贫血与肌少症的相关性分析
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陈鸿桢 , 郑坤 , 吴小雪 , 夏丽 *
解放军医学杂志 | 临床研究 2025,50(4): 444-451
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解放军医学杂志 | 临床研究 2025, 50(4): 444-451
老年人血红蛋白、贫血与肌少症的相关性分析
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陈鸿桢, 郑坤, 吴小雪, 夏丽*
作者信息
  • 重庆医科大学附属第一医院全科医学科，重庆 400016

    • 陈鸿桢，硕士研究生，主要从事肌少症及慢性病社区管理等方面的研究

通讯作者:

夏丽，E-mail：
Correlation between hemoglobin, anemia and sarcopenia in the elderly population
Hong-Zhen Chen, Kun Zheng, Xiao-Xue Wu, Li Xia*
Affiliations
  • Department of General Practice, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
出版时间: 2025-04-28 doi: 10.11855/j.issn.0577-7402.1458.2024.0521
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摘要
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目的 分析重庆市社区老年人血红蛋白(Hb)、贫血与肌少症的相关性。方法 本研究为横断面研究。对2023年3-8月前往重庆市5个社区卫生服务中心体检的老年人群进行人口信息、社会因素调查、人体成分测量、握力、6 m步行速度和血液分析。采用受试者操作特征(ROC)曲线评价Hb预测肌少症的准确性，约登指数确定诊断肌少症及其组成成分的最佳Hb临界值。采用未经调整和调整后的logistic回归分析Hb、贫血与肌少症及其组成成分的关系。结果 共纳入531名老年人，年龄(71.1±6.5)岁。肌少症患病率为13.6%(72/531)，其中男性29例(40.3%)，女性43例(59.7%)。未经调整时Hb与肌少症、肌肉量减少、步速减慢、握力降低相关(P<0.05)，调整可能的混杂因素后Hb仍与肌少症、握力降低明显相关(P<0.05)。Hb每升高10 g/L，肌少症患病率降低2.3%，握力降低的风险降低1.7%(P<0.05)。未经调整时贫血与肌少症、肌肉量减少、握力降低相关(P<0.05)，调整可能的混杂因素后贫血与握力降低明显相关(P<0.05)。诊断男性肌少症的最佳Hb临界值为148 g/L，女性为128 g/L。结论 Hb是肌少症与握力降低的独立危险因素。贫血与肌少症相关，但不是肌少症的独立危险因素。

肌少症  /  贫血  /  血红蛋白  /  肌肉量  /  握力  /  步速  /  老年人

Objective To analyze the correlation between hemoglobin (Hb), anemia, and sarcopenia in the elderly population in Chongqing communities. Methods A cross-sectional study was conducted on elderly individuals who underwent healthy examinations at 5 community health service centers in Chongqing from March to August 2023. Demographic characteristics, social factors, body composition measurement, grip strength, 6-meter gait speed and blood tests were assessed. Receiver operating characteristic (ROC) curve was utilized to evaluate the accuracy of Hb in predicting sarcopenia, and the Youden index was employed to determine the optimal Hb cut-off value for diagnosing sarcopenia and its components. Both unadjusted and adjusted logistic regression analyses were performed to examine the relationship between Hb and anemia with sarcopenia and its components. Results A total of 531 elderly populations were included, with an average age of (71.1±6.5) years. The overall prevalence of sarcopenia was 13.6% (72/531), including 29 males (40.3%) and 43 females (59.7%). Unadjusted analyses showed that Hb was correlated with sarcopenia, decreased muscle mass, slower gait speed, and reduced grip strength (P<0.05). After adjusting for all potential risk factors, Hb was still significantly associated with sarcopenia and reduced grip strength (P<0.05). For every 10 g/L increase in Hb, the risk of sarcopenia decreased by 2.3%, and the risk of reduced grip strength decreased by 1.7% (P<0.05). Anemia was correlated with sarcopenia, reduced muscle mass, and decreased grip strength in unadjusted analyses (P<0.05), while the correlation between anemia and reduced grip strength remained significant after adjustment for all potential risk factors (P<0.05). The optimal Hb cut-off value for diagnosing sarcopenia in males and females were 148 g/L and 128 g/L, respectively. Conclusions Hb is an independent risk factor for sarcopenia and reduced grip strength. Anemia is associated with sarcopenia, but is not an independent risk factor for sarcopenia.

