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Article(id=1240972415900119329, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202311388, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1700409600000, receivedDateStr=2023-11-20, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773800480102, onlineDateStr=2026-03-18, pubDate=1715270400000, pubDateStr=2024-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773800480102, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773800480102, creator=13701087609, updateTime=1773800480102, updator=13701087609, issue=Issue{id=1240972413354176744, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773800479495, creator=13701087609, updateTime=1773800596829, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240972905568334240, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240972905568334241, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1574, endPage=1579, ext={EN=ArticleExt(id=1240972416244052281, articleId=1240972415900119329, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Hearing loss and risk of myogenic in the middle-aged and elderly, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the relationship between hearing loss and the risk of muscular dystrophy in the middle-aged and elderly, so as to provide scientific basis for the prevention and intervention of myogenic in this population.

Methods

In this study, people aged 45 and above in the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015 were selected as research subjects. Self-reported hearing loss was used to evaluate hearing loss. Based on the consensus of Asian muscular dystrophy working group in 2019, muscular dystrophy was determined. Cox proportional hazard model was used to investigate the relationship between hearing loss and the risk of myasthenia.

Results

Among 11 528 middle-aged and elderly people, the incidence of baseline hearing loss was 12.8%. During the 4-year follow-up, there were 558 new cases of muscular dystrophy, with an incidence of 6.4%. The results of the Cox proportional hazard model showed that subjects with hearing loss had an increased risk of muscular dystrophy by 31.1% (HR=1.311, 95%CI: 1.059-1.625) compared with those without hearing loss. The results of stratified analysis showed that the relationship between hearing loss and muscular dystrophy was more obvious in women, the elderly, rural household registration, married people, those with education level of junior high school or above, and those with high annual family income.

Conclusion

Hearing loss is related to the increased risk of muscular dystrophy in middle-aged and elderly people in China. Early screening and intervention for hearing loss may help reduce the incidence of future muscular dystrophy.

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目的

探究中老年人听力损失与肌肉减少症发病风险的关联，以期为中老年人肌肉减少症的预防和干预提供科学依据。

方法

本研究选取2011—2015年中国健康与养老追踪调查（CHARLS）中的45岁及以上中老年人作为研究对象，采用自我报告听力状况评价听力损失，基于亚洲肌肉减少症工作组2019年共识判定肌肉减少症，采用Cox比例风险模型探索中老年人听力损失与肌肉减少症发病风险的关联。

结果

11 528名中老年人中，基线听力损失发生率为12.8%。在4年的随访中，新发肌肉减少症558名，发生率为6.4%。Cox比例风险模型结果显示，与无听力损失的研究对象相比，存在听力损失的研究对象肌肉减少症发病风险增加31.1%（HR=1.311，95%CI: 1.059～1.625)。分层分析结果显示，听力损失与肌肉减少症的关联在女性、老年人、农村户籍、已婚者、教育程度初中及以上者、家庭年收入高者中更明显。

结论

中国中老年人群中听力损失与肌肉减少症发病风险增加有关。对听力损失进行早期筛查并实施干预可能有助于降低未来肌肉减少症的发生。

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李辉，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=XsM1P09LVWbXpdb8LtulNQ==, magXml=zrp8CCKRkfpUanK+pBrYWw==, pdfUrl=null, pdf=uCH1GPO1VQGp6YlfhdQn4Q==, pdfFileSize=559405, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=0GLPh8zMhAQeXIU9eKskmA==, mapNumber=null, authorCompany=null, fund=null, authors=

殷海芹（1978—），女，护师，研究方向：老年相关疾病研究工作

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殷海芹（1978—），女，护师，研究方向：老年相关疾病研究工作

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殷海芹（1978—），女，护师，研究方向：老年相关疾病研究工作

