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Article(id=1240375112139075642, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202310143, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1696953600000, receivedDateStr=2023-10-11, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773658071789, onlineDateStr=2026-03-16, pubDate=1711296000000, pubDateStr=2024-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773658071789, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773658071789, creator=13701087609, updateTime=1773658071789, updator=13701087609, issue=Issue{id=1240375105386238038, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773658070179, creator=13701087609, updateTime=1773658539618, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240377074414833974, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240377074414833975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1123, endPage=1128, ext={EN=ArticleExt(id=1240375112470425682, articleId=1240375112139075642, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Relationship between Cystatin C level and the risk of frailty: an empirical analysis based on CHARLS data, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the relationship between serum cystatin C (CysC) levels and the risk of frailty.

Methods

This study used data from the 2011 China Health and Retirement Longitudinal Study (CHARLS). Through questionnaires and physical examination, 32 items of information were collected from the respondents, such as illness, ability to perform daily activities to calculate the frailty index (FI) to assess the state of frailty. A multivariate logistic regression model was used to explore the relationship between CysC levels and frailty, while restricted cubic spline was used to analyse the non-linear relationship.

Results

A total of 6 941 adults aged 45 years and older, with a mean age of 59.2±9.8 years, 48.1% of whom were male, were included in the study, with a total of 1 004 (14.5%) experiencing frailty. After adjusting for confounders in the multivariate logistic regression model, the risk of developing frailty in the group with the highest CysC level (T3) was 2.13 times higher than that in the group with a lower CysC (T1) (OR =2.13, 95% CI: 1.75-2.60). When CysC was used as a continuous variable, the risk of frailty increased 1.89-fold for each unit increase in CysC. Restricted cubic spline function analyses showed an approximately "J" shaped relationship between CysC levels and the risk of debility (P non-linear<0.05), the risk of frailty increased significantly with increasing CysC levels when CysC levels were ≥1.05 mg/L.

Conclusion

CysC levels are closely related to frailty, and there is a nonlinear relationship between them.

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目的

探讨血清胱抑素C（Cystatin C, CysC）水平与衰弱发生风险之间的关系。

方法

本研究使用2011年中国健康与养老追踪调查（CHARLS）的数据。通过问卷调查和体格检查，收集调查对象的患病情况、日常活动能力等32项信息计算衰弱指数（Frailty index, FI）评估衰弱状态。采用多因素logistic回归模型探究CysC水平和衰弱之间的关系，同时采用限制性立方样条和阈值效应分析二者的剂量–反应关系。

结果

研究共纳入了6 941名45岁及以上的成人，平均年龄为59.2 ± 9.8岁，其中48.1%为男性，共计1 004人（14.5%）发生衰弱。多因素logistic回归模型调整混杂因素后，CysC水平最高组（T3）患衰弱风险是CysC水平最低组（T1）的2.13倍（OR =2.13，95% CI：1.75～2.60）。当CysC作为连续变量时，CysC每升高一个单位，衰弱发生风险增加1.89倍。限制性立方样条函数分析结果显示，CysC水平与衰弱发生风险呈近似“J”型曲线关系（P非线性<0.05），拐点分析显示CysC水平≥1.05 mg/L时，随着CysC水平的升高，衰弱发生风险显著增加。

结论

CysC水平与衰弱密切相关且二者存在非线性关系。

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高燕，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=hab9ay3H2ss6eEEDog93yA==, magXml=lIrev4SZD88MBJ92ilNe5Q==, pdfUrl=null, pdf=muSY2DTPPbWiAWnmapkh0A==, pdfFileSize=739499, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=uG1RrELFWPh5mf2IazcCSw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=21mamTPmmj0IHYm4vmukcg==, mapNumber=null, authorCompany=null, fund=null, authors=

邢玉萍（1997—），女，硕士在读，研究方向：老年心血管疾病；老年综合征

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邢玉萍（1997—），女，硕士在读，研究方向：老年心血管疾病；老年综合征

