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Article(id=1324044675300073734, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044540067328424, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202601054, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1767542400000, receivedDateStr=2026-01-05, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793606450152, onlineDateStr=2026-11-02, pubDate=1777046400000, pubDateStr=2026-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793606450152, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793606450152, creator=13701087609, updateTime=1793606450152, updator=13701087609, issue=Issue{id=1324044540067328424, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='8', pageStart='1345', pageEnd='1536', issueExtLink='null', onlineDate='null', pubDate='1777046400000', pubDateStr='2026-04-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793606417910, creator='13701087609', updateTime=1793670137580, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311799788602160, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044540067328424, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311799788602161, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044540067328424, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1516, endPage=1522, ext={EN=ArticleExt(id=1324044675568509191, articleId=1324044675300073734, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between long-term levels of the C-reactive protein-triglyceride-glucose index and changes in sarcopenia status among middle-aged and older adults, China, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the longitudinal association between long-term levels of the C-reactive protein-triglyceride-glucose index (CTI) and changes in sarcopenia status among middle-aged and older adults in China.

Methods

This study was based on data from the baseline survey and the second follow-up of the China Health and Retirement Longitudinal Study (CHARLS). Long-term CTI levels were characterized using k-means clustering-derived categories and cumulative CTI. Changes in sarcopenia status were defined according to sarcopenia status at baseline and at follow-up. Multivariable logistic regression models were used to examine longitudinal associations. Stratified analyses were performed, and dose–response relationships were assessed using restricted cubic spline models.

Results

A total of 3 377 middle-aged and older participants who met the inclusion and exclusion criteria were included in the analysis. K-means clustering classified long-term CTI levels into three groups: persistently low, persistently moderate, and persistently high. Compared with the persistently low CTI group, individuals with persistently high CTI levels had a significantly higher risk of sarcopenia progression (OR=1.66, 95%CI: 1.07~2.57; P<0.05), with generally consistent directions across subgroups. Using the median cumulative CTI (14.29) as the reference, the risk of sarcopenia progression initially decreased and then increased with increasing cumulative CTI, with a elevation in risk within the range of 15~17. The highest risk was approximately 1.53 times that of the reference value (OR=1.53, 95%CI: 1.17~1.99; P<0.05).

Conclusion

Among middle-aged and older adults in China, persistently high long-term CTI levels are associated with an increased risk of sarcopenia progression, providing epidemiological evidence to support the prevention of the onset and progression of sarcopenia.

, authors=Zhen-yu GAO1, Jia-qi HUANG1, Li-jun LIANG1, Xiong XIAO1, 2, authorsList=Zhen-yu GAO, Jia-qi HUANG, Li-jun LIANG, Xiong XIAO, authorCompany=null, correspAuthors=Xiong XIAO, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324044677086847251, articleId=1324044675300073734, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=中国中老年人群中C反应蛋白-甘油三酯-葡萄糖指数长期水平与肌少症状态变化的关联分析, columnId=1228016570119680182, journalTitle=现代预防医学, columnName=临床与预防, runingTitle=null, highlight=null, articleAbstract=
目的

探究中国中老年人群中C反应蛋白-甘油三酯-葡萄糖指数（C-reactive protein-triglyceride glucose index，CTI）长期水平与肌少症状态变化之间的纵向关联。

方法

本研究基于中国健康与养老追踪调查（CHARLS）基线调查和第二次随访调查的数据。CTI长期水平采用k-means聚类分析得到的类别和累积CTI进行表征。肌少症变化状态根据基线时和随访时的肌少症状态进行定义。通过多变量logistic回归模型开展纵向分析，并进行了分层分析以及采用限制性立方样条进行了剂量-反应分析。

结果

本研究纳入3 377名符合纳排标准的中老年个体。K-means聚类将CTI长期水平分为3类——持续低水平、持续中等水平、持续高水平。相比于CTI持续低水平，高水平时肌少症状态进展风险更大（OR=1.66，95%CI：1.07~2.57，P<0.05），且在亚人群中方向性基本一致。相比于累积CTI中位数14.29，肌少症状态进展的风险随累积CTI的大小先降低后升高，CTI在15~17范围内风险升高，最高约为参考值的1.53倍（OR=1.53，95%CI：1.17~1.99，P<0.05）。

