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Article(id=1241329575695798442, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412303, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1734451200000, receivedDateStr=2024-12-18, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773885633634, onlineDateStr=2026-03-19, pubDate=1752076800000, pubDateStr=2025-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773885633634, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773885633634, creator=13701087609, updateTime=1773885633634, updator=13701087609, issue=Issue{id=1241329570129956900, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='13', pageStart='2305', pageEnd='2496', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773885632307, creator=13701087609, updateTime=1773885763730, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241330121425080472, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241330121425080473, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2484, endPage=2490, ext={EN=ArticleExt(id=1241329576132006079, articleId=1241329575695798442, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Independent and joint effects of knee osteoarthritis and sarcopenia on fall risk among middle-aged and older adults in China, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the independent and joint effects of knee osteoarthritis (KOA) and sarcopenia on fall risk among Chinese middle-aged and older adults.

Methods

Using data from the China Health and Retirement Longitudinal Study (CHARLS), we analyzed baseline data from 2011 and recorded fall events during 9-year follow-up. Multivariable Cox regression models were established to examine independent and joint effects, with sensitivity analyses conducted to verify robustness.

Results

Among 9 037 participants, 3 627 (40.1%) experienced falls during follow-up. Multivariable Cox regression showed both KOA (HR=1.51, 95%CI: 1.38-1.65) and sarcopenia (HR=1.25, 95%CI: 1.11-1.40) were independent risk factors for falls. For joint effects, compared with the non-KOA/non-sarcopenia group, the non-KOA/sarcopenia (HR=1.25, 95%CI:1.09-1.42), KOA/non-sarcopenia (HR=1.51, 95%CI: 1.37-1.67), and KOA/sarcopenia (HR=1.83, 95%CI: 1.46-2.29) groups all showed increased fall risks. Sensitivity analyses confirmed result stability.

Conclusion

Both KOA and sarcopenia increase fall risk in middle-aged and older adults, with their combined effect exceeding individual impacts. Enhanced fall prevention strategies combining early intervention and comprehensive measures should be implemented for this vulnerable population.

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目的

评估膝骨关节炎和肌肉减少症对中国中老年人跌倒风险的独立和联合效应。

方法

本研究采用中国健康与养老追踪调查（China health and retirement longitudinal study，CHARLS）数据，提取2011年基线数据，9年随访期间记录跌倒事件，建立多因素Cox回归模型分析膝骨关节炎和肌肉减少症对跌倒风险的独立和联合效应，进行敏感性分析检验研究结果的可靠性。

结果

本研究共纳入9 037例研究对象，共3 627例研究对象在随访期内发生跌倒事件，跌倒发生率为40.1%。多因素Cox回归分析显示，膝骨关节炎（HR=1.51，95%CI：1.38～1.65）和肌肉减少症（HR=1.25，95%CI：1.11～1.40）均是跌倒的独立危险因素，联合作用分析中，以非膝骨关节炎/非肌肉减少症组为参照，非膝骨关节炎/肌肉减少症组（HR=1.25，95%CI：1.09～1.42）、膝骨关节炎/非肌肉减少症组（HR=1.51，95%CI：1.37～1.67）和膝骨关节炎/肌肉减少症组（HR=1.83，95%CI：1.46～2.29）跌倒风险均增加，敏感性分析显示结果稳定。

结论

膝骨关节炎和肌肉减少症均会增加中老年人的跌倒风险，两种疾病的联合作用对跌倒风险的影响高于各自的独立作用，对患有膝骨关节炎和肌肉减少症的中老年人应加强跌倒预防，通过早期干预治疗并结合其他跌倒预防措施以有效降低我国中老年人的跌倒风险。

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朱明，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=diF9fHKV3nydoBuH2EkFGw==, magXml=BgiKNUDbjPicKuwwmAnXFA==, pdfUrl=null, pdf=z2bmR4GnkzR3NpoTkYmxBQ==, pdfFileSize=744338, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=MOgl0qR4YEdpVku+3GZQlg==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=fGuKZwuPkVbqVO+NG3HGOw==, mapNumber=null, authorCompany=null, fund=null, authors=

王德志（1988—），男，硕士，主治医师，研究方向：髋膝关节疾病的基础和临床研究

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王德志（1988—），男，硕士，主治医师，研究方向：髋膝关节疾病的基础和临床研究

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王德志（1988—），男，硕士，主治医师，研究方向：髋膝关节疾病的基础和临床研究