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tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375112139075642, language=CN, orderNo=3, keyword=横断面研究), Keyword(id=1240746307086766151, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375112139075642, language=CN, orderNo=4, keyword=CHARLS)], refs=[Reference(id=1240746308651241675, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375112139075642, doi=null, pmid=null, pmcid=null, year=2019, volume=34, issue=21, pageStart=68, pageEnd=72, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=周巧学, 周建荣, 库敏, journalName=护理学杂志, refType=null, unstructuredReference=周巧学，周建荣，库敏，等．社区高龄老年人衰弱状况及影响因素的研究[J]．护理学杂志，2019，34（21）：68-72．, articleTitle=社区高龄老年人衰弱状况及影响因素的研究, refAbstract=null), Reference(id=1240746308747710674, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375112139075642, doi=null, pmid=null, pmcid=null, year=2019, volume=34, issue=21, pageStart=68, pageEnd=72, url=null, 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Comparison of the basic characteristics in the frailty and non-frailty groups

, figureFileSmall=null, figureFileBig=null, tableContent=
特征非衰弱组(n=5 937)衰弱组(n=1 004)合计(n=6 941)χ2/t/Z值P值
性别[n(%)]37.885<0.001
男性2 947(49.6)393(39.1)3 340(48.1)
女性2 990(50.4)611(60.9)3 601(51.9)
年龄（岁，）58.3±9.664.5±9.659.2±9.8365.988<0.001
婚姻状况[n(%)]65.252<0.001
未婚/离异/丧偶647(10.9)200(19.9)847(12.2)
已婚5 290(89.1)804(80.1)6 094(87.8)
居住地[n(%)]16.134<0.001
农村4 622(77.9)838(83.5)5 460(78.7)
城镇1 315(22.1)166(16.5)1 481(21.3)
教育状况[n(%)]51.579<0.001
高中以下5 198(87.6)957(95.3)6 155(88.7)
高中及以上739(12.4)47(4.7)786(11.3)
过去一年饮酒情况[n(%)]1.5150.218
每月饮酒<1次3 562(60.0)623(62.1)4 185(60.3)
每月饮酒≥1次2 375(40.0)381(37.9)2 756(39.7)
吸烟情况[n(%)]7.9750.005
现在不吸烟3 522(59.3)643(64.0)4 165(60.0)
现在吸烟2 415(40.7)361(36.0)2 776(40.0)
BMI[kg/m2,n(%)]8.9800.011
低体重324(6.1)67(7.9)391(6.4)
正常体重2 793(52.9)407(47.8)3 200(52.2)
超重/肥胖2 166(41.0)377(44.3)2 543(41.5)
自评健康状况[n(%)]725.660<0.001
非常好/很好/好2 984(50.3)277(27.6)3 261(47.0)
一般2 207(37.2)250(24.9)2 457(35.4)
差746(12.6)477(47.5)1 223(17.6)
CysC（mg/L，）1.0±0.21.1±0.41.0±0.3111.587<0.001
衰弱指数[M(P25,P75)]8.5(4.9,14.3)32.5(28.7,39.3)10.8(5.2,19.5)2 576.142<0.001
), ArticleFig(id=1240746307640414325, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375112139075642, language=CN, label=表1, caption=

衰弱组与非衰弱组基本特征比较

, figureFileSmall=null, figureFileBig=null, tableContent=
特征非衰弱组(n=5 937)衰弱组(n=1 004)合计(n=6 941)χ2/t/Z值P值
性别[n(%)]37.885<0.001
男性2 947(49.6)393(39.1)3 340(48.1)
女性2 990(50.4)611(60.9)3 601(51.9)
年龄（岁，）58.3±9.664.5±9.659.2±9.8365.988<0.001
婚姻状况[n(%)]65.252<0.001
未婚/离异/丧偶647(10.9)200(19.9)847(12.2)
已婚5 290(89.1)804(80.1)6 094(87.8)
居住地[n(%)]16.134<0.001
农村4 622(77.9)838(83.5)5 460(78.7)
城镇1 315(22.1)166(16.5)1 481(21.3)
教育状况[n(%)]51.579<0.001
高中以下5 198(87.6)957(95.3)6 155(88.7)
高中及以上739(12.4)47(4.7)786(11.3)
过去一年饮酒情况[n(%)]1.5150.218
每月饮酒<1次3 562(60.0)623(62.1)4 185(60.3)
每月饮酒≥1次2 375(40.0)381(37.9)2 756(39.7)
吸烟情况[n(%)]7.9750.005
现在不吸烟3 522(59.3)643(64.0)4 165(60.0)
现在吸烟2 415(40.7)361(36.0)2 776(40.0)
BMI[kg/m2,n(%)]8.9800.011
低体重324(6.1)67(7.9)391(6.4)
正常体重2 793(52.9)407(47.8)3 200(52.2)
超重/肥胖2 166(41.0)377(44.3)2 543(41.5)
自评健康状况[n(%)]725.660<0.001
非常好/很好/好2 984(50.3)277(27.6)3 261(47.0)
一般2 207(37.2)250(24.9)2 457(35.4)
差746(12.6)477(47.5)1 223(17.6)
CysC（mg/L，）1.0±0.21.1±0.41.0±0.3111.587<0.001
衰弱指数[M(P25,P75)]8.5(4.9,14.3)32.5(28.7,39.3)10.8(5.2,19.5)2 576.142<0.001
), ArticleFig(id=1240746307762049154, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375112139075642, language=EN, label=Table 2, caption=

