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Article(id=1240722575018488255, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240722566957027366, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202502178, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1739289600000, receivedDateStr=2025-02-12, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773740913395, onlineDateStr=2026-03-17, pubDate=1760025600000, pubDateStr=2025-10-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773740913395, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773740913395, creator=13701087609, updateTime=1773740913395, updator=13701087609, issue=Issue{id=1240722566957027366, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='19', pageStart='3457', pageEnd='3648', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=0, createTime=1773740911472, creator=13701087609, updateTime=1773740981732, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240722861736906836, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240722566957027366, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240722861736906837, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240722566957027366, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3609, endPage=3614, ext={EN=ArticleExt(id=1240722575316283865, articleId=1240722575018488255, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The association between low grip strength and falling in the elderly:a study based on cohort and Mendelian randomization, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=

Objective To explore the relationship between low grip strength and the occurrence of falling in the elderly. Methods A cohort study was conducted using the China Healh and Retirement Longiudinal Sudy (CHARLS) database, including individuals without a history of falling at the 2011 baseline. Demographic characteristics, chronic disease history, and grip strength information of the subjects were collected. Subjects were grouped based on whether they experienced falling during the follow-up from 2013 to 2020. Multivariable logistic regression analysis was used to examine the relationship between low grip strength and falling occurrence. The causal relationship between low grip strength and falling was assessed using two-sample MR based on the corresponding datasets. Datasets were sourced from the IEUGWAS database. MR analysis was conducted using inverse variance weighting (IVW), MR-Egger regression, weighted median estimation (WME), simple mode,and weighted mode methods. Cochran’s Q test, MR-pleiotropy, and leave-one-out methods were employed to evaluate pleiotropy, sensitivity, and heterogeneity. Results After adjusting for age, gender, marital status, disease status and other related confounding factors, low grip strength was still associated with the occurrence of falling. Compared with the normal grip group, the low grip group had an increased risk of falling (OR=1.29, 95% CI: 1.06-1.56, P=0.01). The results of MR also showed that low grip strength increased the occurrence of falling. Conclusion Low grip strength is associated with falling in the elderly. The elderly with low grip strength have a higher risk of falling.

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目的 探讨低握力与老年人跌倒发生之间的关系。方法 利用中国健康与养老追踪调查(China Health and Retirement Longitudinal Study，CHARLS)数据库进行队列研究，纳入2011年基线无跌倒史的人群，搜集受试者的人口学特征、慢性病史、握力等信息，根据2013—2020年随访是否出现跌倒进行分组，多因素logistic回归分析低握力与跌倒发生的关系。使用双样本孟德尔随机化研究（Mendelian randomization,MR）评估低握力数据集与跌倒数据集的因果关系。数据集来自IEUGWAS数据库。用逆方差加权法、MR-Egger回归、加权中位值、简单众数法和加权模型法进行MR分析，采用Cochran Q检验、MR-pleiotropy、留一法(leave-one-out)等评价多效性、敏感性及异质性。结果 在校正了年龄、性别、婚姻状态、疾病状态等相关混杂因素后，低握力与跌倒的发生有关。相比于握力正常组，低握力组发生跌倒的风险增加（OR=1.29，95%CI：1.06～1.56，P=0.01）。MR的结果同样表明，低握力增加了跌倒的发生。结论 低握力与跌倒发生具有相关性。低握力老年人群跌倒发生的风险更高。

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汪青，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=AeUz3ut0BWUTgZy7ZFttHw==, magXml=FEXuc3Wk1kHccrWVaO7fXw==, pdfUrl=null, pdf=BmLOiLe/fmfQwqUypyleZw==, pdfFileSize=819488, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=qyfwVQTXHipS2upr+4I0NQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=na7RjXySWwr/yIz5OGuKNQ==, mapNumber=null, authorCompany=null, fund=null, authors=

夏贤霆（1988—），男，本科，主治医师，研究方向：骨关节疾病及骨质疏松症的研究

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夏贤霆（1988—），男，本科，主治医师，研究方向：骨关节疾病及骨质疏松症的研究

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夏贤霆（1988—），男，本科，主治医师，研究方向：骨关节疾病及骨质疏松症的研究