结论

在中国中老年群体中，CTI长期高水平与肌少症状态进展风险增加相关，为预防肌少症发生、发展提供了理论依据。

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高振宇（2001—），女，硕士在读，研究方向：卫生统计方法与应用

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肖雄，E-mail：
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Definitions of changes in sarcopenia status

, figureFileSmall=null, figureFileBig=null, tableContent=
基线时诊断第二次随访时诊断
无肌少症可能肌少症肌少症
无肌少症维持进展进展
可能肌少症改善维持进展
肌少症改善改善维持
), ArticleFig(id=1324044681901908287, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044675300073734, language=CN, label=表1, caption=

肌少症状态变化规则

, figureFileSmall=null, figureFileBig=null, tableContent=
基线时诊断第二次随访时诊断
无肌少症可能肌少症肌少症
无肌少症维持进展进展
可能肌少症改善维持进展
肌少症改善改善维持
), ArticleFig(id=1324044681964822848, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044675300073734, language=EN, label=Table 2, caption=

Basic characteristics of the study population [(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量全人群（n=3 377）CTI长期水平
持续低水平（n=1 159）持续中等水平（n=1 492）持续高水平（n=726）
年龄（岁）61.34±7.9061.08±7.6761.45±8.0861.55±7.91
性别
男1 594（47.2）623（53.8）682（45.7）289（39.8）
女1 783（52.8）536（46.2）810（54.3）437（60.2）
居住地
城市1 131（33.5）310（26.7）529（35.5）292（40.2）
农村2 246（66.5）849（73.3）963（64.5）434（59.8）
受教育程度
小学以下1 799（53.3）630（54.4）778（52.1）391（53.9）
小学709（21.0）239（20.6）321（21.5）149（20.5）
中学及以上869（25.7）290（25.1）393（26.3）186（25.6）
婚姻状态
已婚2 915（86.3）1 017（87.7）1 271（85.2）627（86.4）
其他462（13.7）142（12.3）221（14.8）99（13.6）
BMI23.79±11.9122.09±3.3824.29±17.3325.47±4.10
是否吸烟
是1 033（30.6）412（35.5）430（28.8）191（26.3）
否2 344（69.4）747（64.5）1 062（71.2）535（73.7）
是否饮酒
是1 123（33.3）448（38.7）480（32.2）195（26.9）
否2 254（66.7）711（61.3）1 012（67.8）531（73.1）
是否锻炼
是3 144（93.1）1 109（95.7）1 389（93.1）646（89.0）
否233（6.9）50（4.3）103（6.9）80（11.0）
睡眠时长（小时）6.29±1.906.29±1.866.27±1.926.37±1.90
是否患有心血管疾病
是1 213（35.9）307（26.5）556（37.3）350（48.2）
否2 164（64.1）852（73.5）936（62.7）376（51.8）
是否患有糖尿病
是230（6.8）35（3.0）85（5.7）110（15.2）
否3 147（93.2）1 124（97.0）1 407（94.3）616（84.8）
是否患有肺部疾病
是344（10.2）99（8.5）162（10.9）83（11.4）
否3 033（89.8）1 060（91.5）1 330（89.1）643（88.6）
CTI20124.70（4.35，5.12）4.28（4.08，4.48）4.77（4.53，5.00）5.45（5.21，5.77）
CTI20154.81（4.44，5.21）4.31（4.07，4.50）4.92（4.72，5.12）5.54（5.28，5.83）
肌少症状态变化
改善293（8.7）104（9.0）133（8.9）56（7.7）
维持2 552（75.6）877（75.7）1 130（75.7）545（75.1）
进展532（15.8）178（15.4）229（15.3）125（17.2）
), ArticleFig(id=1324044683650933057, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044675300073734, language=CN, label=表2, caption=