Association between cystatin c levels and risk of frailty

, figureFileSmall=null, figureFileBig=null, tableContent=
因素模型1模型2模型3
OR (95% CI)P值OR (95% CI)P值OR (95% CI)P值
CysC3.08 (2.45～3.89)<0.0014.43(3.45～5.40)<0.0012.89 (2.19～3.82)<0.001
分组
T1111
T21.18 (0.98～1.41)0.0801.23 (1.02～1.48)0.0271.23 (1.00～1.52)0.052
T32.05 (1.73～2.41)<0.0012.19 (1.84～2.60)<0.0012.13 (1.75～2.60)<0.001
), ArticleFig(id=1240746307862712461, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375112139075642, language=CN, label=表2, caption=

胱抑素C水平与衰弱发生风险的关联

, figureFileSmall=null, figureFileBig=null, tableContent=
因素模型1模型2模型3
OR (95% CI)P值OR (95% CI)P值OR (95% CI)P值
CysC3.08 (2.45～3.89)<0.0014.43(3.45～5.40)<0.0012.89 (2.19～3.82)<0.001
分组
T1111
T21.18 (0.98～1.41)0.0801.23 (1.02～1.48)0.0271.23 (1.00～1.52)0.052
T32.05 (1.73～2.41)<0.0012.19 (1.84～2.60)<0.0012.13 (1.75～2.60)<0.001
), ArticleFig(id=1240746307950792853, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375112139075642, language=EN, label=Table 3, caption=

Threshold effect analysis for the relationship between CysC and frailty index

, figureFileSmall=null, figureFileBig=null, tableContent=
项目Adjusted OR
(95% CI)		P值
拐点 (K)1.050
CysC<1.05 mg/L1.616 (0.736～3.550)0.232
CysC≥1.05 mg/L3.477(1.822～6.422)<0.001
对数似然比检验0.022
), ArticleFig(id=1240746308064039069, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375112139075642, language=CN, label=表3, caption=

血清CysC水平与衰弱指数的阈值效应分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目Adjusted OR
(95% CI)		P值
拐点 (K)1.050
CysC<1.05 mg/L1.616 (0.736～3.550)0.232
CysC≥1.05 mg/L3.477(1.822～6.422)<0.001
对数似然比检验0.022
), ArticleFig(id=1240746308143730852, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375112139075642, language=EN, label=Table 4, caption=

Subgroup analysis of CysC levels and frailty [OR (95% CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
因素T1T2T3P交互值
性别0.492
男11.07(0.76～1.49)1.92(1.43～2.57)
女11.33(1.06～1.67)2.27(1.82～2.83)
年龄（岁）<0.001
45～6511.26(1.00～1.59)2.07(1.63～2.63)
≥6510.73(0.51～1.04)0.92(0.68～1.26)
婚姻状况0.299
未婚/离异/丧偶11.01(0.61～1.68)1.59(1.03～2.44)
已婚11.29(1.05～1.58)2.35(1.93～2.85)
教育状况0.161
高中以下11.24(1.02～1.50)2.12(1.77～2.54)
高中及以上11.24(0.50～3.07)4.05(1.81～9.05)
BMI（kg/m2）0.655
低体重11.10(0.44～2.77)2.44(1.07～5.53)
正常体重11.13(0.84～1.52)1.94(1.48～2.56)
超重/肥胖11.39(1.03～1.87)2.42(1.82～3.23)
), ArticleFig(id=1240746308219228329, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375112139075642, language=CN, label=表4, caption=