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Meta-analysis on the Association between Knee Osteoarthritis and Sarcopenia[J] . Acta Academiae Medicinae Jiangxi, 2024, 64(2): 28-34.(In Chinese), articleTitle=Meta-analysis on the Association between Knee Osteoarthritis and Sarcopenia, refAbstract=null), Reference(id=1241329763298636057, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, doi=null, pmid=null, pmcid=null, year=2025, volume=10, issue=2, pageStart=52, pageEnd=null, url=null, language=null, rfNumber=[32], rfOrder=39, authorNames=Blajovan MD, Abu-Awwad SA, Tomescu MC, journalName=Geriatrics, refType=null, unstructuredReference=Blajovan MD, Abu-Awwad SA, Tomescu MC, et al. The role of inflammatory sarcopenia in increasing fall risk in older adults:exploring the impact on Mobility-Impaired and immunocompromised patients[J] . 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Archivum Immunologiae et Therapiae Experimentalis, 2020, 68(3): 16., articleTitle=Decreased serum adiponectin reflects low vitamin D, high interleukin 6, and poor physical performance in knee osteoarthritis, refAbstract=null)], funds=[Fund(id=1241329756596138958, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, awardId=ZR202306250007, language=CN, fundingSource=山东省自然科学基金(ZR202306250007), fundOrder=null, country=null), Fund(id=1241329756684219351, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, awardId=Q-2023143, language=CN, fundingSource=山东省中医药科技项目(Q-2023143), fundOrder=null, country=null), Fund(id=1241329756831020004, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, awardId=202304071439, language=CN, fundingSource=山东省医药卫生科技项目(202304071439), fundOrder=null, country=null), Fund(id=1241329756919100394, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, awardId=RZY2023C06, language=CN, fundingSource=日照市中医药科技项目(RZY2023C06), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241329751915295301, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, xref=null, ext=[AuthorCompanyExt(id=1241329751932072519, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, companyId=1241329751915295301, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Rizhao Hospital of Traditional Chinese Medicine, Rizhao, Shandong 276800, China), AuthorCompanyExt(id=1241329751965626953, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, companyId=1241329751915295301, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=日照市中医医院，山东 日照 276800)])], figs=[ArticleFig(id=1241329755388179288, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, language=EN, label=Figure 1, caption=Flowchart for inclusion and exclusion of participants, figureFileSmall=gzeE0aHqxUXZS7uOO1MLLA==, figureFileBig=MOgl0qR4YEdpVku+3GZQlg==, tableContent=null), ArticleFig(id=1241329755484648296, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, language=CN, label=图1, caption=研究对象纳入和排除流程图, figureFileSmall=gzeE0aHqxUXZS7uOO1MLLA==, figureFileBig=MOgl0qR4YEdpVku+3GZQlg==, tableContent=null), ArticleFig(id=1241329755606283125, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, language=EN, label=Table 1, caption=

Basic characteristics of the subjects ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总数(n=9 037)未跌倒(n=5 410)跌倒(n=3 627)χ2 值P值
性别118.739<0.001
男4 502(49.8)2 949(54.5)1 553(42.8)
女4 535(50.2)2 461(45.5)2 074(57.2)
年龄（岁）79.747<0.001
<605 106(56.5)3 263(60.3)1 843(50.8)
≥603 931(43.5)2 147(39.7)1 784(49.2)
教育程度74.075<0.001
小学及以下5 952(65.9)3 373(62.3)2 579(71.1)
中学及以上3 085(34.1)2 037(37.7)1 048(28.9)
婚姻状况42.346<0.001
已婚8 020(88.7)4 897(90.5)3 123(86.1)
未婚/离异/丧偶1 017(11.3)513(9.5)504(13.9)
夜间睡眠时间（h）59.515<0.001
<74 364(48.3)2 433(45.0)1 931(53.2)
7～93 936(43.6)2 511(46.4)1 425(39.3)
>9737(8.2)466(8.6)271(7.5)
BMI(kg/m2)13.5990.004
偏瘦（<18.5）550(6.1)296(5.5)254(7)
正常（18.5～23.9）4 800(53.1)2 874(53.1)1 926(53.1)
超重（24～28）2 642(29.2)1 632(30.2)1 010(27.8)
肥胖（>28）1 045(11.6)608(11.2)437(12)
慢性病50.219<0.001
无其他慢性病4 180(46.3)2 667(49.3)1 513(41.7)
有其他慢性病4 857(53.7)2 743(50.7)2 114(58.3)
吸烟情况30.414<0.001
目前不吸烟6 142(68.0)3 557(65.7)2 585(71.3)
目前吸烟2 895(32.0)1 853(34.3)1 042(28.7)
饮酒情况13.429<0.001
不饮酒6 657(73.7)3 910(72.3)2 747(75.7)
饮酒2 380(26.3)1 500(27.7)880(24.3)
KOA143.032<0.001
否7 987(88.4)4 960(91.7)3 027(83.5)
是1 050(11.6)450(8.3)600(16.5)
肌少症43.44<0.001
否8 282(91.6)5 043(93.2)3 239(89.3)
是755(8.4)367(6.8)388(10.7)
), ArticleFig(id=1241329755732112258, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, language=CN, label=表1, caption=