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The World of Survey and Research, 2021(8): 3-10., articleTitle=A study on the current situation and influencing factors of Mobile payment use among middle and elderly People, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1240986254918086866, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972415900119329, xref=1., ext=[AuthorCompanyExt(id=1240986254934864085, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972415900119329, companyId=1240986254918086866, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Disinfection supply Center of the 960 Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army, Jinan,Shandong 250031, China), AuthorCompanyExt(id=1240986254943252694, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972415900119329, companyId=1240986254918086866, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.中国人民解放军联勤保障部队第九六〇医院消毒供应中心，山东 济南 250031)]), AuthorCompany(id=1240986255438180573, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972415900119329, xref=2., ext=[AuthorCompanyExt(id=1240986255446569182, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972415900119329, companyId=1240986255438180573, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.中国人民解放军联勤保障部队第九六〇医院耳鼻咽喉头颈外科，山东 济南 250031)])], figs=[ArticleFig(id=1240986258994950558, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972415900119329, language=EN, label=Table 1, caption=

Characteristics of the study subjects at baseline ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量人数无听力损失组听力损失组χ2值P值
年龄(岁)268.879<0.001
45～596 481 (56.2)5 944 (59.1)537 (36.4)
≥605 047 (43.8)4 110 (40.9)937 (63.6)
性别4.0460.044
男性5 701 (49.5)4 936 (49.1)765 (51.9)
女性5 827 (50.5)5 118 (50.9)709 (48.1)
户籍类型42.759<0.001
农村9 134 (79.2)7 871 (78.3)1 263 (85.7)
城镇2 394 (20.8)2 183 (21.7)211 (14.3)
婚姻状况63.933<0.001
已婚10 164 (88.2)8 957 (89.1)1 207 (81.9)
未婚/离异/丧偶1 364 (11.8)1 097 (10.9)267 (18.1)
文化程度191.845<0.001
文盲2 949 (25.6)2 382 (23.7)567 (38.5)
小学4 724 (41.0)4 122 (41.0)602 (40.8)
初中及以上3 855 (33.4)3 550 (35.3)305 (20.7)
家庭年收入（万元）4.3040.038
<17 584 (65.8)6 579 (65.4)1 005 (68.2)
≥13 944 (34.2)3 475 (34.6)469 (31.8)
吸烟5.2660.022
否6 831 (59.3)5 998 (59.7)833 (56.5)
是4 697 (40.7)4 056 (40.3)641 (43.5)
饮酒7.6480.006
否7 586 (65.8)6 569 (65.3)1 017 (69.0)
是3 942 (34.2)3 485 (34.7)457 (31.0)
体育锻炼4.3580.037
否6 711 (58.2)5 816 (57.8)895 (60.7)
是4 817 (41.8)4 238 (42.2)579 (39.3)
慢性病患病85.081<0.001
否3 839 (33.3)3 504 (34.9)335 (22.7)
是7 689 (66.7)6 550 (65.1)1 139 (77.3)
功能限制169.767<0.001
无10 120 (87.8)8 979 (89.3)1 141 (77.4)
有1 408 (12.2)1 075 (10.7)333 (22.6)
抑郁症状148.320<0.001
否7 729 (67.0)6 946 (69.1)783 (53.1)
是3 799 (33.0)3 108 (30.9)691 (46.9)
), ArticleFig(id=1240986259284357552, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972415900119329, language=CN, label=表1, caption=