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Open Med (Wars), 2023, 18(1): 20230748., articleTitle=A prospective cohort study of the impact of chronic disease on fall injuries in middle-aged and older adults, refAbstract=null), Reference(id=1240933515731194344, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240722575018488255, doi=null, pmid=null, pmcid=null, year=2023, volume=18, issue=1, pageStart=502, pageEnd=null, url=null, language=null, rfNumber=[31], rfOrder=33, authorNames=Chen S, Han HW, Jin J, journalName=Journal of Orthopaedic Surgery and Research, refType=null, unstructuredReference=Chen S, Han HW, Jin J, et al. Osteoarthritis and sarcopenia-related traits: the cross-sectional study from NHANES 2011-2014 and Mendelian randomization study[J]. Journal of Orthopaedic Surgery and Research, 2023, 18(1): 502., articleTitle=Osteoarthritis and sarcopenia-related traits: the cross-sectional study from NHANES 2011-2014 and Mendelian randomization study, refAbstract=null), Reference(id=1240933515815080428, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240722575018488255, doi=null, pmid=null, pmcid=null, year=2019, volume=29, issue=6, pageStart=471, pageEnd=479, url=null, language=null, rfNumber=[32], rfOrder=34, authorNames=Hwang SH, Lee DH, Min J, journalName=Journal of Renal Nutrition: the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation, refType=null, unstructuredReference=Hwang SH, Lee DH, Min J, et al. Handgrip strength as a predictor of All-Cause mortality in patients with chronic kidney disease undergoing dialysis: a Meta-Analysis of prospective cohort studies[J].Journal of Renal Nutrition: the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation, 2019, 29(6): 471-479., articleTitle=Handgrip strength as a predictor of All-Cause mortality in patients with chronic kidney disease undergoing dialysis: a Meta-Analysis of prospective cohort studies, refAbstract=null), Reference(id=1240933515924132335, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240722575018488255, doi=null, pmid=null, pmcid=null, year=2019, volume=62, issue=5, pageStart=789, pageEnd=799, url=null, language=null, rfNumber=[33], rfOrder=35, authorNames=Yeung CHC, Au Yeung SL, Fong SSM, journalName=Diabetologia, refType=null, unstructuredReference=Yeung CHC, Au Yeung SL, Fong SSM, et al.Lean mass, grip strength and risk of type 2 diabetes: a bi-directional Mendelian randomisation study[J]. Diabetologia, 2019, 62(5): 789-799., articleTitle=Lean mass, grip strength and risk of type 2 diabetes: a bi-directional Mendelian randomisation study, refAbstract=null), Reference(id=1240933516024795633, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240722575018488255, doi=null, pmid=null, pmcid=null, year=2023, volume=171, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[34], rfOrder=36, authorNames=Peralta M, Dias CM, Marques A, journalName=Experimental Gerontology, refType=null, unstructuredReference=Peralta M, Dias CM, Marques A, et al. Longitudinal association between grip strength and the risk of heart diseases among European middle-aged and older adults[J]. 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注：A为MR效应量散点图；B为MR森林图；C为MR留一法结果图；D为MR漏斗图。