sarcopenia  /  anemia  /  hemoglobin  /  muscle mass  /  grip strength  /  gait speed  /  elderly population
陈鸿桢, 郑坤, 吴小雪, 夏丽. 老年人血红蛋白、贫血与肌少症的相关性分析. 解放军医学杂志, 2025 , 50 (4) : 444 -451 . DOI: 10.11855/j.issn.0577-7402.1458.2024.0521
Hong-Zhen Chen, Kun Zheng, Xiao-Xue Wu, Li Xia. Correlation between hemoglobin, anemia and sarcopenia in the elderly population[J]. Medical Journal of Chinese People’s Liberation Army, 2025 , 50 (4) : 444 -451 . DOI: 10.11855/j.issn.0577-7402.1458.2024.0521
正文
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肌少症是一种以全身进行性骨骼肌肌肉量和力量丧失为特征的综合征[1]，主要发生于老年人群，易导致众多不良健康结局，如衰弱、跌倒、失能、功能下降、抑郁、住院时间延长、更高的发病率和病死率等[2-5]。由于地区、种族、生活方式和诊断标准的不同，不同地区肌少症的患病率也不同。据报道，亚洲地区老年人肌少症患病率为5.5%~26.7%[1]，我国老年人肌少症总体患病率为17%[6]，且西部地区的患病率高于东部地区[2]，住院老年人的患病率高于社区老年人[6]。我国居民年龄结构趋于老龄化，加上缺乏运动和多种合并症的存在，肌少症已成为我国老年人面临的重大健康问题，加重了我国卫生系统和社会的经济负担。
贫血也常见于老年人，据中国疾病预防控制中心营养与健康研究所统计数据显示，我国老年男性贫血患病率为10.2%，老年女性为9.8%[7]。老年贫血患者中1/3存在营养缺乏，1/3合并慢性炎症或慢性疾病，余1/3原因不明[8]。贫血与虚弱呈明显相关关系，可增加身体机能下降、肌肉无力和跌倒等的风险[9-10]，即使轻度贫血也会明显增高发病率和病死率[11]。此前多项研究发现，贫血与肌肉力量降低、躯体功能下降有关[12-14]。肌肉力量和躯体功能为肌少症的诊断因素，因此两者之间可能存在一定联系。Tseng等[12]提出贫血与肌少症之间的关系可能是双向的：营养不良可导致贫血和肌少症，而肌少症引起的慢性消瘦可能进一步消耗老年人的血红蛋白(hemoglobin，Hb)。Hb水平低下可能造成骨骼肌处于慢性缺氧状态，影响骨骼肌发挥正常的生理功能[15]。2016年，Hb首次被报道为诊断或预测肌少症的重要生物标志物[16]。目前，肌少症主要通过运动和营养支持干预治疗，尚无推荐的一线临床用药[17]。为此，本研究探讨Hb、贫血与肌少症的关系，以期指导治疗贫血或连续监测Hb水平，干预肌少症的发生发展，从而提高老年人的生活质量，减轻家庭和社会经济负担。
1 资料与方法
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1.1 研究对象
本研究为横断面研究。选取2023年3-8月重庆市主城区及区县共5个社区≥60岁的体检人群作为研究对象。纳入标准：(1)年龄≥60岁的社区老年人群；(2)具备基本沟通能力，能配合完成相关检查。排除标准：(1)近4周有基础疾病病情恶化；(2)严重心、肺、肾、脑疾病；(3)合并严重脏器功能障碍或不全，或因骨折长期卧床预期无法完成步速检测；(4)具有电阻抗分析禁忌证，包括植入起搏器或除颤仪。所有参与者均签署知情同意书，本研究获重庆医科大学附属第一医院伦理委员会审批[2023年科研伦理(2023-172)]。