CysC水平与衰弱的亚组分析[OR(95% CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
因素T1T2T3P交互值
性别0.492
男11.07(0.76～1.49)1.92(1.43～2.57)
女11.33(1.06～1.67)2.27(1.82～2.83)
年龄（岁）<0.001
45～6511.26(1.00～1.59)2.07(1.63～2.63)
≥6510.73(0.51～1.04)0.92(0.68～1.26)
婚姻状况0.299
未婚/离异/丧偶11.01(0.61～1.68)1.59(1.03～2.44)
已婚11.29(1.05～1.58)2.35(1.93～2.85)
教育状况0.161
高中以下11.24(1.02～1.50)2.12(1.77～2.54)
高中及以上11.24(0.50～3.07)4.05(1.81～9.05)
BMI（kg/m2）0.655
低体重11.10(0.44～2.77)2.44(1.07～5.53)
正常体重11.13(0.84～1.52)1.94(1.48～2.56)
超重/肥胖11.39(1.03～1.87)2.42(1.82～3.23)
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胱抑素c水平与衰弱发生风险的关系——基于CHARLS的实证研究
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邢玉萍 1 , 邢辉 1 , 李淼 1 , 高燕 2
现代预防医学 | 临床与预防 2024,51(6): 1123-1128
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现代预防医学 | 临床与预防 2024, 51(6): 1123-1128
胱抑素c水平与衰弱发生风险的关系——基于CHARLS的实证研究
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邢玉萍1, 邢辉1, 李淼1, 高燕2
作者信息
  • 1.山东中医药大学第一临床医学院，山东 济南 250035
  • 2.中国人民解放军联勤保障部队第九六○医院

    • 邢玉萍（1997—），女，硕士在读，研究方向：老年心血管疾病；老年综合征

通讯作者:

高燕，E-mail：
Relationship between Cystatin C level and the risk of frailty: an empirical analysis based on CHARLS data
Yu-ping XING1, Hui XING1, Miao LI1, Yan GAO2
Affiliations
  • Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250035, China
出版时间: 2024-03-25 doi: 10.20043/j.cnki.MPM.202310143
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摘要
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目的

探讨血清胱抑素C（Cystatin C, CysC）水平与衰弱发生风险之间的关系。

方法

本研究使用2011年中国健康与养老追踪调查（CHARLS）的数据。通过问卷调查和体格检查，收集调查对象的患病情况、日常活动能力等32项信息计算衰弱指数（Frailty index, FI）评估衰弱状态。采用多因素logistic回归模型探究CysC水平和衰弱之间的关系，同时采用限制性立方样条和阈值效应分析二者的剂量–反应关系。

结果

研究共纳入了6 941名45岁及以上的成人，平均年龄为59.2 ± 9.8岁，其中48.1%为男性，共计1 004人（14.5%）发生衰弱。多因素logistic回归模型调整混杂因素后，CysC水平最高组（T3）患衰弱风险是CysC水平最低组（T1）的2.13倍（OR =2.13，95% CI：1.75～2.60）。当CysC作为连续变量时，CysC每升高一个单位，衰弱发生风险增加1.89倍。限制性立方样条函数分析结果显示，CysC水平与衰弱发生风险呈近似“J”型曲线关系（P非线性<0.05），拐点分析显示CysC水平≥1.05 mg/L时，随着CysC水平的升高，衰弱发生风险显著增加。

结论

CysC水平与衰弱密切相关且二者存在非线性关系。

衰弱  /  胱抑素C  /  横断面研究  /  CHARLS
Objective

To investigate the relationship between serum cystatin C (CysC) levels and the risk of frailty.

Methods

This study used data from the 2011 China Health and Retirement Longitudinal Study (CHARLS). Through questionnaires and physical examination, 32 items of information were collected from the respondents, such as illness, ability to perform daily activities to calculate the frailty index (FI) to assess the state of frailty. A multivariate logistic regression model was used to explore the relationship between CysC levels and frailty, while restricted cubic spline was used to analyse the non-linear relationship.