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Comparison of general data between the two groups［（$\bar{x}±s$）， n（%），M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量无跌倒组
(n=2 524)		新发跌倒组
(n=1 525)		t/Z/χ2值P值
BMI(kg/m2)23.00±3.9822.99±3.960.110.914
晚上睡眠时间（h）6.37±1.906.17±1.943.280.001
年龄（岁）65.00 (62.00，
70.00)		66.00 (63.00，
72.00)		2.940.003
性别62.10<0.001
女性1 101 (43.62)860 (56.39)
男性1 423 (56.38)665 (43.61)
婚姻17.46<0.001
其他442 (17.51)349 (22.89)
已婚并与配偶生活2 082 (82.49)1 176 (77.11)
居住地2.630.105
城市936 (37.08)527 (34.56)
农村1 588 (62.92)998 (65.44)
高血压0.630.428
无1 742 (69.15)1 033 (67.96)
有777 (30.85)487 (32.04)
糖尿病2.830.092
无2 345 (93.80)1 404 (92.43)
有155 (6.20)115 (7.57)
肿瘤1.010.316
无2 487 (99.04)1 510 (99.34)
有24 (0.96)10 (0.66)
肺病0.100.757
无2 212 (87.95)1 331 (87.62)
有303 (12.05)188 (12.38)
心脏病1.620.203
无2 163 (86.31)1 290 (84.87)
有343 (13.69)230 (15.13)
中风6.510.011
无2 456 (97.54)1 464 (96.13)
有62 (2.46)59 (3.87)
精神疾病7.950.005
无2 492 (99.20)1 489 (98.22)
有20 (0.80)27 (1.78)
关节炎63.29<0.001
无1 749 (69.43)869 (57.10)
有770 (30.57)653 (42.90)
血脂异常0.060.807
无2 243 (90.30)1 358 (90.53)
有241 (9.70)142 (9.47)
肝脏疾病1.440.231
无2 443 (97.29)1 463 (96.63)
有68 (2.71)51 (3.37)
肾脏疾病7.310.007
无2 389 (95.22)1 413 (93.21)
有120 (4.78)103 (6.79)
消化系统疾病15.63<0.001
无2 048 (81.30)1 156 (76.10)
有471 (18.70)363 (23.90)
哮喘病0.080.772
无2 371 (94.16)1 426 (93.94)
有147 (5.84)92 (6.06)
记忆疾病2.470.116
无2 475 (98.33)1 482 (97.63)
有42 (1.67)36 (2.37)
现在是否饮酒1.000.002
否1 708 (67.67)1 104 (72.39)
是816 (32.33)421 (27.61)
现在是否吸烟18.163<0.001
否1 658 (65.69)1 100 (72.13)
是866 (34.31)425 (27.87)
是否退休11.36<0.001
否1 977 (80.07)1 251 (84.36)
是492 (19.93)232 (15.64)
教育35.24<0.001
小学以下1 312 (52.02)925 (60.66)
小学678 (26.88)374 (24.53)
中学349 (13.84)154 (10.10)
高中及以上183 (7.26)72 (4.72)
低握力17.71<0.001
否2 202 (87.24)1 257 (82.43)
是322 (12.76)268 (17.57)
视力障碍3.200.074
无178 (7.06)131 (8.60)
有2 345 (92.94)1 393 (91.40)
听力障碍2.700.100
无292 (11.57)203 (13.32)
有2 231(88.43)1 321(86.68)
), ArticleFig(id=1240933512145064271, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240722575018488255, language=CN, label=表1, caption=

两组一般资料比较［（$\bar{x}±s$），n（%），M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量无跌倒组
(n=2 524)		新发跌倒组
(n=1 525)		t/Z/χ2值P值
BMI(kg/m2)23.00±3.9822.99±3.960.110.914
晚上睡眠时间（h）6.37±1.906.17±1.943.280.001
年龄（岁）65.00 (62.00，
70.00)		66.00 (63.00，
72.00)		2.940.003
性别62.10<0.001
女性1 101 (43.62)860 (56.39)
男性1 423 (56.38)665 (43.61)
婚姻17.46<0.001
其他442 (17.51)349 (22.89)
已婚并与配偶生活2 082 (82.49)1 176 (77.11)
居住地2.630.105
城市936 (37.08)527 (34.56)
农村1 588 (62.92)998 (65.44)
高血压0.630.428
无1 742 (69.15)1 033 (67.96)
有777 (30.85)487 (32.04)
糖尿病2.830.092
无2 345 (93.80)1 404 (92.43)
有155 (6.20)115 (7.57)
肿瘤1.010.316
无2 487 (99.04)1 510 (99.34)
有24 (0.96)10 (0.66)
肺病0.100.757
无2 212 (87.95)1 331 (87.62)
有303 (12.05)188 (12.38)
心脏病1.620.203
无2 163 (86.31)1 290 (84.87)
有343 (13.69)230 (15.13)
中风6.510.011
无2 456 (97.54)1 464 (96.13)
有62 (2.46)59 (3.87)
精神疾病7.950.005
无2 492 (99.20)1 489 (98.22)
有20 (0.80)27 (1.78)
关节炎63.29<0.001
无1 749 (69.43)869 (57.10)
有770 (30.57)653 (42.90)
血脂异常0.060.807
无2 243 (90.30)1 358 (90.53)
有241 (9.70)142 (9.47)
肝脏疾病1.440.231
无2 443 (97.29)1 463 (96.63)
有68 (2.71)51 (3.37)
肾脏疾病7.310.007
无2 389 (95.22)1 413 (93.21)
有120 (4.78)103 (6.79)
消化系统疾病15.63<0.001
无2 048 (81.30)1 156 (76.10)
有471 (18.70)363 (23.90)
哮喘病0.080.772
无2 371 (94.16)1 426 (93.94)
有147 (5.84)92 (6.06)
记忆疾病2.470.116
无2 475 (98.33)1 482 (97.63)
有42 (1.67)36 (2.37)
现在是否饮酒1.000.002
否1 708 (67.67)1 104 (72.39)
是816 (32.33)421 (27.61)
现在是否吸烟18.163<0.001
否1 658 (65.69)1 100 (72.13)
是866 (34.31)425 (27.87)
是否退休11.36<0.001
否1 977 (80.07)1 251 (84.36)
是492 (19.93)232 (15.64)
教育35.24<0.001
小学以下1 312 (52.02)925 (60.66)
小学678 (26.88)374 (24.53)
中学349 (13.84)154 (10.10)
高中及以上183 (7.26)72 (4.72)
低握力17.71<0.001
否2 202 (87.24)1 257 (82.43)
是322 (12.76)268 (17.57)
视力障碍3.200.074
无178 (7.06)131 (8.60)
有2 345 (92.94)1 393 (91.40)
听力障碍2.700.100
无292 (11.57)203 (13.32)
有2 231(88.43)1 321(86.68)
), ArticleFig(id=1240933512245727572, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240722575018488255, language=EN, label=Table 2, caption=