研究对象基本特征［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总数(n=9 037)未跌倒(n=5 410)跌倒(n=3 627)χ2 值P值
性别118.739<0.001
男4 502(49.8)2 949(54.5)1 553(42.8)
女4 535(50.2)2 461(45.5)2 074(57.2)
年龄（岁）79.747<0.001
<605 106(56.5)3 263(60.3)1 843(50.8)
≥603 931(43.5)2 147(39.7)1 784(49.2)
教育程度74.075<0.001
小学及以下5 952(65.9)3 373(62.3)2 579(71.1)
中学及以上3 085(34.1)2 037(37.7)1 048(28.9)
婚姻状况42.346<0.001
已婚8 020(88.7)4 897(90.5)3 123(86.1)
未婚/离异/丧偶1 017(11.3)513(9.5)504(13.9)
夜间睡眠时间（h）59.515<0.001
<74 364(48.3)2 433(45.0)1 931(53.2)
7～93 936(43.6)2 511(46.4)1 425(39.3)
>9737(8.2)466(8.6)271(7.5)
BMI(kg/m2)13.5990.004
偏瘦（<18.5）550(6.1)296(5.5)254(7)
正常（18.5～23.9）4 800(53.1)2 874(53.1)1 926(53.1)
超重（24～28）2 642(29.2)1 632(30.2)1 010(27.8)
肥胖（>28）1 045(11.6)608(11.2)437(12)
慢性病50.219<0.001
无其他慢性病4 180(46.3)2 667(49.3)1 513(41.7)
有其他慢性病4 857(53.7)2 743(50.7)2 114(58.3)
吸烟情况30.414<0.001
目前不吸烟6 142(68.0)3 557(65.7)2 585(71.3)
目前吸烟2 895(32.0)1 853(34.3)1 042(28.7)
饮酒情况13.429<0.001
不饮酒6 657(73.7)3 910(72.3)2 747(75.7)
饮酒2 380(26.3)1 500(27.7)880(24.3)
KOA143.032<0.001
否7 987(88.4)4 960(91.7)3 027(83.5)
是1 050(11.6)450(8.3)600(16.5)
肌少症43.44<0.001
否8 282(91.6)5 043(93.2)3 239(89.3)
是755(8.4)367(6.8)388(10.7)
), ArticleFig(id=1241329755853747085, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, language=EN, label=Table 2, caption=

Association of knee osteoarthritis and sarcopenia with falls

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人数跌倒人数（%）模型1模型2模型3
HR值(95%CI)P值HR值(95%CI)P值HR值(95%CI)P值
非KOA7 9873 027(37.9)1(Ref)1(Ref)1(Ref)
KOA1 050600(57.1)1.81(1.66～1.98)<0.0011.63(1.49～1.79)<0.0011.51(1.38～1.65)<0.001
非肌少症8 2823 239(39.1)1(Ref)1(Ref)1(Ref)
肌少症755388(51.4)1.64(1.47～1.82)<0.0011.27(1.14～1.42)<0.0011.25(1.11～1.40)<0.001
), ArticleFig(id=1241329755929244567, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, language=CN, label=表2, caption=

KOA和肌少症与跌倒风险的关联

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人数跌倒人数（%）模型1模型2模型3
HR值(95%CI)P值HR值(95%CI)P值HR值(95%CI)P值
非KOA7 9873 027(37.9)1(Ref)1(Ref)1(Ref)
KOA1 050600(57.1)1.81(1.66～1.98)<0.0011.63(1.49～1.79)<0.0011.51(1.38～1.65)<0.001
非肌少症8 2823 239(39.1)1(Ref)1(Ref)1(Ref)
肌少症755388(51.4)1.64(1.47～1.82)<0.0011.27(1.14～1.42)<0.0011.25(1.11～1.40)<0.001
), ArticleFig(id=1241329756021519265, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, language=EN, label=Table 3, caption=