Results

A total of 6 941 adults aged 45 years and older, with a mean age of 59.2±9.8 years, 48.1% of whom were male, were included in the study, with a total of 1 004 (14.5%) experiencing frailty. After adjusting for confounders in the multivariate logistic regression model, the risk of developing frailty in the group with the highest CysC level (T3) was 2.13 times higher than that in the group with a lower CysC (T1) (OR =2.13, 95% CI: 1.75-2.60). When CysC was used as a continuous variable, the risk of frailty increased 1.89-fold for each unit increase in CysC. Restricted cubic spline function analyses showed an approximately "J" shaped relationship between CysC levels and the risk of debility (P non-linear<0.05), the risk of frailty increased significantly with increasing CysC levels when CysC levels were ≥1.05 mg/L.

Conclusion

CysC levels are closely related to frailty, and there is a nonlinear relationship between them.

Frailty  /  Cystatin C  /  Cross-sectional studies  /  CHARLS
邢玉萍, 邢辉, 李淼, 高燕. 胱抑素c水平与衰弱发生风险的关系——基于CHARLS的实证研究. 现代预防医学, 2024 , 51 (6) : 1123 -1128 . DOI: 10.20043/j.cnki.MPM.202310143
Yu-ping XING, Hui XING, Miao LI, Yan GAO. Relationship between Cystatin C level and the risk of frailty: an empirical analysis based on CHARLS data[J]. Modern Preventive Medicine, 2024 , 51 (6) : 1123 -1128 . DOI: 10.20043/j.cnki.MPM.202310143
正文
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衰弱是一种新兴的全球健康负担，其患病率将随着人口老龄化的快速增长而上升。衰弱的特征是多个生理系统的功能下降，伴随着对压力源的脆弱性增加，其本质为个体储备能力和抵御能力下降，最终导致机体功能更易受损[1]。研究表明，衰弱会导致跌倒、残疾、心血管疾病和死亡等不良结局的发生风险升高，造成巨大的经济负担[2-4]。衰弱是一个动态过程，识别衰弱的潜在危险因素，探索影响衰弱的预测指标，有助于更精准地干预衰弱，逆转衰弱状态[5]。
胱抑素C是一种半胱氨酸蛋白酶抑制剂，广泛存在于各种组织的有核细胞和体液中，是一种低分子量蛋白质的碱性非糖化蛋白质[6]。据报道，CysC与死亡率、终末期肾病、心血管事件、衰弱等密切相关[7]。已有研究指出较高的胱抑素C水平与衰弱发生风险有关联[8-9]，但涉及的研究对象大多集中在65岁以上的群体，因此，本研究利用中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）的数据，纳入45岁以上的人群研究CysC水平与衰弱之间的关联，以期降低衰弱的发病率，为衰弱提供可靠的预测指标。
1 资料与方法
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1.1 资料来源和研究对象
研究对象来自CHARLS项目中2011年的数据，CHARLS是一项具有全国代表性的随机抽样调查，为保证样本的无偏性和代表性，该项目采用多阶段抽样，按照概率比例规模抽样，从全国30个省级行政单位范围内随机抽取450个村进行追踪调查，每两年追踪调查一次[10-11]。CHARLS经北京大学伦理审查委员会批准，所有研究对象均由本人或家属签署了知情同意书。CHARLS是研究中老年人口健康状况和可能影响因素的可靠数据库。本研究排除了缺失血清CysC信息和衰弱指数相关信息的参与者，最终纳入拥有完整数据的6 941名合格参与者。