1.2 人口信息、社会和经济因素统计
所有参与调查的研究员在调查前均通过统一培训，向受试对象介绍本研究背景、目的、方法、可能出现的风险及补偿，在获得受试者同意并签署知情同意书后，收集信息。受试对象按照本研究自制的调查问卷回答相关问题，主要包括受试对象的基本信息，如姓名、性别、年龄、身高、体重、婚姻状况、收入、文化程度、居住状况、生活方式(饮酒、吸烟)等。
1.3 肌少症的诊断标准及检测方法
1.3.1 人体成分测量
使用日本TANITA MC-780人体成分分析仪通过多频生物电阻抗分析法(bioelectrical impedance analysis，BIA)测定研究对象的四肢骨骼肌量(appendicular skeletal muscle mass，ASM)，使用身高的平方校正ASM的绝对值。
1.3.2 肌肉力量测定
使用CAMRY EH101弹簧式电子握力计测定，测定时研究对象优势手手臂垂直于地面尽可能使用最大力量拉动握力计，电子握力计自动记录一次过程中的最大握力，取两次上肢握力测量结果的较大值作为该研究对象的最大握力值。
1.3.3 躯体功能测定
以6 m步速作为评价研究对象躯体功能的标准，研究对象以固定的常规步行速度通过测试区域2次，取平均值作为该研究对象的6 m步行速度。
1.3.4 诊断标准
采用亚洲肌少症工作组(Asian Working Group for Sarcopenia，AWGS) 2019年发布的肌少症诊断共识，肌少症定义为肌肉量减少和肌肉力量下降或躯体功能下降：(1)肌肉量减少定义为男性<7.0 kg/m2，女性<5.7 kg/m2；(2)肌肉力量下降定义为男性握力<28 kg，女性握力<18 kg；(3)躯体功能下降定义为6 m步速<1.0 m/s。满足(1)+(2)或(1)+(3)或(1)+(2)+(3)则诊断为肌少症。按照有无肌少症将研究对象分为肌少症组(n=72)与非肌少症组(n=459)。
1.4 血液标本的采集及处理
研究对象晨起后空腹于当地社区卫生服务中心完成血液标本采集。采集完成后立即送至社区卫生服务中心完成血液分析，包括白细胞计数(white blood cells，WBC)、Hb和肌酐等。
1.5 贫血的诊断标准
采用世界卫生组织(World Health Organization，WHO)贫血诊断标准，男性Hb<130 g/L，女性Hb<120 g/L诊断为贫血。
1.6 营养状况评价
使用老年人微营养评分(MNA-SF)评估老年人营养状况，包含食量减少程度、体重下降程度、活动能力、急性疾病或心理创伤、精神状况、体重指数(body mass index，BMI) 6个维度。总分14分，≥12分表示正常，不存在营养不良；≤11分提示可能存在营养不良。
1.7 日常生活能力评价
采用日常生活活动功能量表(ADL)-巴氏量表(Barthel index)评估老年人独立生活的能力，包含10项指标，即进食、移位、个人卫生、如厕、洗澡、在平地上移动、上下楼梯、穿脱衣裤鞋袜、大便控制、小便控制。总分100分，<100分表示依赖，视为日常生活能力受损。
1.8 患病情况
由专业人员通过询问研究对象“是否曾有医师明确告诉您患有某类疾病”或“您是否正在服用某类药物”确定该研究对象所患疾病，如高血压、糖尿病等。
1.9 统计学处理