Combined effects of knee osteoarthritis with sarcopenia on falls

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人数跌倒人数（%）模型1模型2模型3
HR值(95%CI)P值HR值(95%CI)P值HR值(95%CI)P值
非KOA/非肌少症7 3652 726(37.0)1(Ref)1(Ref)1(Ref)
非KOA/肌少症622301(48.4)1.60(1.42～1.80)<0.0011.26(1.12～1.43)<0.0011.25(1.09～1.42)0.001
KOA/非肌少症917513(55.9)1.79(1.63～1.97)<0.0011.63(1.48～1.8)<0.0011.51(1.37～1.67)<0.001
KOA/肌少症13387(65.4)2.71(2.19～3.35)<0.0012.03(1.63～2.52)<0.0011.83(1.46～2.29)<0.001
), ArticleFig(id=1241329756109599656, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, language=CN, label=表3, caption=

KOA与肌少症对跌倒风险的联合作用

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人数跌倒人数（%）模型1模型2模型3
HR值(95%CI)P值HR值(95%CI)P值HR值(95%CI)P值
非KOA/非肌少症7 3652 726(37.0)1(Ref)1(Ref)1(Ref)
非KOA/肌少症622301(48.4)1.60(1.42～1.80)<0.0011.26(1.12～1.43)<0.0011.25(1.09～1.42)0.001
KOA/非肌少症917513(55.9)1.79(1.63～1.97)<0.0011.63(1.48～1.8)<0.0011.51(1.37～1.67)<0.001
KOA/肌少症13387(65.4)2.71(2.19～3.35)<0.0012.03(1.63～2.52)<0.0011.83(1.46～2.29)<0.001
), ArticleFig(id=1241329756227040178, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, language=EN, label=Table 4, caption=

Sensitivity analysis of combined effects of knee osteoarthritis with sarcopenia on falls

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人数跌倒人数（%）HR(95%CI)P值
多重插补法
非KOA/非肌少症7 7002 860(37.1)1(Ref)
非KOA/肌少症659318(48.3)1.24(1.09～1.41)0.001
KOA/非肌少症981552(56.3)1.51(1.37～1.66)<0.001
KOA/肌少症14591(63.4)1.77(1.42～2.21)<0.001
排除随访≤2年
非KOA/非肌少症6 2071 812(29.2)1(Ref)
非KOA/肌少症457182(39.8)1.19(1.01～1.40)0.041
KOA/非肌少症692314(45.4)1.48(1.31～1.68)<0.001
KOA/肌少症8242(51.2)1.53(1.11～2.10)0.009
), ArticleFig(id=1241329756323509181, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575695798442, language=CN, label=表4, caption=

KOA和肌少症的联合作用与跌倒关系的敏感性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人数跌倒人数（%）HR(95%CI)P值
多重插补法
非KOA/非肌少症7 7002 860(37.1)1(Ref)
非KOA/肌少症659318(48.3)1.24(1.09～1.41)0.001
KOA/非肌少症981552(56.3)1.51(1.37～1.66)<0.001
KOA/肌少症14591(63.4)1.77(1.42～2.21)<0.001
排除随访≤2年
非KOA/非肌少症6 2071 812(29.2)1(Ref)
非KOA/肌少症457182(39.8)1.19(1.01～1.40)0.041
KOA/非肌少症692314(45.4)1.48(1.31～1.68)<0.001
KOA/肌少症8242(51.2)1.53(1.11～2.10)0.009
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膝骨关节炎和肌肉减少症对中国中老年人跌倒风险的独立和联合作用
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王德志 , 蒲文荣 , 朱明 , 马超 , 刘玉龙 , 孟虎
现代预防医学 | 临床与预防 2025,52(13): 2484-2490
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现代预防医学 | 临床与预防 2025, 52(13): 2484-2490
膝骨关节炎和肌肉减少症对中国中老年人跌倒风险的独立和联合作用
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王德志, 蒲文荣, 朱明 , 马超, 刘玉龙, 孟虎
作者信息
  • 日照市中医医院，山东 日照 276800

    • 王德志（1988—），男，硕士，主治医师，研究方向：髋膝关节疾病的基础和临床研究

通讯作者:

朱明，E-mail:
Independent and joint effects of knee osteoarthritis and sarcopenia on fall risk among middle-aged and older adults in China
De-zhi WANG, Wen-rong PU, Ming ZHU , Chao MA, Yu-long LIU, Hu MENG
Affiliations
  • Rizhao Hospital of Traditional Chinese Medicine, Rizhao, Shandong 276800, China
出版时间: 2025-07-10 doi: 10.20043/j.cnki.MPM.202412303
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摘要
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目的

评估膝骨关节炎和肌肉减少症对中国中老年人跌倒风险的独立和联合效应。

方法

本研究采用中国健康与养老追踪调查（China health and retirement longitudinal study，CHARLS）数据，提取2011年基线数据，9年随访期间记录跌倒事件，建立多因素Cox回归模型分析膝骨关节炎和肌肉减少症对跌倒风险的独立和联合效应，进行敏感性分析检验研究结果的可靠性。

结果

本研究共纳入9 037例研究对象，共3 627例研究对象在随访期内发生跌倒事件，跌倒发生率为40.1%。多因素Cox回归分析显示，膝骨关节炎（HR=1.51，95%CI：1.38～1.65）和肌肉减少症（HR=1.25，95%CI：1.11～1.40）均是跌倒的独立危险因素，联合作用分析中，以非膝骨关节炎/非肌肉减少症组为参照，非膝骨关节炎/肌肉减少症组（HR=1.25，95%CI：1.09～1.42）、膝骨关节炎/非肌肉减少症组（HR=1.51，95%CI：1.37～1.67）和膝骨关节炎/肌肉减少症组（HR=1.83，95%CI：1.46～2.29）跌倒风险均增加，敏感性分析显示结果稳定。

结论

膝骨关节炎和肌肉减少症均会增加中老年人的跌倒风险，两种疾病的联合作用对跌倒风险的影响高于各自的独立作用，对患有膝骨关节炎和肌肉减少症的中老年人应加强跌倒预防，通过早期干预治疗并结合其他跌倒预防措施以有效降低我国中老年人的跌倒风险。

中老年人  /  膝骨关节炎  /  肌肉减少症  /  跌倒风险  /  中国健康与养老追踪调查
Objective

To evaluate the independent and joint effects of knee osteoarthritis (KOA) and sarcopenia on fall risk among Chinese middle-aged and older adults.

Methods

Using data from the China Health and Retirement Longitudinal Study (CHARLS), we analyzed baseline data from 2011 and recorded fall events during 9-year follow-up. Multivariable Cox regression models were established to examine independent and joint effects, with sensitivity analyses conducted to verify robustness.

Results

Among 9 037 participants, 3 627 (40.1%) experienced falls during follow-up. Multivariable Cox regression showed both KOA (HR=1.51, 95%CI: 1.38-1.65) and sarcopenia (HR=1.25, 95%CI: 1.11-1.40) were independent risk factors for falls. For joint effects, compared with the non-KOA/non-sarcopenia group, the non-KOA/sarcopenia (HR=1.25, 95%CI:1.09-1.42), KOA/non-sarcopenia (HR=1.51, 95%CI: 1.37-1.67), and KOA/sarcopenia (HR=1.83, 95%CI: 1.46-2.29) groups all showed increased fall risks. Sensitivity analyses confirmed result stability.

Conclusion

Both KOA and sarcopenia increase fall risk in middle-aged and older adults, with their combined effect exceeding individual impacts. Enhanced fall prevention strategies combining early intervention and comprehensive measures should be implemented for this vulnerable population.