研究对象的基线特征［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量人数无听力损失组听力损失组χ2值P值
年龄(岁)268.879<0.001
45～596 481 (56.2)5 944 (59.1)537 (36.4)
≥605 047 (43.8)4 110 (40.9)937 (63.6)
性别4.0460.044
男性5 701 (49.5)4 936 (49.1)765 (51.9)
女性5 827 (50.5)5 118 (50.9)709 (48.1)
户籍类型42.759<0.001
农村9 134 (79.2)7 871 (78.3)1 263 (85.7)
城镇2 394 (20.8)2 183 (21.7)211 (14.3)
婚姻状况63.933<0.001
已婚10 164 (88.2)8 957 (89.1)1 207 (81.9)
未婚/离异/丧偶1 364 (11.8)1 097 (10.9)267 (18.1)
文化程度191.845<0.001
文盲2 949 (25.6)2 382 (23.7)567 (38.5)
小学4 724 (41.0)4 122 (41.0)602 (40.8)
初中及以上3 855 (33.4)3 550 (35.3)305 (20.7)
家庭年收入（万元）4.3040.038
<17 584 (65.8)6 579 (65.4)1 005 (68.2)
≥13 944 (34.2)3 475 (34.6)469 (31.8)
吸烟5.2660.022
否6 831 (59.3)5 998 (59.7)833 (56.5)
是4 697 (40.7)4 056 (40.3)641 (43.5)
饮酒7.6480.006
否7 586 (65.8)6 569 (65.3)1 017 (69.0)
是3 942 (34.2)3 485 (34.7)457 (31.0)
体育锻炼4.3580.037
否6 711 (58.2)5 816 (57.8)895 (60.7)
是4 817 (41.8)4 238 (42.2)579 (39.3)
慢性病患病85.081<0.001
否3 839 (33.3)3 504 (34.9)335 (22.7)
是7 689 (66.7)6 550 (65.1)1 139 (77.3)
功能限制169.767<0.001
无10 120 (87.8)8 979 (89.3)1 141 (77.4)
有1 408 (12.2)1 075 (10.7)333 (22.6)
抑郁症状148.320<0.001
否7 729 (67.0)6 946 (69.1)783 (53.1)
是3 799 (33.0)3 108 (30.9)691 (46.9)
), ArticleFig(id=1240986259963834812, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972415900119329, language=EN, label=Table 2, caption=

Assignment of variables

, figureFileSmall=null, figureFileBig=null, tableContent=
项目赋值
听力损失0=否，1=是
肌肉减少症0=未发病，1=发病
年龄原值输入
性别0=男性，1=女性
户籍类型0=农村，1=城镇
婚姻状况0=已婚，1=未婚/离异/丧偶
文化程度0=文盲，1=小学，2=初中及以上
家庭年收入（万元）0=<1，1=≥1
吸烟0=否，1=是
饮酒0=否，1=是
体育锻炼0=否，1=是
慢性病患病0=否，1=是
功能限制0=否，1=是
抑郁症状0=否，1=是
), ArticleFig(id=1240986260504900039, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972415900119329, language=CN, label=表2, caption=

各变量赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
项目赋值
听力损失0=否，1=是
肌肉减少症0=未发病，1=发病
年龄原值输入
性别0=男性，1=女性
户籍类型0=农村，1=城镇
婚姻状况0=已婚，1=未婚/离异/丧偶
文化程度0=文盲，1=小学，2=初中及以上
家庭年收入（万元）0=<1，1=≥1
吸烟0=否，1=是
饮酒0=否，1=是
体育锻炼0=否，1=是
慢性病患病0=否，1=是
功能限制0=否，1=是
抑郁症状0=否，1=是
), ArticleFig(id=1240986260664283605, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972415900119329, language=EN, label=Table 3, caption=

Cox proportional risk analysis of hearing loss and sarcopenia in middle-aged and older adults

, figureFileSmall=null, figureFileBig=null, tableContent=
变量HR值(95%CI) P 值
听力损失（否）
是1.311(1.059 ~ 1.625)0.1430.013
年龄1.088(1.077 ~ 1.098)0.005<0.001
性别（男性）
女性1.455(1.135 ~ 1.867)0.1850.003
户籍类型（农村）
城镇0.576(0.436 ~ 0.760)0.082<0.001
婚姻状况（已婚）
未婚/离异/丧偶1.101(0.888 ~ 1.365)0.1210.381
文化程度（文盲）
小学0.876(0.716 ~ 1.070)0.0900.194
初中及上0.587(0.438 ~ 0.787)0.080<0.001
家庭年收入（万元，<1）
≥10.965(0.804 ~ 1.158)0.0900.700
吸烟（否）
是1.111(0.883 ~ 1.399)0.1310.369
饮酒（否）
是0.913(0.742 ~ 1.123)0.0960.389
体育锻炼（否）
是0.921(0.775 ~ 1.094)0.0810.349
慢性病患病（否）
是0.841(0.702 ~ 1.007)0.0770.059
功能限制（否）
是0.892(0.694 ~ 1.147)0.1140.374
抑郁症状（否）
是1.315(1.102 ~ 1.571)0.1190.002
), ArticleFig(id=1240986261029188065, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972415900119329, language=CN, label=表3, caption=