Multivariable logistic regression analysis of the relationship between low grip strength and falling occurrence

, figureFileSmall=null, figureFileBig=null, tableContent=
VariablesModel1Model2Model3
OR (95%CI)P值OR (95%CI)P值OR (95%CI)P值
低握力
否1.00 (Reference)1.00 (Reference)1.00 (Reference)
是1.46(1.22 ～ 1.74)<0.0011.39(1.15 ～ 1.67)<0.0011.29(1.06 ～ 1.56)0.010
), ArticleFig(id=1240933512338002264, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240722575018488255, language=CN, label=表2, caption=

多因素logistic回归分析低握力与跌倒发生的关系

, figureFileSmall=null, figureFileBig=null, tableContent=
VariablesModel1Model2Model3
OR (95%CI)P值OR (95%CI)P值OR (95%CI)P值
低握力
否1.00 (Reference)1.00 (Reference)1.00 (Reference)
是1.46(1.22 ～ 1.74)<0.0011.39(1.15 ～ 1.67)<0.0011.29(1.06 ～ 1.56)0.010
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低握力与老年人跌倒发生的相关性——基于队列和孟德尔随机化的研究
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夏贤霆 1 , 王卫明 1 , 徐锋 2 , 吴晓峰 2 , 高峰 2 , 林华 3 , 汪青 2
现代预防医学 | 健康与社会行为 2025,52(19): 3609-3614
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现代预防医学 | 健康与社会行为 2025, 52(19): 3609-3614
低握力与老年人跌倒发生的相关性——基于队列和孟德尔随机化的研究
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夏贤霆1, 王卫明1, 徐锋2, 吴晓峰2, 高峰2, 林华3, 汪青2
作者信息
  • 1.昆山市第六人民医院骨科，江苏 昆山 215300
  • 2.昆山市中医医院骨科，江苏 昆山 215300
  • 3.南京鼓楼医院骨科

    • 夏贤霆（1988—），男，本科，主治医师，研究方向：骨关节疾病及骨质疏松症的研究

通讯作者:

汪青，E-mail:
The association between low grip strength and falling in the elderly:a study based on cohort and Mendelian randomization
Xian-ting XIA1, Wei-ming WANG1, Feng XU2, Xiao-feng WU2, Feng GAO2, Hua LIN3, Qing WANG2
Affiliations
  • Department of Orthopedics, Kunshan Sixth People’s Hospital, Kunshan, Jiangsu 215300, China
出版时间: 2025-10-10 doi: 10.20043/j.cnki.MPM.202502178
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摘要
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目的 探讨低握力与老年人跌倒发生之间的关系。方法 利用中国健康与养老追踪调查(China Health and Retirement Longitudinal Study，CHARLS)数据库进行队列研究，纳入2011年基线无跌倒史的人群，搜集受试者的人口学特征、慢性病史、握力等信息，根据2013—2020年随访是否出现跌倒进行分组，多因素logistic回归分析低握力与跌倒发生的关系。使用双样本孟德尔随机化研究（Mendelian randomization,MR）评估低握力数据集与跌倒数据集的因果关系。数据集来自IEUGWAS数据库。用逆方差加权法、MR-Egger回归、加权中位值、简单众数法和加权模型法进行MR分析，采用Cochran Q检验、MR-pleiotropy、留一法(leave-one-out)等评价多效性、敏感性及异质性。结果 在校正了年龄、性别、婚姻状态、疾病状态等相关混杂因素后，低握力与跌倒的发生有关。相比于握力正常组，低握力组发生跌倒的风险增加（OR=1.29，95%CI：1.06～1.56，P=0.01）。MR的结果同样表明，低握力增加了跌倒的发生。结论 低握力与跌倒发生具有相关性。低握力老年人群跌倒发生的风险更高。

老年人群  /  握力  /  跌倒  /  孟德尔随机化

Objective To explore the relationship between low grip strength and the occurrence of falling in the elderly. Methods A cohort study was conducted using the China Healh and Retirement Longiudinal Sudy (CHARLS) database, including individuals without a history of falling at the 2011 baseline. Demographic characteristics, chronic disease history, and grip strength information of the subjects were collected. Subjects were grouped based on whether they experienced falling during the follow-up from 2013 to 2020. Multivariable logistic regression analysis was used to examine the relationship between low grip strength and falling occurrence. The causal relationship between low grip strength and falling was assessed using two-sample MR based on the corresponding datasets. Datasets were sourced from the IEUGWAS database. MR analysis was conducted using inverse variance weighting (IVW), MR-Egger regression, weighted median estimation (WME), simple mode,and weighted mode methods. Cochran’s Q test, MR-pleiotropy, and leave-one-out methods were employed to evaluate pleiotropy, sensitivity, and heterogeneity. Results After adjusting for age, gender, marital status, disease status and other related confounding factors, low grip strength was still associated with the occurrence of falling. Compared with the normal grip group, the low grip group had an increased risk of falling (OR=1.29, 95% CI: 1.06-1.56, P=0.01). The results of MR also showed that low grip strength increased the occurrence of falling. Conclusion Low grip strength is associated with falling in the elderly. The elderly with low grip strength have a higher risk of falling.