Middle-aged and older adults  /  Knee osteoarthritis  /  Sarcopenia  /  Fall risk  /  China Health and Retirement Longitudinal Study
王德志, 蒲文荣, 朱明, 马超, 刘玉龙, 孟虎. 膝骨关节炎和肌肉减少症对中国中老年人跌倒风险的独立和联合作用. 现代预防医学, 2025 , 52 (13) : 2484 -2490 . DOI: 10.20043/j.cnki.MPM.202412303
De-zhi WANG, Wen-rong PU, Ming ZHU, Chao MA, Yu-long LIU, Hu MENG. Independent and joint effects of knee osteoarthritis and sarcopenia on fall risk among middle-aged and older adults in China[J]. Modern Preventive Medicine, 2025 , 52 (13) : 2484 -2490 . DOI: 10.20043/j.cnki.MPM.202412303
正文
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随着全球人口老龄化进程加速，中老年人跌倒已成为威胁公共健康的重大社会问题。受到年龄增长所致生理因素与疾病所致病理因素的叠加影响，中老年人在身体协调性方面更易出现问题，往往成为跌倒的高风险人群[1]。中老年人跌倒不仅会对个人健康造成严重影响，还会给家庭和社会带来沉重的负担。据报道，60%～75%的老人在跌倒后报告受伤，又有6%～8%的受伤合并骨折[2]，跌倒所造成的继发性损伤会导致中老年人的生活质量降低，严重者甚至失能或死亡。鉴于中老年人的高跌倒风险以及跌倒的严重后果，我们应高度重视中老年人群的跌倒防治工作。
膝骨关节炎（knee osteoarthritis，KOA）是一种以中老年人为主要患病人群的关节退变性疾病，随着人口老龄化程度的不断加剧，发病率逐年上升[3]，有一些证据表明患有KOA的中老年人跌倒风险增加[4-5]。肌肉减少症（sarcopenia，简称肌少症）是一种以骨骼肌质量和功能逐渐下降为特征的疾病[6]，也好发于中老年人，近年来不断得到重视，肌少症会影响执行日常生活任务的能力，被认为是影响跌倒的危险因素[7]。KOA和肌少症都是中老年人常见的慢性疾病，往往并存且相互影响，形成一种复杂的病理生理关系[8-9]。关于KOA和肌少症与跌倒风险的关联效应，中国人群的相关数据较少，已有研究也是局限于某地区或某群体的小样本研究，缺乏全国代表性的大样本研究，关于二者的联合作用与跌倒风险的关系更无中外文献的报道。基于这一背景，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，探究中国中老年人群KOA和肌少症对跌倒风险的独立和联合效应，以期根据中国的经济社会发展水平为相关公共卫生政策的制定提供参考。
1　资料与方法
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1.1　研究对象
中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）是一项针对45岁以上中国人群的全国性纵向调查。该调查采用多阶段抽样方法，覆盖中国大部分地区和人口，具有较强的代表性。本研究使用了CHARLS 2011年的基线调查数据以及2013、2015、2018和2020年的随访调查数据。CHARLS 2011年基线调查时共纳入17 708名参与者，依次排除协变量数据缺失者（n=4 914）、年龄<45岁者（n=251）、KOA诊断数据缺失者（n=2 467）、肌少症诊断数据缺失者（n=643）、随访调查跌倒数据缺失者（n=396），最终纳入9 037例数据完整的研究对象，纳排过程见图1。CHARLS已获北京大学伦理审查委员会审查通过，所有研究对象签署知情同意书，所有数据对外开放并允许规范使用。
1.2　研究变量
1.2.1　自变量
本研究的自变量为KOA和肌少症。
参照既往类似研究[10]，KOA由CHARLS调查中经医生诊断的关节炎和同时存在的膝关节疼痛来确定，具体访谈问题为：（1）是否被医生诊断为关节炎？（2）是否经常受到身体疼痛的困扰？（3）身体的哪个部位感觉到疼痛？对前二个问题均做出“是”的回答，对第三个问题做出“膝盖”的回答，则被判定为患有KOA。