听力损失与中老年人肌肉减少症的Cox比例风险分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量HR值(95%CI) P 值
听力损失（否）
是1.311(1.059 ~ 1.625)0.1430.013
年龄1.088(1.077 ~ 1.098)0.005<0.001
性别（男性）
女性1.455(1.135 ~ 1.867)0.1850.003
户籍类型（农村）
城镇0.576(0.436 ~ 0.760)0.082<0.001
婚姻状况（已婚）
未婚/离异/丧偶1.101(0.888 ~ 1.365)0.1210.381
文化程度（文盲）
小学0.876(0.716 ~ 1.070)0.0900.194
初中及上0.587(0.438 ~ 0.787)0.080<0.001
家庭年收入（万元，<1）
≥10.965(0.804 ~ 1.158)0.0900.700
吸烟（否）
是1.111(0.883 ~ 1.399)0.1310.369
饮酒（否）
是0.913(0.742 ~ 1.123)0.0960.389
体育锻炼（否）
是0.921(0.775 ~ 1.094)0.0810.349
慢性病患病（否）
是0.841(0.702 ~ 1.007)0.0770.059
功能限制（否）
是0.892(0.694 ~ 1.147)0.1140.374
抑郁症状（否）
是1.315(1.102 ~ 1.571)0.1190.002
), ArticleFig(id=1240986261134045677, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972415900119329, language=EN, label=Table 4, caption=

Stratified analysis of the association between hearing loss and sarcopenia

, figureFileSmall=null, figureFileBig=null, tableContent=
分组变量HR值(95%CI) P 值
性别
男性听力损失 (否)1.276(0.924 ~ 1.761)0.2100.139
女性听力损失 (否)1.338(1.002 ~ 1.787)0.1970.048
年龄（岁）
<60听力损失 (否)1.482(0.887 ~ 2.475)0.3880.133
≥60听力损失 (否)1.313(1.038 ~ 1.661)0.1580.023
婚姻状况
已婚听力损失 (否)1.498(1.175 ~ 1.909)0.1850.001
未婚/离异/丧偶听力损失 (否)0.880(0.558 ~ 1.388)0.2050.582
户籍类型
农村听力损失 (否)1.313(1.048 ~ 1.646)0.1510.018
城镇听力损失 (否)1.204(0.597 ~ 2.430)0.4310.604
文化程度
文盲听力损失 (否)1.257(0.932 ~ 1.694)0.1920.134
小学听力损失 (否)1.166(0.807 ~ 1.686)0.2190.414
初中及以上听力损失 (否)2.189(1.252 ~ 3.828)0.6240.006
家庭年收入（万元）
<1听力损失 (否)1.166(0.897 ~ 1.515)0.1560.251
≥1听力损失 (否)1.721(1.184 ~ 2.501)0.3280.004
), ArticleFig(id=1240986261251486202, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972415900119329, language=CN, label=表4, caption=