采用SPSS 27.0软件进行统计分析。符合正态分布的计量资料以$\bar{x}±s$表示，组间比较采用t检验；不符合正态分布的计量资料以M(Q1，Q3)表示，组间比较采用Mann-Whitney U检验。计数资料以例(%)表示，组间比较采用χ2检验。采用受试者操作特征(receiver operating characteristic curve，ROC)曲线评价Hb预测肌少症的准确性，使用约登指数(Youden index)确定诊断肌少症及其组成成分的最佳Hb临界值。采用未经调整和调整后的logistic回归模型分析Hb、贫血与肌少症及其组成成分之间的关系。双侧P<0.05为差异有统计学意义。
2 结果
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2.1 基本情况
共纳入531名老年人，其中男性222名(41.8%)，女性309名(58.2%)，年龄(71.1±6.5)岁。其中，肌少症组72例(13.6%)，年龄(75.9±6.9)岁，包括男性29例(40.3%)，女性43例(59.7%)；非肌少症组459名(86.4%)，年龄(70.3±6.1)岁，包括男性193名(42.0%)，女性266名(58.0%)。贫血总患病率为19.2%(102/531)，男性贫血患病率为19.4%(43/222)，女性贫血患病率为19.1%(59/309)。与非肌少症组比较，肌少症组患者年龄较大、BMI较低、文化程度偏低、婚姻状况不佳(P<0.05)；同时，其糖尿病患病率较高、易出现日常生活能力受损和营养不良风险(P<0.05)；两组性别、收入情况、吸烟、饮酒、WBC、肌酐和是否患有高血压等差异无统计学意义(P>0.05)(表1)。
2.2 Hb、贫血与肌少症及组成成分之间的关系
肌少症组Hb水平低于非肌少症组，差异有统计学意义[(127±13) g/L vs. (134±14) g/L，P<0.001]。贫血老年人中有23名(22.5%，23/102)患有肌少症，差异有统计学意义(P=0.003)，贫血的老年人更易患有肌少症(表1)。Hb水平较低的老年人更易出现肌肉量减少(P=0.008)、握力降低(P=0.001)、步速减慢(P<0.001)。贫血老年人更易出现肌肉量减少(P=0.039)、握力降低(P<0.001)，但贫血老年人的步速与无贫血者差异无统计学意义(P=0.054)(表2)。
2.3 Hb、贫血与肌少症及其组成成分的logistic回归分析
未经调整和调整后Hb、贫血与肌少症及其组成成分的关系如表3所示。未经调整时，Hb与肌少症、肌肉量减少、步速减慢、握力降低相关(P<0.05)，经过调整后Hb仍与肌少症、握力降低明显相关(P(P<0.05)。Hb每升高10 g/L，肌少症患病率降低2.3%(P<0.05)，握力降低的风险降低1.7%(P<0.05)。未经调整时，贫血与肌少症、肌肉量减少、握力降低相关(P<0.05)，经过调整后贫血与握力降低明显相关<0.05)。老年人中贫血较无贫血者发生握力降低的风险增加96.7%。
2.4 ROC曲线分析评估诊断肌少症及其组成成分的
最佳Hb临界值不同性别诊断肌少症及其组成成分的最佳Hb临界值如图1所示。确诊肌少症的Hb临界值为128 g/L，AUC为0.640(男性AUC=0.657，女性AUC=0.658)。预测男性肌少症的最佳Hb临界值为148 g/L(敏感度=0.897，特异度=0.352)，女性为128 g/L(敏感度=0.698，特异度=0.590)。确诊肌肉量减少的最佳Hb临界值为128 g/L，AUC为0.591(男性AUC=0.581，女性AUC=0.635)，预测男性肌肉量减少的最佳Hb临界值为148 g/L(敏感度=0.805，特异度=0.348)，女性为128 g/L(敏感度=0.635，特异度=0.588)。预测握力降低的最佳Hb临界值为123 g/L，AUC为0.583(‍男性AUC=0.651，女性AUC=0.593)，预测男性握力降低最佳Hb临界值为135 g/L(敏感度=0.462，特异度=0.778)，女性为123 g/L(敏感度=0.407，特异度=0.794)。预测步速减慢的最佳Hb临界值为128 g/L，AUC为0.594(男性AUC=0.607，女性AUC=0.561)，预测男性步速减慢的最佳Hb临界值为140 g/L(敏感度=0.573，特异度=0.639)，女性为128 g/L(敏感度=0.521，特异度=0.636)。