1.2 研究方法
CHARLS研究包括了调查问卷、体格检查和实验室检测等。本研究探讨血清CysC水平和衰弱指数的相关性。研究者摘取符合研究目的的完整数据，其中血压的测定采用欧姆龙HEM-7200血压计三次测量的平均值（mmHg）；欧姆龙HN286电子人体秤测量体重（kg）；静脉血样本由医务人员从禁食超过12小时的参与者身上采集，采用免疫比浊法在中心实验室获得血清CysC水平。
1.3 主要分析指标与判定标准
1.3.1 CysC
根据血清CysC水平的三分位数分为3组，分别为T1组：<0.9 mg/L，共2 334例；T2组：0.9～1.05 mg/L，共2 198例；T3组：>1.05 mg/L，共2 409例。
1.3.2 衰弱
衰弱状态由衰弱指数（Frailty index, FI）进行评估，FI根据本研究中参与者的32项健康调查报告得出，是从0到100的连续指标，分数越高表示衰弱程度越高。基于先前的研究[12]和CHARLS数据目录，本研究共选择32个项目构建衰弱指数。这些条目包括慢性患病情况（高血压、糖尿病、心脏病、中风、癌症、关节炎、慢性肺病、哮喘、记忆相关疾病）、身体机能（独立穿衣、洗澡或淋浴、吃饭、上下床等），视力障碍，听力障碍，心理健康和认知状况等32个指标。将满足不健康条件的指标记为1分，不满足的指标记为0分。对于每个参与者，FI计算为当前健康缺陷的总和除以32并乘以100。因此，FI是范围为0至100的连续变量，并且较高的值指示较高的衰弱程度。与既往研究一致，衰弱定义为FI ≥ 25 [13]。
1.4 统计分析
计量资料符合正态分布采用（），采用 t检验进行组间比较，若不符合则采用 M（P25，P75）进行描述，采用秩和检验进行组间比较；计数资料采用率和构成比进行描述，组间比较采用 χ2检验。我们建立了logistic回归分析模型，将CysC作为连续变量和分类变量（三分位数）进行分析，结果以优势比（OR）和95%置信区间（CI）表示。模型1是未调整模型；模型2调整了性别、婚姻状况、教育水平、居住地；模型3在模型2的基础上进一步调整吸烟状况、饮酒状况、体质指数、自评健康状况。采用限制性立方样条和阈值效应分析进一步探究CysC水平与衰弱风险的剂量–反应关系。本研究将年龄、性别、婚姻状况、受教育程度和BMI分为不同亚组进行分析，以T1为参照，模型调整了年龄、性别、居住地、教育程度、婚姻状况、吸烟、饮酒、自评健康状况、体质指数。所有上述统计分析均使用软件R 4.1.2和风锐统计软件V 1.8完成。检验水准α=0.05。
2 结果
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2.1 研究对象基本情况
本研究纳入6 941名研究对象，年龄为（59.2±9.8）岁，其中女性3 601名（51.9%）。衰弱的患病率为14.5%（1 004/6 941）。与非衰弱人群相比，衰弱人群的年龄更大，偏向女性，未婚/离异/丧偶，居住在农村，学历高中以下，低体重和超重/肥胖，自评健康状况差，CysC水平更高，差异具有统计学意义（P<0.05）。详见表1。
2.2 CysC水平与衰弱的关联分析
CysC作为连续变量进行分析，调整性别、婚姻状况、教育状况、居住地、吸烟和饮酒、体重指数、自评健康状况后，结果显示CysC水平每增加一个单位，衰弱发生风险增加1.89倍（OR =2.89，95% CI：2.19～3.82）。将CysC水平按照三分位数分为3组，调整混杂因素后，CysC最高组（T3）引发衰弱风险是CysC水平最低组（T1）的 2.13倍，T2组与衰弱发生风险无关联（OR=1.23；95% CI：1～1.52），详见表2。
2.3 CysC水平与衰弱的剂量-反应关系
限制性立方样条分析结果显示，在调整性别、婚姻状况、教育状况、居住地、吸烟和饮酒、体质指数、自评健康状况后，CysC水平与衰弱发生风险存在非线性关系，呈近似“J”型曲线关系（P 非线性＝0.006），见图1。拐点分析结果显示，当CysC水平≥1.05 mg/L时，随着CysC水平的升高，衰弱风险显著增加。见表3。
2.4 亚组分析
以CysC三分位数分组，调整混杂因素后，纳入性别、年龄、婚姻状况、受教育水平、BMI进行亚组分析。多因素 logistic回归模型分析结果显示，年龄与CysC水平对衰弱之间有交互作用，在45～65岁分层中，T3水平较T1水平衰弱风险增加1.07倍，在≥65岁分层中，T3和T1水平衰弱风险比较，差异无统计学意义。在不同性别、婚姻状态、受教育程度及不同BMI水平的人群中，T3和T1水平衰弱风险比较，差异均有统计学意义，结果稳定。见表4。
3 讨论
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本研究选取2011年CHARLS数据，探讨了CysC与衰弱发生风险的关系。我们将CysC三分位数分组进行多因素 logistic回归模型分析，结果显示，CysC最高组（T3组）引起衰弱风险是CysC水平最低组（T1组）的2.13倍。此外，采用限制性立方样条函数和阈值效应探讨了CysC水平与衰弱发生风险的剂量-反应关系，二者呈近似“J”型曲线关系，当CysC水平≥1.05 mg/L时，随着CysC的升高，衰弱指数显著增加。