听力损失与肌肉减少症关联的分层分析

, figureFileSmall=null, figureFileBig=null, tableContent=
分组变量HR值(95%CI) P 值
性别
男性听力损失 (否)1.276(0.924 ~ 1.761)0.2100.139
女性听力损失 (否)1.338(1.002 ~ 1.787)0.1970.048
年龄（岁）
<60听力损失 (否)1.482(0.887 ~ 2.475)0.3880.133
≥60听力损失 (否)1.313(1.038 ~ 1.661)0.1580.023
婚姻状况
已婚听力损失 (否)1.498(1.175 ~ 1.909)0.1850.001
未婚/离异/丧偶听力损失 (否)0.880(0.558 ~ 1.388)0.2050.582
户籍类型
农村听力损失 (否)1.313(1.048 ~ 1.646)0.1510.018
城镇听力损失 (否)1.204(0.597 ~ 2.430)0.4310.604
文化程度
文盲听力损失 (否)1.257(0.932 ~ 1.694)0.1920.134
小学听力损失 (否)1.166(0.807 ~ 1.686)0.2190.414
初中及以上听力损失 (否)2.189(1.252 ~ 3.828)0.6240.006
家庭年收入（万元）
<1听力损失 (否)1.166(0.897 ~ 1.515)0.1560.251
≥1听力损失 (否)1.721(1.184 ~ 2.501)0.3280.004
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中老年人听力损失与肌肉减少症发病风险的前瞻性队列研究
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殷海芹 1 , 李辉 2
现代预防医学 | 流行病与统计方法 2024,51(9): 1574-1579
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现代预防医学 | 流行病与统计方法 2024, 51(9): 1574-1579
中老年人听力损失与肌肉减少症发病风险的前瞻性队列研究
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殷海芹1, 李辉2
作者信息
  • 1.中国人民解放军联勤保障部队第九六〇医院消毒供应中心，山东 济南 250031
  • 2.中国人民解放军联勤保障部队第九六〇医院耳鼻咽喉头颈外科，山东 济南 250031

    • 殷海芹（1978—），女，护师，研究方向：老年相关疾病研究工作

通讯作者:

李辉，E-mail:
Hearing loss and risk of myogenic in the middle-aged and elderly
Hai-qin YIN1, Hui LI2
Affiliations
  • Disinfection supply Center of the 960 Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army, Jinan,Shandong 250031, China
出版时间: 2024-05-10 doi: 10.20043/j.cnki.MPM.202311388
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摘要
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目的

探究中老年人听力损失与肌肉减少症发病风险的关联，以期为中老年人肌肉减少症的预防和干预提供科学依据。

方法

本研究选取2011—2015年中国健康与养老追踪调查（CHARLS）中的45岁及以上中老年人作为研究对象，采用自我报告听力状况评价听力损失，基于亚洲肌肉减少症工作组2019年共识判定肌肉减少症，采用Cox比例风险模型探索中老年人听力损失与肌肉减少症发病风险的关联。

结果

11 528名中老年人中，基线听力损失发生率为12.8%。在4年的随访中，新发肌肉减少症558名，发生率为6.4%。Cox比例风险模型结果显示，与无听力损失的研究对象相比，存在听力损失的研究对象肌肉减少症发病风险增加31.1%（HR=1.311，95%CI: 1.059～1.625)。分层分析结果显示，听力损失与肌肉减少症的关联在女性、老年人、农村户籍、已婚者、教育程度初中及以上者、家庭年收入高者中更明显。

结论

中国中老年人群中听力损失与肌肉减少症发病风险增加有关。对听力损失进行早期筛查并实施干预可能有助于降低未来肌肉减少症的发生。

听力损失  /  肌肉减少症  /  中老年人  /  队列研究
Objective

To investigate the relationship between hearing loss and the risk of muscular dystrophy in the middle-aged and elderly, so as to provide scientific basis for the prevention and intervention of myogenic in this population.

Methods

In this study, people aged 45 and above in the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015 were selected as research subjects. Self-reported hearing loss was used to evaluate hearing loss. Based on the consensus of Asian muscular dystrophy working group in 2019, muscular dystrophy was determined. Cox proportional hazard model was used to investigate the relationship between hearing loss and the risk of myasthenia.

Results

Among 11 528 middle-aged and elderly people, the incidence of baseline hearing loss was 12.8%. During the 4-year follow-up, there were 558 new cases of muscular dystrophy, with an incidence of 6.4%. The results of the Cox proportional hazard model showed that subjects with hearing loss had an increased risk of muscular dystrophy by 31.1% (HR=1.311, 95%CI: 1.059-1.625) compared with those without hearing loss. The results of stratified analysis showed that the relationship between hearing loss and muscular dystrophy was more obvious in women, the elderly, rural household registration, married people, those with education level of junior high school or above, and those with high annual family income.