研究对象的基本特征[（%）]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量全人群（n=3 377）CTI长期水平
持续低水平（n=1 159）持续中等水平（n=1 492）持续高水平（n=726）
年龄（岁）61.34±7.9061.08±7.6761.45±8.0861.55±7.91
性别
男1 594（47.2）623（53.8）682（45.7）289（39.8）
女1 783（52.8）536（46.2）810（54.3）437（60.2）
居住地
城市1 131（33.5）310（26.7）529（35.5）292（40.2）
农村2 246（66.5）849（73.3）963（64.5）434（59.8）
受教育程度
小学以下1 799（53.3）630（54.4）778（52.1）391（53.9）
小学709（21.0）239（20.6）321（21.5）149（20.5）
中学及以上869（25.7）290（25.1）393（26.3）186（25.6）
婚姻状态
已婚2 915（86.3）1 017（87.7）1 271（85.2）627（86.4）
其他462（13.7）142（12.3）221（14.8）99（13.6）
BMI23.79±11.9122.09±3.3824.29±17.3325.47±4.10
是否吸烟
是1 033（30.6）412（35.5）430（28.8）191（26.3）
否2 344（69.4）747（64.5）1 062（71.2）535（73.7）
是否饮酒
是1 123（33.3）448（38.7）480（32.2）195（26.9）
否2 254（66.7）711（61.3）1 012（67.8）531（73.1）
是否锻炼
是3 144（93.1）1 109（95.7）1 389（93.1）646（89.0）
否233（6.9）50（4.3）103（6.9）80（11.0）
睡眠时长（小时）6.29±1.906.29±1.866.27±1.926.37±1.90
是否患有心血管疾病
是1 213（35.9）307（26.5）556（37.3）350（48.2）
否2 164（64.1）852（73.5）936（62.7）376（51.8）
是否患有糖尿病
是230（6.8）35（3.0）85（5.7）110（15.2）
否3 147（93.2）1 124（97.0）1 407（94.3）616（84.8）
是否患有肺部疾病
是344（10.2）99（8.5）162（10.9）83（11.4）
否3 033（89.8）1 060（91.5）1 330（89.1）643（88.6）
CTI20124.70（4.35，5.12）4.28（4.08，4.48）4.77（4.53，5.00）5.45（5.21，5.77）
CTI20154.81（4.44，5.21）4.31（4.07，4.50）4.92（4.72，5.12）5.54（5.28，5.83）
肌少症状态变化
改善293（8.7）104（9.0）133（8.9）56（7.7）
维持2 552（75.6）877（75.7）1 130（75.7）545（75.1）
进展532（15.8）178（15.4）229（15.3）125（17.2）
), ArticleFig(id=1324044683730624834, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044675300073734, language=EN, label=Table 3, caption=

Association between long-term CTI levels and changes in sarcopenia status

, figureFileSmall=null, figureFileBig=null, tableContent=
变量维持vs改善进展vs改善
OR（95%CI）P值OR（95%CI）P值
CTI长期水平
持续低水平Ref-Ref-
持续中等水平1.03（0.78~1.37）0.831.12（0.80~1.57）0.48
持续高水平1.24（0.85~1.80）0.271.66（1.07~2.57）<0.05
), ArticleFig(id=1324044683965505859, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044675300073734, language=CN, label=表3, caption=

CTI长期水平与肌少症状态变化的关联分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量维持vs改善进展vs改善
OR（95%CI）P值OR（95%CI）P值
CTI长期水平
持续低水平Ref-Ref-
持续中等水平1.03（0.78~1.37）0.831.12（0.80~1.57）0.48
持续高水平1.24（0.85~1.80）0.271.66（1.07~2.57）<0.05
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中国中老年人群中C反应蛋白-甘油三酯-葡萄糖指数长期水平与肌少症状态变化的关联分析
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高振宇 1 , 黄佳琪 1 , 梁丽君 1 , 肖雄 1, 2
现代预防医学 | 临床与预防 2026,53(8): 1516-1522
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现代预防医学 |临床与预防 2026 , 53 (8) : 1516 -1522
中国中老年人群中C反应蛋白-甘油三酯-葡萄糖指数长期水平与肌少症状态变化的关联分析
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高振宇1, 黄佳琪1, 梁丽君1, 肖雄1, 2
作者信息
  • 1.四川大学华西公共卫生学院/华西第四医院流行病与卫生统计学系，四川　成都　610041
  • 2.主动健康与食品营养安全四川省重点实验室
通讯作者:
肖雄，E-mail：
作者简介:

高振宇（2001—），女，硕士在读，研究方向：卫生统计方法与应用

Association between long-term levels of the C-reactive protein-triglyceride-glucose index and changes in sarcopenia status among middle-aged and older adults, China
Zhen-yu GAO1, Jia-qi HUANG1, Li-jun LIANG1, Xiong XIAO1, 2
Affiliations
  • Department of Epidemiology and Health Statistics, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2026-04-25 doi: 10.20043/j.cnki.MPM.202601054
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摘要
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目的

探究中国中老年人群中C反应蛋白-甘油三酯-葡萄糖指数（C-reactive protein-triglyceride glucose index，CTI）长期水平与肌少症状态变化之间的纵向关联。

方法

本研究基于中国健康与养老追踪调查（CHARLS）基线调查和第二次随访调查的数据。CTI长期水平采用k-means聚类分析得到的类别和累积CTI进行表征。肌少症变化状态根据基线时和随访时的肌少症状态进行定义。通过多变量logistic回归模型开展纵向分析，并进行了分层分析以及采用限制性立方样条进行了剂量-反应分析。

结果

本研究纳入3 377名符合纳排标准的中老年个体。K-means聚类将CTI长期水平分为3类——持续低水平、持续中等水平、持续高水平。相比于CTI持续低水平，高水平时肌少症状态进展风险更大（OR=1.66，95%CI：1.07~2.57，P<0.05），且在亚人群中方向性基本一致。相比于累积CTI中位数14.29，肌少症状态进展的风险随累积CTI的大小先降低后升高，CTI在15~17范围内风险升高，最高约为参考值的1.53倍（OR=1.53，95%CI：1.17~1.99，P<0.05）。

结论

在中国中老年群体中，CTI长期高水平与肌少症状态进展风险增加相关，为预防肌少症发生、发展提供了理论依据。

中国中老年人群  /  C反应蛋白-甘油三酯-葡萄糖指数  /  肌少症  /  CTI  /  AWGS
Objective

To investigate the longitudinal association between long-term levels of the C-reactive protein-triglyceride-glucose index (CTI) and changes in sarcopenia status among middle-aged and older adults in China.

Methods

This study was based on data from the baseline survey and the second follow-up of the China Health and Retirement Longitudinal Study (CHARLS). Long-term CTI levels were characterized using k-means clustering-derived categories and cumulative CTI. Changes in sarcopenia status were defined according to sarcopenia status at baseline and at follow-up. Multivariable logistic regression models were used to examine longitudinal associations. Stratified analyses were performed, and dose–response relationships were assessed using restricted cubic spline models.

Results

A total of 3 377 middle-aged and older participants who met the inclusion and exclusion criteria were included in the analysis. K-means clustering classified long-term CTI levels into three groups: persistently low, persistently moderate, and persistently high. Compared with the persistently low CTI group, individuals with persistently high CTI levels had a significantly higher risk of sarcopenia progression (OR=1.66, 95%CI: 1.07~2.57; P<0.05), with generally consistent directions across subgroups. Using the median cumulative CTI (14.29) as the reference, the risk of sarcopenia progression initially decreased and then increased with increasing cumulative CTI, with a elevation in risk within the range of 15~17. The highest risk was approximately 1.53 times that of the reference value (OR=1.53, 95%CI: 1.17~1.99; P<0.05).

Conclusion

Among middle-aged and older adults in China, persistently high long-term CTI levels are associated with an increased risk of sarcopenia progression, providing epidemiological evidence to support the prevention of the onset and progression of sarcopenia.