肌少症根据《亚洲肌少症工作组2019年共识》[11]进行诊断，肌少症的判定由肌肉质量、肌肉力量、身体机能三个部分来确定，当低肌肉质量合并低肌肉力量或低肌肉质量合并低身体机能时，研究对象被判定患有肌少症。参考既往研究[12]，肌肉质量估算公式为0.193×体重+0.107×身高- 4.157×性别-0.037×年龄-2.631（体重、身高、年龄单位分别为kg、cm、岁，男性赋值为1，女性赋值为2），除以身高（m）的二次方进行调整后,男性<7.0 kg/m2，女性<5.7 kg/m2判定为低肌肉质量；肌肉力量采用握力进行评价，男性握力<28.0 kg，女性握力<18.0 kg判定为低肌肉力量；身体机能采用5次起坐试验评价，时间≥12 s判定为低身体机能。
1.2.2　因变量
本研究中的因变量为自我报告的跌倒事件，访谈问题为“自上次访问，您有没有摔倒？”，2013年开始随访调查，出现跌倒事件即随访终止，2020年作为随访的最终时间点。
1.2.3　协变量
参考以往文献选择协变量[9,13]。本研究纳入的协变量包括性别、年龄、教育程度、婚姻状况、吸烟情况、饮酒情况、夜间睡眠时间、身体质量指数（body mass index，BMI）和是否合并其他慢性病。根据CHARLS调查问卷，本研究将吸烟情况分为目前吸烟和目前不吸烟，其中目前不吸烟包括从不吸烟和曾经吸烟。本研究中的其他慢性病是指CHARLS调查问卷中除关节炎外的其他慢性病，包括高血压、血脂异常、糖尿病、恶性肿瘤、慢性肺部疾病、肝脏疾病、心脏病、中风、肾脏疾病、消化系统疾病、情感及精神方面问题、与记忆相关的疾病、哮喘。
1.3　统计学方法
所有分析均采用Free Statistic sversion 1.9.2软件和R(http://www.R-project.org，R基金会)统计软件包完成。计数资料以频数（n）和构成比（%）表示，组间比较采用χ2检验，计量资料采用（均值±标准差）表示，组间比较采用t检验。KOA与肌少症对跌倒风险的独立和联合效应采用多因素Cox回归模型进行分析，共拟合3个模型，模型1不调整任何协变量，模型2调整性别、年龄、教育程度、婚姻状况，模型3在模型2基础上调整吸烟情况、饮酒情况、夜间睡眠时间、BMI、慢性病。本研究以模型3为基础进行敏感性分析以检验结果的可靠性，共进行二次敏感性分析：（1）对缺失协变量数据的样本进行多重插补，以减少数据缺失可能引发的偏倚；（2）筛除随访时间≤2年的研究对象，以消除随访时间过短潜在的偶然性误差。双侧检验，检验水准α=0.05。
2　结果
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2.1　研究对象基本特征
本研究纳入9 037例研究对象，男性4 502例，女性4 535例，KOA 1 050例，患病率11.6%，肌少症755例，患病率8.4%，在中位随访时间为7年的随访中，共3 627例研究对象发生跌倒事件，跌倒发生率40.1%。对跌倒组和未跌倒组的性别、年龄、教育程度、婚姻状况、夜间睡眠时间、BMI、慢性病、吸烟情况和饮酒情况等一般资料进行比较，χ2检验结果显示均有统计学差异。见表1。
2.2　KOA和肌少症与跌倒风险关系的多因素Cox回归分析
多因素Cox回归分析显示KOA和肌少症均是跌倒的独立危险因素（HR>1,P<0.05），不同模型显示结果稳定。完全调整模型（模型3）显示，KOA人群的跌倒风险是非KOA人群的1.51（95%CI：1.38～1.65）倍，肌少症人群的跌倒风险是非肌少症人群的1.25（95%CI：1.11～1.40）倍。见表2。
2.3　KOA与肌少症的联合作用和跌倒风险关系的多因素Cox回归分析
根据是否患有KOA和肌少症将研究对象分为非KOA/非肌少症组、非KOA/肌少症组、KOA/非肌少症组和KOA/肌少症组，以评估KOA和肌少症对跌倒风险的联合影响。完全调整模型（模型3）显示，以非KOA/非肌少症组为参照，非KOA/肌少症组、KOA/非肌少症组、KOA/肌少症组的跌倒风险分别是非KOA/非肌少症组的1.25（95%CI：1.09～1.42）、1.51（95%CI：1.37～1.67）和1.83（95%CI：1.46～2.29）倍，均有统计学意义（P<0.05）。见表3。
2.4　敏感性分析
本研究以模型3为基础进行了2次敏感性分析，2次敏感性分析结果与主要研究结果基本一致，即KOA/肌少症组的跌倒风险最高，高于非KOA/肌少症组、KOA/非肌少症组和非KOA/非肌少症组。敏感性分析提示本研究结果具有相当可靠性。见表4。
3　讨论
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在这项包含9 037例中国中老年人的九年纵向研究中，我们探究了KOA和肌少症对跌倒风险的独立和联合效应，结果表明KOA和肌少症均是中老年人跌倒的独立危险因素，KOA与肌少症并存更会显著增加跌倒风险，敏感性分析进一步验证了这种关联效应的稳定性。