3 讨论
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根据AWGS 2019标准，本研究社区老年人肌少症患病率为13.6%，略高于江涛等[6]的Meta分析(社区中有11.0%的老年人患有肌少症)。肌少症是一种与增龄相关的疾病[2]，肌肉纤维从50岁开始减少，80岁以上老年人肌肉纤维将减少50%[18]。肌肉减少状态(sarcopenic state)可通过减少Ⅱ型肌纤维的数量、大小和线粒体数量影响肌肉功能[19-20]。同时，衰老会引起体内激素变化，如男性睾酮减少、女性雌激素减少，此种变化也会导致骨骼肌肌肉量减少[21]。另外，与Dai等[22]的研究结果一致，本研究也未观察到不同性别肌少症患病率的差异。本研究发现，低体重的老年人更易患肌少症，这可能与老年人营养结构不平衡有关，特别是蛋白质摄入减少，与多数研究结果相似[22-23]；而超重或肥胖的老年人较低体重老年人罹患肌少症的风险降低4.3%(结果未展示)，这一结果支持“肥胖悖论(the obesity paradox)”[24]。造成上述结果的原因可能是超重或肥胖老年人有较高的蛋白质摄入，不存在营养风险，因为本研究发现存在营养风险的老年人更容易患肌少症。同时，本研究结果显示，文化程度较高的老年人患肌少症的风险较低，这可能与受过较高教育的老年人对健康关注度更高等因素有关。此外，婚姻状况与肌少症明显相关，与其他婚姻状况(未婚、丧偶等)相比，已婚老年人可能有更良好的家庭关系、更健康的心理状况。而日常生活能力受损的老年人存在运动功能下降，因而罹患肌少症的风险更大。
另外，本研究未发现组间WBC存在统计学差异。van Atteveld等[25]发现，步速较慢和握力较低的老年人WBC水平较高，但调整混杂因素后肌少症与非肌少症老年人WBC无统计学差异。肌少症与机体慢性轻度炎症有关，而较高的WBC水平往往提示急性感染，这或许能解释本研究WBC与肌少症无关这一结果。也有研究表明，较高的WBC可能增加未来10年个体衰弱的患病风险[26]，目前尚缺乏其与肌少症相关性方面的研究。肌酐是人体肌肉代谢的产物，血清肌酐值与全身肌肉总量关系密切，肌酐水平较低可能意味着肌肉量低下[27]。Thongprayoon等[28]发现，低肌酐值和高肌酐值均与住院病死率增高相关。研究发现，血清肌酐与骨骼肌质量指数(skeletal muscle index，SMI)、握力弱相关[27]。分析原因可能为单次血清肌酐值容易受到肉类饮食及肾脏排泄率等的影响，出现不稳定现象[29]，从而使得肌少症与肌酐值无关。Kashani等[30]提出使用公式“血清肌酐值(mg/dl)/胱抑素C(mg/dl)×100”预测肌少症的发生，并将其定义为Sarcopenia index。
本研究发现，患有肌少症、肌肉量减少、握力降低和步速减慢的老年人Hb水平较低，但通过调整可能的混杂因素后，Hb与肌少症、握力降低明显相关，与肌肉量减少、步速减慢无关。随着年龄增长，促红细胞生成素(erythropoietin，EPO)分泌减少和造血储备减少，导致Hb水平降低[31]。目前，Hb对骨骼肌的影响机制尚未明确，但作为机体向全身各组织器官输送氧的物质，Hb低水平可能影响机体向骨骼肌运输氧气，使骨骼肌处于慢性缺氧状态，从而对骨骼肌产生不利影响[15,32]。多项研究表明，Hb水平较低的老年人其肌肉密度、肌肉力量、肌肉量和躯体功能较低下[33-34]，分析原因可能为低Hb水平与毛细血管、肌肉纤维的结构和功能改变有关，从而损害骨骼肌肌肉量及力量[35-36]。Hirani等[33]发现，低Hb水平可能与轻度炎症有关。炎性因子通过作用于细胞连接结构影响骨骼肌局部血管舒张和收缩功能，同时可导致骨骼肌胰岛素抵抗增加，降低胰岛素对蛋白质分解代谢的抑制作用，造成骨骼肌蛋白质合成分解失衡，最终使骨骼肌萎缩[37-39]。