Middle-aged and elderly Chinese population  /  C-reactive protein-triglyceride-glucose index  /  Sarcopenia  /  CTI  /  AWGS
高振宇, 黄佳琪, 梁丽君, 肖雄. 中国中老年人群中C反应蛋白-甘油三酯-葡萄糖指数长期水平与肌少症状态变化的关联分析. 现代预防医学, 2026 , 53 (8) : 1516 -1522 . DOI: 10.20043/j.cnki.MPM.202601054
Zhen-yu GAO, Jia-qi HUANG, Li-jun LIANG, Xiong XIAO. Association between long-term levels of the C-reactive protein-triglyceride-glucose index and changes in sarcopenia status among middle-aged and older adults, China[J]. Modern Preventive Medicine, 2026 , 53 (8) : 1516 -1522 . DOI: 10.20043/j.cnki.MPM.202601054
正文
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肌少症被定义为与年龄相关的进行性、全身性肌肉疾病，特征为骨骼肌质量和功能下降，并与包括跌倒、功能障碍、住院、心血管代谢疾病、痴呆和全因死亡在内的不良健康结局风险增加密切相关[1]。据估计，中国肌少症患病率约为20%[2]，现已成为我国公共卫生领域的巨大挑战。近期，亚洲肌少症工作组（Asian Working Group for Sarcopenia，AWGS）提出的2025年共识更新，该共识建议将关注点从诊断和管理老年人的老年肌少症扩展开来，并强调从中年开始促进肌肉健康的重要性，定义了新的肌少症诊断标准[3]。在此背景下，对我国中老年人群肌少症相关的研究仍需进一步更新。
已知肌少症的发病机制复杂，涉及包括炎症状态[4]、胰岛素抵抗[5]、脂质代谢紊乱[6]在内的多种病理过程。然而，当前多数流行病学研究仍依赖于单一维度的生物标志物（如仅用C反应蛋白（C-Reactive Protein，CRP）反映炎症[7]，或仅用甘油三酯-葡萄糖指数（Triglyceride-Glucose Index，TyG）反映胰岛素抵抗[8]），难以全面评估这些病理机制在肌少症发生中的协同或叠加效应。C反应蛋白-甘油三酯-葡萄糖指数（C-reactive protein-triglyceride glucose index，CTI）由CRP和经过广泛验证的TyG组合而成，已成为一种新型的整合炎症和代谢的双维生物标志物，在癌症、心血管疾病、脑卒中等疾病中包括表现出良好的预测性能，且研究发现比单一指标更优[9–12]。这一特性使其特别适用于研究具有多重病理背景的肌少症。若CTI被证实与肌少症相关，则提示在临床实践和社区筛查中，关注炎症与代谢的联合异常可能比关注单一指标更具预警意义。此外，肌少症是一种长期发展、可以状态转化的慢性疾病[13]，识别人群中真实存在的CTI长期水平的模式，比单一时点的暴露更能从揭示长期的炎症-代谢紊乱模式与肌少症的状态变化的纵向关联，有望更深刻地揭示慢性累积暴露的致病效应，从而为精准预防肌少症的发生、发展提供流行病学依据。然而，目前有关CTI与肌少症之间关联的人群证据仍处于空白状态。
因此，本研究基于中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）的纵向数据，采用k-means聚类识别中老年人群中存在的CTI长期水平的模式，旨在研究CTI的长期水平与新诊断标准下的肌少症状态变化之间的纵向关联，并且进一步探究了累积CTI与肌少症状态变化之间的剂量-反应关系，以期对我国中老年群体肌少症的精准预防提供相应依据。
1　对象与方法
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1.1　研究对象