越来越多的研究表明CysC水平和衰弱发生风险密切相关[14-15]。一项前瞻性队列研究表明，胱抑素C不仅是早期肾损伤的灵敏指标，而且可以作为评估衰弱和身体功能下降的风险标志物[16]。印度一项针对65岁以上人群的横断面研究表明较高的胱抑素C水平与更高的衰弱风险显著相关[17]。但这些研究仅针对65岁以上的人群，而本研究纳入了45岁以上的人群，提高了对45～65岁人群衰弱的风险的认识。此外，美国一项基于67岁及以上老年男性的前瞻性研究发现，较高的CysC水平与衰弱风险和死亡率增加相关，CysC水平可作为衰老研究生物标志物[18]。包括这项研究在内的多数研究使用衰弱表型评估衰弱，而本研究中使用FI评估衰弱，FI包含更多的维度，可以更全面地反映衰弱程度。因此，本研究以更全面的衰弱评估方案，在更广泛的人群中探讨了胱抑素C与衰弱风险的相关性。
衰弱是一种年龄相关的临床综合征，目前关于衰弱风险的研究集中在65岁以上的老年人群，这个人群中因为年龄增长、肌少症、营养摄入等因素共同影响，衰弱发生风险显著增加[19-20]。但目前65岁以下人群衰弱危险因素的研究较少，本研究采用65岁作为分界值进行亚组分析，结果显示，年龄与CysC水平对衰弱有交互作用，在小于65岁人群中，随着CysC水平的升高，衰弱风险显著增加。而在大于65岁的人群中，这种量效关系差异没有统计学意义。这表明不同人群对CysC与衰弱的关联有不同的敏感性，早期暴露于高水平CysC的中年人群有更高的衰弱风险，提示我们在中年人群中制定相关筛查和干预方案的必要性。出现这种结果可能有两个原因：（1）与中年人群相比，老年人衰弱的危险因素更多，比如高龄、营养不良、认知障碍、肌少症等[21-22]，这些都降低了CysC的独立作用。（2）在中年人群中，在不伴有上述衰弱的危险因素时，高水平CysC对衰弱的独立作用更显著。这提示临床，在<65岁的中年群体中，CysC水平可作为衰弱的可靠预测指标。
目前，CysC增加衰弱风险的相关机制尚不明确，炎症反应和肥胖参与了这个过程[23]：（1）CysC水平升高会增加肥胖发生风险[24]，肥胖降低生长激素和睾酮的水平，从而影响肌肉质量导致衰弱发生[25]（2）CysC水平升高引起的衰弱可能归因于炎症反应[26]。有研究表明较高的CysC水平会伴随C反应蛋白（CRP）水平升高，引发炎症反应，而炎症状态会引发免疫功能和肌肉质量下降，进而导致衰弱[27]。
本研究是一项基于全国人群的临床研究，具有全国代表性并且样本量较大。此外，本研究补充了国内关于65岁以下人群CysC水平与衰弱发生风险的证据，为中老年人群衰弱的预防和控制提供了新的思路。但同样存在以下局限性：衰弱评估包含的32项内容通过问卷调查获得，可能存在信息偏倚；本研究使用CHARLS数据库2011年的数据进行横断面研究，由于没有2018年血清CysC数据因此无法进行CysC与衰弱发生风险的因果关系推断。未来需要进行队列研究，进一步明确 CysC与衰弱之间的因果关系。
综上所述，CysC水平与衰弱发生风险密切相关，较高的CysC水平增加衰弱的发生风险，CysC水平与衰弱指数呈近似“J”型曲线关系，CysC可以作为中老年人群衰弱患病的预测指标。未来应进一步研究CysC水平与衰弱发生风险之间潜在的作用机制。
基金
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  • 军队后勤科研项目保健专项课题(23BJZ45)
文献
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2024年第51卷第6期
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doi: 10.20043/j.cnki.MPM.202310143
  • 接收时间：2023-10-11
  • 首发时间：2026-03-16
  • 出版时间：2024-03-25
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  • 收稿日期：2023-10-11
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军队后勤科研项目保健专项课题(23BJZ45)
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    1.山东中医药大学第一临床医学院，山东 济南 250035
    2.中国人民解放军联勤保障部队第九六○医院

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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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