本研究发现，贫血老年人更易发生肌少症、肌肉量减少、握力降低，但通过调整可能的混杂因素后，贫血与握力降低明显相关，与肌少症、肌肉量减少、步速减慢无关。有动物实验表明，贫血状态下，骨骼肌摄氧量下降[15]，这可能是由于贫血时引起氧合Hb释放氧的能力或红细胞间距改变，从而导致骨骼肌氧气扩散能力下降[40-41]。
贫血可间接反映机体整体营养状况，而营养不良被认为是肌少症的重要影响因素。营养缺乏性贫血最常见的原因是缺铁。缺铁可导致肌红蛋白和细胞色素浓度以及氧化酶活性降低，骨骼肌局部氧浓度及肌纤维利用氧的能力降低。Stugiewicz等[42]发现，缺铁大鼠骨骼肌中乳酸脱氢酶同工酶活性增加，表明骨骼肌能量代谢明显转向无氧代谢，以最大限度地提高肌肉功能。同时缺铁也可诱导5'-AMP活化蛋白激酶(AMPK)激活。AMPK是细胞能量损伤的主要传感器，其长期慢性激活会增加己糖激酶Ⅱ的表达，有助于缺铁骨骼肌的能量代谢从有氧氧化逐渐转变为糖酵解[42]。Ohira等[43]发现，缺铁性贫血小鼠Ⅱa型肌纤维向Ⅱx型肌纤维转化，肌肉力量下降加重。Cartier等[44]拍摄了缺铁大鼠肌肉的线粒体，发现线粒体嵴的密度明显降低。线粒体嵴上有线粒体酶的特异性结合位点，线粒体嵴密度降低这种改变持续存在可能改变线粒体的形态[45]，从而降低骨骼肌肌纤维利用氧的能力。
本研究ROC曲线分析结果显示，诊断男性肌少症的最佳Hb临界值为148 g/L，女性为128 g/L；诊断男性肌肉量减少的最佳Hb临界值为148 g/L，女性为128 g/L；诊断男性握力降低的最佳Hb临界值为135 g/L，女性为123 g/L；诊断男性步速减慢的最佳Hb临界值为140 g/L，女性为128 g/L。诊断不同性别肌少症及其组成成分的Hb临界值均未达到贫血诊断标准，提示老年人即使未出现贫血，也有可能出现肌少症或其他系统疾病，一旦诊断贫血更应立即查明病因并及时给予纠正。
综上所述，本研究结果表明，Hb是肌少症与握力降低的独立危险因素，贫血是肌少症的影响因素，但不是肌少症的独立危险因素，贫血会增加罹患肌少症和握力降低的风险。未来可进一步研究贫血与肌少症的因果关系。Hb虽已被列为诊断肌少症的生物标志物，但Hb水平低下或贫血导致肌少症发生的机制尚未明确，未来仍需深入研究。
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doi: 10.11855/j.issn.0577-7402.1458.2024.0521
  • 接收时间：2023-11-07
  • 首发时间：2025-10-30
  • 出版时间：2025-04-28
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  • 收稿日期：2023-11-07
  • 录用日期：2023-12-28
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    重庆医科大学附属第一医院全科医学科，重庆 400016

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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