本研究对象来自于CHARLS。CHARLS是一项针对我国中老年人群开展的大型研究，收集了社会人口学特征、生活方式以及健康状态等多维度数据[14]。基线调查于2011—2012年开展。本次研究利用2011—2012年CHARLS基线调查和2015年第二次随访调查的相关数据进行分析。本研究纳入同时参与基线调查和第二次随访调查14 576人，排除标准如下：（1）肌少症相关诊断指标缺失（n=5 076）；（2）采集血样时非空腹及CTI构建指标缺失（n=4 668）；（3）基线时年龄小于50岁或在62~64岁之间（n=1 455）。最终纳入分析者共3 377人。
CHARLS严格遵循伦理规范，所有调查程序均获得北京大学生物医学伦理委员会的审核批准（IRB00001052-11015），参与者均签署了知情同意书。
1.2　研究方法
1.2.1　暴露测量
CTI通过以下公式计算：
CTI=0.412×ln（CRP[mg/L]）+ln（TG[mg/dL]×FPG[mg/dL]）/2[9]。
累积CTI=（CTI2012+CTI2015）/2×（2015-2012）
其中CRP为C反应蛋白，TG为甘油三酯，FPG为空腹血糖。CTI2012是基线时的CTI，CTI2015是第二次随访时的CTI。累积CTI的量化方式与此前研究报告一致[15-16]。
1.2.2　结局变量
本研究采用AWGS提出的2025共识更新中的诊断标准[3]，基于肌肉力量和肌肉质量诊断肌少症状态。诊断标准具体如下：（1）在50~64岁人群中，低肌肉力量阈值分别为20 kg（女性）和34 kg（男性）；低肌肉质量阈值分别为5.5 kg/m2（女性）和7.2 kg/m2（男性）。（2）在65岁及以上人群中，低肌肉力量阈值分别为18 kg（女性）和28 kg（男性）；低肌肉质量阈值分别为5.4 kg/m2（女性）和7.0 kg/m2（男性）。当同时存在低肌肉力量和低肌肉质量时诊断为肌少症，只存在低肌肉力量时为可能肌少症，否则为无肌少症。
本研究中肌肉质量采用四肢骨骼肌质量（appendicular skeletal muscle mass，ASM）进行估算，使用了人体测量方程：
ASM=0.193×体重（kg）+0.107×身高（cm）-4.157×性别（1为男性，2为女性）-0.037×年龄（yr）-2.631
该方程在中国人群中得到了验证，被证实与双能X线吸收测定法测得肌肉质量相当[17]。身高调整的肌肉质量（ASM/Ht2）通过将ASM值除以身高的平方米来计算。肌肉力量采用握力评估中双手两次或三次试验中的最大值进行估计。
肌少症状态的变化定义为改善、维持、进展三种状态，具体规则见表1。
1.2.3　协变量
协变量的选择基于有向无环图[18]，涵盖年龄、性别、受教育程度（小学以下、小学、中学及以上）、居住地（城市、农村）、婚姻状态（已婚、其他）、吸烟状态（是、否）、饮酒状态（是、否）、锻炼状态（是、否）、睡眠时长（小时/天）、身体质量指数（body mass Index，BMI）、自报的心血管疾病（是、否）、糖尿病（是、否）、肺部疾病（是、否）。
1.3　统计分析方法
本研究采用k-means聚类对基线期和第二次随访期的CTI进行分类，确定CTI长期水平，并采用肘部法确定最优聚类数，并以累积CTI为长期水平的量化指标。根据k-means聚类分组的CTI组别进行分组描述，除CTI2012及CTI2015采用中位数（P25，P75）描述，其余连续变量采用均值±标准差描述，分类变量均采用频数和构成比描述。
为了研究CTI长期水平与肌少症状态变化之间的纵向关联，采用多分类logistic回归模型进行变化分析。其中，控制了上述一系列非时变混杂以及时变混杂的基线和变化情况，缺失值采用mice包随机森林法进行插补，结果根据Rubin法则合并。结果报告为比值比（odds ratio，OR）和95%置信区间（confidence interval，CI）。为了探索可能存在的人群异质性，进一步以年龄、性别等关键协变量作为分层因素进行分层分析。此外，还使用限制性立方样条模型（4个节点，位置基于数据的5th、35th、65th、95th分位数）对累积CTI与肌少症状态变化可能存在的非线性关系进行了分析。所有分析均采用双侧检验，检验水准α=0.05。所有数据分析在R语言（4.4.1）软件中进行。