Elderly population  /  Grip strength  /  Falling  /  Mendelian randomization
夏贤霆, 王卫明, 徐锋, 吴晓峰, 高峰, 林华, 汪青. 低握力与老年人跌倒发生的相关性——基于队列和孟德尔随机化的研究. 现代预防医学, 2025 , 52 (19) : 3609 -3614 . DOI: 10.20043/j.cnki.MPM.202502178
Xian-ting XIA, Wei-ming WANG, Feng XU, Xiao-feng WU, Feng GAO, Hua LIN, Qing WANG. The association between low grip strength and falling in the elderly:a study based on cohort and Mendelian randomization[J]. Modern Preventive Medicine, 2025 , 52 (19) : 3609 -3614 . DOI: 10.20043/j.cnki.MPM.202502178
正文
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跌倒是老年人意外损伤和死亡的主要原因之一。近年的流行病学研究发现，全球范围内老年人跌倒的发生率高达26.5%，其中10%的跌倒会导致严重损伤，包括髋部骨折、创伤性脑损伤或硬膜下血肿等[1]。跌倒的风险因素较为复杂，主要有年龄、认知障碍、行动能力、步态及疾病等，其中肌力下降是一个关键因素[2]。握力是指手部力量的总和，可作为一种客观、简便的肌力测量工具，在一定程度上反映了全身肌力状态。一些研究发现，低握力是糖尿病、脑卒中、恶性肿瘤等疾病预后不良的标志[3-5]。目前，国外的横断面观察性研究发现，低握力与跌倒具有关联[6]，然而，在中国老年人群，低握力是否会增加跌倒风险，低握力与跌倒是否存在因果关系，目前仍不十分清楚。本研究利用中国健康与养老追踪调查(China Health and Retirement Longitudinal Study，CHARLS)数据库进行队列研究，并结合孟德尔随机化(Mendelian randomization, MR)分析，探讨老年人低握力与跌倒发生的相关性及因果关系，为老年人跌倒的评估及防治提供新的思路。
1　资料与方法
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1.1　队列研究
1.1.1　资料来源
研究资料来源于CHARLS数据库2011—2020年的随访结果。本研究基线数据采集于2011年，随访数据（跌倒）来源2013—2020年。CHARLS调查已经过北京大学生物医学伦理审查委员会批准（伦理号：IRB00001052-11015）。
1.1.2　研究对象
纳入标准：（1）2011年基线无跌倒史的人群。排除标准：（1）年龄<60周岁或者年龄数据缺失的个体；（2）2013—2015年跌倒随访资料缺失的个体；（3）2011年基线握力数据缺失的个体；（4）2011年基线协变量数据，如身高、体重、性别数据缺失的个体。
1.1.3　变量
人口学特征包括年龄、性别、受教育程度（小学以下、小学、中学、高中以上）、婚姻（已婚、其他）、居住地（农村、城市）、吸烟情况(正在吸烟，不吸烟)、饮酒情况(正在饮酒、不饮酒)、退休情况（已退休、未退休）、夜间睡眠时间、跌倒（有、无）。慢性病病史包括视力障碍、听力障碍、糖尿病、高血压、血脂异常、恶性肿瘤、慢性肺病、肝病、心脏病、肾脏病、消化系统疾病、精神及记忆相关疾病、关节炎及哮喘。握力的测量方法：由训练有素的志愿者使用标准化测力计（中国粤建WL-1000，南通悦健物理测量仪器有限公司，中国南通）进行测量，单位为公斤。受试者站立并使用惯用手或非惯用手开始测试，同时接受口头鼓励。每个受试者以直角（90°）握住测力计并挤压手柄几秒钟，对左右手进行两次测量，本研究采取测量结果的最大值[7]。根据测量结果，男性<28 kg，女性<18 kg，定义为低握力[8]。身体质量指数（body mass index, BMI）（kg/m2）=体重/身高的二次方。
1.1.4　研究方法
纳入的基线数据包括性别、年龄、BMI、居住地、学历及婚姻状态、吸烟饮酒状况、慢性病患病情况、退休情况、夜间睡眠时间及握力情况。结局指标为2013—2020年随访出现跌倒。依据研究对象在2013—2020年是否出现过跌倒，分为新发跌倒组及无跌倒组。本研究最终纳入研究对象4 049例，其中新发跌倒组1 525例，无跌倒组2 524例。分析低握力对于跌倒发生的影响。
1.1.5　统计学方法
本研究采用SPSS 25.0统计软件进行数据分析。符合正态分布的连续变量使用（）表示，不符合正态分布连续变量以中位数［M（P25，P75）］表示。分类变量采用百分比(%)表示，组间比较采用χ2检验。两组正态分布连续变量使用t检验比较，两组非正态分布的连续变量使用非参数检验比较。使用logistic回归模型分析跌倒的发生与各因素之间的关系。检验水准α=0.05。