Conclusion

Hearing loss is related to the increased risk of muscular dystrophy in middle-aged and elderly people in China. Early screening and intervention for hearing loss may help reduce the incidence of future muscular dystrophy.

Hearing loss  /  Muscle loss  /  Middle-aged and elderly  /  Cohort study
殷海芹, 李辉. 中老年人听力损失与肌肉减少症发病风险的前瞻性队列研究. 现代预防医学, 2024 , 51 (9) : 1574 -1579 . DOI: 10.20043/j.cnki.MPM.202311388
Hai-qin YIN, Hui LI. Hearing loss and risk of myogenic in the middle-aged and elderly[J]. Modern Preventive Medicine, 2024 , 51 (9) : 1574 -1579 . DOI: 10.20043/j.cnki.MPM.202311388
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随着人口老龄化的趋势加快，中老年人年龄相关听力损失和肌肉减少症的患病率正在增加。听力损失是一种感觉障碍，指一个人由于生理障碍、疾病和年龄而导致的听觉功能丧失或下降[1]。根据世界卫生组织发布的《世界听觉报告》，在全球75亿人口中，约20%患有听力损失[2]。听力损失已被证明与多种不良健康事件有关，如痴呆[3]和衰弱[4]。然而，很少有研究关注听力损失与骨骼和肌肉相关疾病的关联。肌肉减少症是一种年龄退行性疾病，其主要表现为肌肉质量和身体功能加速流失[5]，目前已被视为影响中老年人生命质量和全因死亡的重要危险因素[6-7]。先前一项系统综述[8]表明，目前仅有两篇横断面研究探索了感觉功能（嗅觉和视力）与肌肉减少症的关联[9-10]，尚缺乏纵向研究证据支持。此外，由于以往研究主要基于国外人群开展调查，我国仍缺乏中老年人听力损失与肌肉减少症关联的研究证据。因此，为深入了解两者的前瞻性关联并为今后临床环境中开展肌肉减少症的早期预警提供依据，本研究拟采用前瞻性队列研究设计探索我国中老年人听力损失与肌肉减少症关联。
1　资料与方法
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1.1　资料来源
本研究数据来源于中国健康与养老追踪调查数据库（China Health and Retirement Longitudinal Survey, CHARLS），该调查自2011年启动全国基线调查，采用人口规模成比例的概率抽样，选取45岁及以上中老年人作为研究对象，收集全国中老年人的人口社会特征及健康状况数据。本研究采用前瞻性队列研究设计，以2011年CHARLS调查作为基线，以2015年调查作为随访，构建为期4年的队列。因2018第四期CHARLS调查未收集生物标志物数据，无法评价肌肉减少症，因此未纳入分析。研究对象的纳入标准：（1）基线调查时年龄小于45周岁；（2）基线调查具有完整的听力及握力、身高等身体测量数据。排除标准：（1）基线时患有肌肉减少症；（2）随访调查失访或死亡及缺失身体测量数据。本研究基线共纳入11 528名中老年人，其中随访中失访或死亡者及缺失身体测量数据者2 820人，最终8 708名参与者纳入最终的队列分析中。CHARLS已获得北京大学伦理审查委员会审查通过，所有研究对象均签署知情同意书。
1.2　研究变量
1.2.1　听力损失
听力损失的评价基于研究对象的自我报告，CHARLS调查中询问研究对象“您的听力如何？”，答项包括5个：极好、很好、好、一般、不好。参考先前研究的界定方法[11]，本研究将听力状况分为两类：听力正常（极好、很好、好、一般）与听力损失（不好）。