2　结果
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2.1　研究对象基本特征
研究对象平均年龄为61.34岁，女性（52.58%）较男性比例稍大，大部分居住在农村（66.5%），受教育程度在小学以下人数最多（53.3%），已婚者占86.3%，BMI均值为23.79。CTI长期水平得到聚类结果见图1，分别为类1（持续低水平）：CTI在2012年及2015年分别为4.28（4.08，4.48）、4.31（4.07，4.50）；类2（持续中等水平）：CTI在2012年及2015年分别为4.77（4.53，5.00）、4.92（4.72，5.12）；类3（持续高水平）：CTI在2012年及2015年分别为5.45（5.21，5.77）、5.54（5.28，5.83）。在CTI各水平参与者中，肌少症状态改善比例分别为9.0%（CTI持续低水平）、8.9%（CTI持续中等水平）以及7.7%（CTI持续高水平）。详见表2。
2.2　CTI长期水平与肌少症状态变化的关联分析
在调整了时变与非时变混杂变量后，分析结果如表3所示。与CTI持续低水平相比，CTI持续中等水平（OR=1.03，95%CI：0.78~1.37，P=0.83）和持续高水平（OR=1.24，95%CI：0.85~1.80，P=0.27）与肌少症状态维持的风险增加未显示关联。CTI持续中等水平同样未显示与肌少症状态进展的关联（OR=1.12，95%CI：0.80~1.57，P=0.48）。然而，CTI持续高水平增加了肌少症进展的风险（OR=1.66，95% CI：1.07~2.57，P<0.05），表明长期处于高水平CTI状态的个体，其肌少症状态呈现进展的可能性是低水平暴露者的1.66倍。
2.3　分层分析
结果如图2所示。以CTI持续低水平为参考组，CTI不同长期水平在受教育程度、居住地、性别及年龄各亚组中，与肌少症状态维持总体上未观察到关联。相比之下，CTI持续处于高水平时，在居住在农村（OR=2.20，95%CI：1.24~3.92）、受教育程度为小学以下（OR=2.25，95%CI：1.25~4.03）的人中，与肌少症状态进展风险增加相关。可能是受制于样本量大小，其余各亚组尽管未观察到关联，但显示出相同趋势。
总体来看，不同教育水平、居住地、性别及年龄分层中，各亚组效应方向基本一致，未观察到明显的效应反转。
2.4　累积CTI与肌少症状态变化的关联
根据上述表3结果，推测CTI长期水平与肌少症状态变化存在剂量-反应关系。结果显示，相对于中位数14.29，累计CTI大小与肌少症状态维持及进展风险总体呈现先降低后升高的趋势。在进展组中，OR曲线呈现此种趋势更为明显，在累积CTI大小为15~17范围内风险升高，最高约为参考值的1.53倍（OR=1.53，95%CI：1.17~1.99，P<0.05）。
3　讨论
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本研究基于CHARLS数据，在AWGS提出的2025年共识更新的新诊断标准下[3]，对中国中老年人群的CTI长期水平与肌少症状态变化之间的纵向关联进行了分析。结果表明，长期持续高水平的CTI与肌少症状态进展风险增加相关，且此种关联与累积CTI的大小有关。研究结果提示我们CTI作为一种新的炎症代谢双重指标，可能可以为提出肌少症发生、发展及转归更精准的预防策略做出贡献。
既往关于CTI的研究多集中于代谢相关的心脑血管疾病中[10，19–22]，CTI在不同队列、不同人群亚组中与心血管疾病、卒中、2型糖尿病、心肾代谢综合征的发病率、死亡率都体现了较强的关联性，且预测性能比单一指标更优。肌少症的发病机制同样涉及炎症、胰岛素抵抗、脂质代谢紊乱。三者在肌少症发病机制中互相协同，在慢性炎症状态下，CRP与促炎细胞因子（如TNF-α、IL-6）协同作用，激活骨骼肌细胞内的泛素-蛋白酶体系统，促进肌肉蛋白质降解，同时会促进胰岛素抵抗[23]。在胰岛素抵抗时，mTORC1活性下调，蛋白质合成减少[5]。高TG水平则往往伴随着骨骼肌内的异位脂肪沉积，其可通过旁分泌作用产生促炎脂肪因子以及诱发胰岛素抵抗，进一步加剧肌肉纤维的变性和流失[6]。然而，目前只有单一指标TyG、CRP与肌少症横断面研究[7,8]，我们的研究证明了CTI这种复合指数与肌少症状态变化的关联，这有望推动肌少症的早期识别策略从单一风险因子评估向综合风险状态评估转变，为开发更有效的风险预测模型提供新方向。