本研究中，KOA人群的跌倒风险是非KOA人群的1.51倍（95%CI：1.38～1.66），与国外的一项meta分析结果相近（OR=1.35；95%CI：1.20～1.51）[14]。疼痛是KOA患者的主要临床症状，会对机体协调产生负面影响，增加跌倒的风险[15]，研究发现KOA患者K-L分级越高，疼痛评分越高，患者跌倒及继发相关损伤的风险越高[16]。伴随身体活动水平下降，KOA患者通常不同程度出现肌肉萎缩和肌力下降，导致平衡控制能力减弱而容易跌倒[17-18]。KOA还会引起本体感觉不同程度减退，导致关节位置的静态感知能力和关节运动的动态感知能力下降，从而增加跌倒风险[19-20]。KOA会不同程度遭遇破坏膝关节周围组织结构，影响膝关节稳定性，Chaharmahali等人[21]发现不稳定的膝关节会导致步态异常和姿势控制能力变差，从而面临更高的跌倒风险。
基于国外人群的一项研究发现肌少症会导致跌倒风险增加1.85（95%CI：1.24～ 2.77）倍[22]，而目前我国对肌少症的认识尚处于初级阶段，未给予足够的重视，更是缺乏基于中国人群的肌少症与跌倒风险相关性的研究数据，本研究首次基于我国全国性大样本数据发现肌少症导致跌倒风险增加1.25（95%CI：1.11～1.40）倍。低肌肉质量和弱肌肉力量会损害老年人的身体活动能力，包括步速、耐力、平衡、敏捷性、灵活性和反应时间，所有这些都是跌倒的高风险因素[23]。患有肌少症的个体更容易表现出认知障碍，导致精力不集中和反应力下降[24]，同样导致跌倒风险增加。肌少症可能存在的的激素水平异常或营养不良会损害神经肌肉协调和平衡能力，也会引起跌倒风险升高[22,25-26]。
本研究还发现KOA和肌少症对跌倒风险的影响可产生联合效应，与仅患有KOA或肌少症之一的研究对象相比，同时患有KOA和肌少症的研究对象发生跌倒的风险显著高于两者独立的影响，潜在机制可能是KOA和肌少症互为危险因素，彼此加重病情，进而共同增加跌倒风险，已有研究也表明KOA和肌少症之间在病理表现与发生机制等方面存在密切联系[8,27]。肌少症能够诱发并加重KOA，肌肉力量和质量的下降会破坏膝关节的稳定机制，导致关节稳定性降低，一定程度上也会改变生物力学结构，进而加速关节退变[28]，动物实验也证实肌肉萎缩会加速关节退变和加重炎症程度[29-30]。KOA同样也是肌少症发生发展的危险因素，KOA患者通常伴有疼痛与功能受限，导致肌肉活动减少，引起肌量减少和肌力下降[31]，炎症反应会引起肌肉代谢紊乱，加速肌肉蛋白分解和抑制肌肉蛋白合成，肿瘤坏死因子（TNF-α）和白细胞介素-6（IL-6）可能参与这一过程[32-34]。总而言之，KOA和肌少症两种疾病在其发生发展的过程中，通过潜在的病理生理机制互为因果，推动各自病情的进一步加重，进而通过各自的路径对跌倒风险的升高产生协同作用。
综上所述，KOA和肌少症均是我国中老年人跌倒的高危因素，两种慢性疾病的联合作用对跌倒风险的影响较单独作用更大，我们将在后续工作中进一步研究其中潜在的病理生理机制。通过本研究，我们认为对患有KOA和肌少症的中老年人群应早期发现和及时治疗，尤其应高度重视同时合并这两种疾病的人群，积极加强跌倒预防，同时配合其他跌倒预防措施以有效降低此类人群的跌倒风险，从而减轻与跌倒相关的家庭和社会负担。
本研究的主要优势是使用全国性大样本数据，代表性强，同时采用纵向队列研究方法，随访时间长，因果论证强度高。但本研究也存在一定局限性，例如跌倒事件是由研究对象自我报告，存在可能的回忆偏倚，本研究还可能存在尚未明确的潜在混杂因素，但以上局限性并不影响本研究的整体可靠性。
基金
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  • 山东省自然科学基金(ZR202306250007)
  • 山东省中医药科技项目(Q-2023143)
  • 山东省医药卫生科技项目(202304071439)
  • 日照市中医药科技项目(RZY2023C06)
文献
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doi: 10.20043/j.cnki.MPM.202412303
  • 接收时间：2024-12-18
  • 首发时间：2026-03-19
  • 出版时间：2025-07-10
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  • 收稿日期：2024-12-18
基金
山东省自然科学基金(ZR202306250007)
山东省中医药科技项目(Q-2023143)
山东省医药卫生科技项目(202304071439)
日照市中医药科技项目(RZY2023C06)
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    日照市中医医院，山东 日照 276800

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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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