1.2.2　肌肉减少症
根据《亚洲肌肉减少症工作组2019年共识》[12]，肌肉减少症的评价采用低肌肉质量、低肌肉力量、低身体机能三个组分来确定。本研究基于先前验证的肌肉质量估算公式估计肌肉质量（0.193×体重+0.107×身高-4.157×性别-0.03×年龄-2.631）[13]，使用调整身高后的肌肉质量（千克/身高的二次方）判定低肌肉质量（男性<7.0 kg/m2，女性<5.4 kg/m2）[12]。低肌肉力量采用握力进行评价，CHARLS采用标准握力器测量了研究对象的手握力，本研究将男性握力<28 kg，女性握力<18 kg判定为低肌肉力量。低身体机能采用5次起坐试验测量，时间大于等于12 s被判定为低身体机能。基于诊断共识，当低肌肉质量与低肌肉力量/低身体机共存时，研究对象被确定为患有肌肉减少症。
1.2.3　协变量
本研究纳入的协变量包括年龄、性别、户籍类型、婚姻状况、文化程度、家庭年收入、吸烟、饮酒、体育锻炼、慢性病患病、功能限制和抑郁症状。其中，功能限制采用6项日常生活活动测量：穿衣、洗澡、吃饭、上下床、上厕所和控制大小便[14]，当有1项及以上活动有困难完成时被判定为功能限制。抑郁症状采用10条目流调中心抑郁量表[15]进行评价，每个条目计分为0～3分，总分为0～30分，总分≥10分被判定为存在抑郁症状。
1.3　统计分析
采用Stata 16.0软件进行统计分析，听力正常与听力损失组的基线资料比较采用χ2检验，采用Cox比例风险模型分析听力损失与肌肉减少症发生的前瞻性关联，同时进行了不同性别、年龄、户籍类型、婚姻状况、文化程度和家庭年收入间的分层分析。检验水准α=0.05。
2　结果
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2.1　研究对象的基线特征
11 528名研究对象中男性5 701名（49.5%），女性5 827名（50.5%），平均年龄（58.8±9.1）岁，听力损失者1 474名（12.8%）。随访4年后，8 708名参与者新发肌肉减少症558名，发生率为6.4%。χ2检验结果显示，无听力损失组和听力损失组在年龄、性别、户籍类型、婚姻状况、文化程度、家庭年收入、吸烟、饮酒、体育锻炼、慢性病患病、功能限制和抑郁症状间分布差异具有统计学意义。见表1
2.2　听力损失与中老年人肌肉减少症的前瞻性关联
以是否发生肌肉减少症为因变量，以是否听力损失为自变量，以肌少症患病情况为因变量，以年龄、性别、户籍类型、婚姻状况、文化程度、家庭年收入、吸烟、饮酒、体育锻炼、慢性病患病、功能限制和抑郁症状为协变量，进行多因素Cox比例风险回归分析。结果表明，与无听力损失者相比，听力损失的中老年人4年后肌肉减少症发病风险更高（HR=1.311，95%CI:1.059～1.625，P=0.013）。变量赋值情况见表2，Cox比例风险回归分析见表3。
2.3　听力损失与中老年人肌肉减少症关联的分层分析
分层分析结果显示，听力损失与肌肉减少症的关联在女性、≥60岁的老年人、已婚者、农村户籍、教育程度初中及以上者、家庭年收入≥1万元者中更明显。然而，未发现听力损失与性别、年龄、婚姻状况、户籍类型、文化程度和家庭年收入存在显著的交互作用（P for交互>0.05）。见表4。
3　讨论
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本研究基于一项全国代表性样本的中老年人跟踪调查，探索了听力损失与4年后新发肌肉减少症的前瞻性关联。研究发现，听力损失会增加中老年人肌肉减少症的发病风险，该研究为深入了解听力状况与肌肉减少症的关联提供了高等级的研究证据，并为今后临床环境中肌肉减少症的早期预警提供了新指标。