本研究发现CTI长期水平可能主要与“从非肌少症向肌少症发展”这一特定路径相关，而与“保持非肌少症状态”的关联较弱。这一纵向关联揭示了累积暴露的重要性，提示对肌少症发展起关键作用的可能不是指标的短期波动，而是其长期维持的异常状态。防控重点应从针对单一时点的异常值干预，转向对长期异常状态的持续性管理。这意味着需要制定长期、综合的生活方式或医学干预策略。值得注意的是，在我们研究累积CTI与肌少症状态变化的剂量-反应关系时，随着累积CTI大小的升高体现出了风险先下降后上升的趋势，这提示可能存在潜在的双向性。TyG也具有类似的效应[24]。已知肌少症风险与营养状态相关[25]，较低的TG和FPG水平或许同时意味着较低的蛋白质、维生素D等水平[26]，尤其考虑到在老年人中可能存在的进食障碍。因此，未来的风险模型和干预方案需要更精细地权衡代谢紊乱与营养不足这双重挑战，从而设置更合理的异常值范围、更全面的干预指导。
本研究的优势与创新主要体现在以下三个方面：首先，首次将CTI这一更具整合性的双维标志物应用于肌少症纵向研究，弥补了单一指标可能无法全面反映复杂病理的局限。其次，采用纵向数据分析CTI长期模式与疾病状态变化，为两者间的关联提供了比横断面数据仅研究相关性更强的证据，从而为中老年人群肌少症早期干预提供理论基础。最后，通过探讨剂量-反应关系，加深了对可能存在的双向性的风险规律的全面理解。但此研究亦有局限性，第一，CHARLS重复调查样本量受限，不可避免地在进行亚组分析时样本量不足，可能影响到部分结果的统计效能。第二，本文肌肉量估算可能存在误差，因使用人体测量方程估算ASM，虽经中国人群验证，但仍与与双能X线吸收测定法有差距，可能在一定程度上会导致错分偏倚，影响其与CTI的真实关联。第三，对于肌少症这种慢性、渐进性疾病，3年内发生状态变化的个体可能占比较小。部分变化可能反映了测量误差或短期波动，而非真实的疾病进程。尤其是改善组人数较小，且可能存在异质性，如因急性疾病恢复、测量误差等。第四，因为本文仍为关联性研究，而非严格的因果推断，仍可能存在肌少症导致的活动减少、身体成分改变影响CTI水平导致反向因果关系。第五，尽管已控制主要混杂因素，但仍可能有如膳食摄入等未测量的变量作为残余混杂存在。第六，肌少症的诊断标准在各人种间不同[27]，本研究仅针对中国队列，可能影响到结果的外推性。
综上，在中国中老年群体中，CTI长期高水平增加了从非肌少症向肌少症发展的风险，CTI作为一种新型的代谢炎症复合指标，将其作为关键指标纳入风险预测模型，可为肌少症的早期预防与干预提供新工具。
基金
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  • 国家自然科学基金面上项目(82574204)
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2026年第53卷第8期
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doi: 10.20043/j.cnki.MPM.202601054
  • 接收时间：2026-01-05
  • 首发时间：2026-11-02
  • 出版时间：2026-04-25
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  • 收稿日期：2026-01-05
基金
国家自然科学基金面上项目(82574204)
作者信息
    1.四川大学华西公共卫生学院/华西第四医院流行病与卫生统计学系，四川　成都　610041
    2.主动健康与食品营养安全四川省重点实验室

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