1.2　MR研究
1.2.1　一般资料
本研究为双样本MR，遵循国际STROBE-MR报道标准。数据集来自IEUGWAS数据库（https://gwas.mrcieu.ac.uk/）。低握力数据来自欧洲生物信息研究所（GWAS ID：ebi-a-GCST90007526）。该研究提供了256 523例欧洲人群的分析数据，包括48 596例患者及207 927例对照。9 336 415个SNPs用于GWAS分析。跌倒数据来自英国生物银行（UK Biobank）（GWAS ID：ukb-b-2535）。该研究提供了461 725例欧洲人群的分析数据，9 851 867个SNPs用于GWAS分析。
1.2.2　工具变量选择
将SNPs作为工具变量，须满足关联性、独立性及排他性三个核心假说。在本项研究中，SNP成为工具变量的标准是：（1）SNP与低握力密切相关；（2）SNP独立于影响握力和跌倒的混杂因素；（3）SNP与跌倒无直接关系，只能通过低握力对跌倒产生作用。基于常规GWAS显著阈值（P<5×10-8），连锁不平衡参数设置为10 000 kb，r2<0.001，最终筛选出16个低握力关联的SNPs，在LDlink数据库中（https://ldlink.nih.gov/）查询，剔除与混杂因素及结局变量有关的SNP，最后计算弱工具变量F值，F=[R2×(N-1-K)]/[K×(1-R2)]，剔除F<10的SNPs。
1.2.3　统计学方法
采用R语言（4.4.2版本）及TwoSampleMR程序包进行计算。以逆方差加权法（inverse variance weighted,IVW）作为主要因果效应估计。MR-Egger回归、加权中位值（weighted median estimator，WME）、简单众数法（simple mode）和加权模型法（weighted mode）作为辅助，检验结果的可靠性及稳定性。比值比（odds ratio，OR）及95%置信区间（confidence interval，CI）描述因果效应。检验水准α=0.05。
1.2.4　敏感性、异质性及多效性分析
采用Cochran Q检验计算截距和P值，分析IVW和MR-Egger的SNP异质性。MR-pleiotropy函数进行水平多效性检验，常用MR-Egger法的截距项表示，P<0.05为存在异质性及水平多效性。采用留一法(leave-one-out)逐一去除各个SNP并计算剩余SNPs的合并效应，分别评估每个SNP对总因果效应的影响。
2　结果
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2.1　队列研究结果
2.1.1　两组一般资料比较
本研究共纳入研究对象共4 049例。其中男性1 961例，女性2 088例，平均年龄为66.00(62.00，71.00)岁，筛选方法见图1。新发跌倒组的年龄、女性占比、低学历（初中及初中以下）占比、慢性病史（中风、精神疾病、关节炎、肾脏疾病、消化系统疾病）及低握力占比高于无跌倒组，见表1。
2.1.2　低握力与跌倒发生的相关性
以是否发生跌倒作为因变量，以单因素（P<0.1）为标准，将年龄、性别、婚姻状态、糖尿病、中风、精神疾病、关节炎、肾脏、消化系统、吸烟饮酒、退休、教育及握力状态作为自变量，进行多因素logistic回归分析，结果表明，低握力与跌倒的发生具有相关性（OR=1.29，95%CI：1.06～1.56，P=0.01）。见表2。
2.2　MR分析
以低握力作为暴露因素，共提取到16个SNPs，剔除与混杂因素相关的SNPs后留有10个SNPs纳入研究。F统计量计算结果显示所有SNPs的F统计量均大于10。IVW的结果显示，低握力与跌倒发生的概率增加有关（OR=1.02，95%CI：1.01～1.04，P=0.038），见图2。5种统计方法的回归斜率方向一致，见图3A。Cochran Q检验未观测到异质性（Pivw=0.78，PMR-Egger=0.69），因此IVW采用固定效应模型结果。多效性分析证实，截距为0.000 4，不存在多效性（P=0.79）。逐步剔除法证实，排除单个SNP后结果稳定，见图3C。上述结果均证实低握力增加了跌倒的发生。
3　讨论
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据世界卫生组织报告，每年大约有三分之一的65岁及以上老年人至少会发生一次跌倒，且随着年龄的增长，这一比率会更高[9-10]。跌倒会造成老年人群意外损伤、残疾、甚至死亡[11]。既往的一些研究发现，运动系统的退变或疾病，如下肢肌力下降、骨关节炎会导致老年人跌倒风险增加[12-14]。此外，前庭功能及感官功能下降也会增加跌倒风险[15-16]。最后，心血管、糖尿病及精神类疾病也与老年人跌倒风险增加有关[17-19]。