最近新加坡一项横断面研究探索了多民族老年人听力障碍对肌肉减少症的影响，然而其并未发现听力障碍与肌肉减少症有关[16]。本研究结果为探索两者的纵向关联提供了中国的研究证据。文献梳理发现，尽管很少研究直接关注上述关联，但部分研究已探索听力损失与肌肉减少症组分之间的相关性。国内一项对381名住院老年患者的横断面研究发现，自我报告的听力状况与手握力显著正相关，即听力状况越好，老年患者的手握力越强[17]。韩国一项对3 075名社区老年人的横断面研究也发现，自我报告的听力敏锐度受损均与低握力显著相关[18]。日本的横断面研究还发现自我感知的听力障碍与步行速度较慢显著相关，这间接提示听力障碍与身体功能限制有关。这些结果均为本研究的发现提供了间接支持。听力损失与肌肉减少症的关联机制可能涉及以下几个方面。首先，存在听力损失的中老年人可能由于接收外界信息受限，从而减少社会交往活动，致使其容易诱发孤独感和抑郁情绪[19]，而先前研究已证实抑郁是肌肉减少症的重要危险因素[20]。其次，听力损失与肌肉减少症可能存在共同的与年龄相关的病理机制，如炎症反应和氧化应激[21]。最后，先前研究还发现听力损失与老年人较少的体力活动有关[22]，这可能影响肌肉功能的维持和促进，从而增加肌肉减少症的发生风险。
分层分析结果显示，听力损失与肌肉减少症的关联在女性、老年人、已婚者、农村户籍、教育程度初中及以上者和家庭年收入高者中更明显。值得注意的是考虑到女性、60岁及以上老年人及农村户籍者的听力损失与肌肉减少症关联系数的置信区间下限接近于0，这些性别、年龄及婚姻状况差异今后还需进一步验证。第一，性别差异存在的原因可能与女性更容易出现肌肉减少症有关，从而加大了听力损失与肌肉减少症的关联。先前研究也发现，女性中老年人患有肌肉减少症的比例是男性的1.2倍[23]。第二，听力损失及肌肉减少症均与年龄密切相关，在老年人中两者的关联更强可能与存在共同的致病机制有关[21]。第三，大量研究已经证实中老年人健康状况存在明显的城乡不平等现象，由于城乡居住环境、生活条件等方面的差异，农村中老年人出现不良健康状况的风险更高[24-25]。本研究也发现，农村中老年人的听力损失患病率为13.8%，显著高于城镇中老年人的8.8%，较高的患病率致使其出现肌肉减少症的风险更大。第四，听力损失与肌肉减少症关联的婚姻状况差异可能是由于分层导致的样本量减少有关，考虑到已婚者与未婚/离异/丧偶者样本量差距较大，今后还需进一步探索。此外，教育程度及家庭年收入是社会经济地位的重要体现。先前研究发现教育程度越高和收入越高的中老年人互联网使用率和手机支付使用比例更高[26-27]。初中及以上者和家庭年收入高的中老年人可能由于日常使用电子设备，从而一定程度影响了其听觉功能，从而致使听力损失的可能性增加，导致与肌肉减少症的关联更强。值得注意的是由于本研究未发现显著的交互作用，上述的分层分析结果还需要在更大的样本人群中进行验证，这有助于更精准地识别听力损失与肌肉减少症关联间的社会人口学差异。
综上所述，本研究表明听力损失与中国中老年人肌肉减少症发病风险增加有关，听力损失可能是中老年人肌肉减少症的早期预警指标。考虑到本研究中听力状况为自我报告，未来建议采用基于标准听力测量仪器进一步验证本研究发现，并探索听力损失与肌肉减少症关联的生物学机制。
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2024年第51卷第9期
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doi: 10.20043/j.cnki.MPM.202311388
  • 接收时间：2023-11-20
  • 首发时间：2026-03-18
  • 出版时间：2024-05-10
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  • 收稿日期：2023-11-20
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    1.中国人民解放军联勤保障部队第九六〇医院消毒供应中心，山东 济南 250031
    2.中国人民解放军联勤保障部队第九六〇医院耳鼻咽喉头颈外科，山东 济南 250031

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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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