我们的研究发现，低握力与跌倒的发生具有相关性，在校正了年龄、性别、婚姻状态、疾病状态等相关混杂因素后，低握力仍与跌倒的发生有关。相比于握力正常组，低握力组发生跌倒的风险增加（OR= 1.29，95%CI：1.06～1.56，P=0.01）。MR的结果同样表明，低握力增加了跌倒的发生。现有的研究表明，低握力与跌倒风险增加之间的关联可能通过多种机制实现，涉及神经肌肉、认知及慢性疾病等方面，包括：（1）整体肌肉功能下降的反映。握力是全身肌肉力量的可靠指标，低握力常提示肌肉质量和功能下降，下肢肌肉力量减弱会直接影响平衡和步态稳定性，增加跌倒风险[20]。Strandkvist[21]的研究发现，下肢肌肉群功能与握力显著相关，握力是评估老年人下肢力量的有效方法。Neri[22]的研究也发现，握力可能代表整体肌肉力量，而整体肌肉力量是比绝对肌肉力量更敏感的跌倒风险标志物。（2）平衡与步态受损。低握力可能反映整体运动功能退化，随着个体年龄的增长，下肢的肌肉功能、平衡能力和前庭稳定性会发生变化，步行活动能力随着年龄的增长而降低，因此增加了跌倒的风险[23]。握力不仅与核心肌群力量存在关联、影响身体姿势控制，国外的一些还研究发现，握力和前庭功能都会随着年龄增长自然下降，两者的变化可同步出现，提示着相似的老化机制，因此握力在一定程度上可反映前庭功能及整体平衡能力[24-25]。（3）认知能力下降。认知障碍早期即出现步速减慢、步幅变异性增大，同时认知受损者识别危险（如湿滑地面）和反应能力降低，导致跌倒风险增加[26]。Cui[27]的一项荟萃分析发现，握力与老年人认知障碍及痴呆发生风险呈相关性，握力可能是认知能力下降及痴呆发作的早期间接非认知标志物。Marques[28]的研究也发现，在65岁以上老年人群中，握力与抑郁症的发生存在显著的负相关性。Kim[29]的研究发现，低握力水平与视听功能受损程度显著相关，且感官功能下降越严重，其与肌无力的相关性越高。（4）慢性疾病与炎症的影响。一些慢性疾病（如糖尿病、关节炎或心血管疾病）可能会损害感觉功能（如周围神经病变）或运动功能，间接增加跌倒风险，有研究发现，慢性疾病数量与跌倒风险正性相关[30]。Chen[31]的研究发现，握力与OA的发生呈显著的负相关性，握力越低的老年人群OA的患病率越高。许多研究还发现，握力与心血管疾病、糖尿病、慢性肾病等慢性疾病的发生发展具有显著的负相关性[32-34]。可见，握力下降对老年人来说，不仅仅意味着手部功能的退化，还可能对他们的独立生活能力以及整体健康状况产生深远影响，从而导致了该人群跌倒风险的增加。
本研究的优点及不足之处：一是，本研究是一项基于中国健康与养老追踪调查数据库的纵向队列研究，纳入的样本数量大，且具有全国代表性，因此本文的研究结果可以推广到中国中老年普通人群。二是，本研究在纵向队列研究的基础上结合了MR研究，使得低握力增加跌倒风险的因果关系更加明确。本研究也存在一定的不足之处。一方面，运动、饮食、生活环境等与跌倒有关的混杂因素并未全部纳入。另一方面，队列研究的数据来自中国人群，而MR的数据来自欧洲，人种的差异可能会存在一定的偏倚。
综上，本研究的结果表明，老年人群中低握力与跌倒的发生具有因果关系。低握力可能会增加跌倒的风险。增强肌肉功能，提高握力是否有助于减少跌倒的发生，仍需要开展进一步的前瞻性研究。
基金
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  • 昆山市医学高层次人才培养项目(昆卫[2024]9号)
  • 昆山市中医医院金杏优才项目(03rczc-25)
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参考文献 引证文献
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2025年第52卷第19期
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doi: 10.20043/j.cnki.MPM.202502178
  • 接收时间：2025-02-12
  • 首发时间：2026-03-17
  • 出版时间：2025-10-10
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  • 收稿日期：2025-02-12
基金
昆山市医学高层次人才培养项目(昆卫[2024]9号)
昆山市中医医院金杏优才项目(03rczc-25)
作者信息
    1.昆山市第六人民医院骨科，江苏 昆山 215300
    2.昆山市中医医院骨科，江苏 昆山 215300
    3.南京鼓楼医院骨科

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2种不同金属材料的力学参数
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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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