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Article(id=1324078148354192113, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078037817504735, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202508030, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1754150400000, receivedDateStr=2025-08-03, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614430750, onlineDateStr=2026-11-02, pubDate=1770652800000, pubDateStr=2026-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614430750, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614430750, creator=13701087609, updateTime=1793614430750, updator=13701087609, issue=Issue{id=1324078037817504735, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='3', pageStart='385', pageEnd='576', issueExtLink='null', onlineDate='null', pubDate='1770652800000', pubDateStr='2026-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614404396, creator='13701087609', updateTime=1793614474144, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078330420527919, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078037817504735, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078330420527920, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078037817504735, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=564, endPage=569, ext={EN=ArticleExt(id=1324078150048690930, articleId=1324078148354192113, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between Cardiovascular-Kidney-Metabolic syndrome and risk of falls among middle-aged and older adults, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the relationship between Cardiovascular-Kidney-Metabolic (CKM) syndrome stages and fall risk among middle-aged and older Chinese adults, providing evidence for early risk identification.

Methods

Utilising longitudinal data from the China Health and Retirement Longitudinal Study (2015 and 2018), 7 861 participants aged 45 and older were included after excluding those with missing baseline anthropometric, blood, or key questionnaire data. CKM syndrome was staged according to the American Heart Association scientific statement. The outcome was self-reported falls within the past three years assessed in 2018. Modified Poisson regression models estimated incidence rate ratios (IRR) and 95%confidence intervals (CI), adjusting for demographics, lifestyle, physical and sensory function, cognitive and mental health,other health conditions, and the living environment. Subgroup analyses tested interactions with physical and sensory functions.

Results

During 3 years follow-up, 1 438 (18.3%) participants reported at least one fall. At baseline, CKM Stage 2 was the most prevalent (5 241; 66.7%), followed by Stage 4 (1 746; 22.2%), Stage 3 (472; 6.0%), and Stage 1 (402; 5.1%). Compared with Stage 1, CKM Stage 3 was associated with a 32% increased risk of falls (IRR=1.32, 95% CI: 1.03-1.69). No significant interactions were observed between CKM stages and grip strength, balance, hearing, and visual function (P for interaction >0.05).

Conclusion

CKM syndrome staging is positively associated with fall risk in middle-aged and older adults. CKM Stage 3 may represent a critical window for fall prevention interventions.

, authors=Guo-qian ZHANG1, Xia-li CHEN2, authorsList=Guo-qian ZHANG, Xia-li CHEN, authorCompany=null, correspAuthors=Xia-li CHEN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324078150719779573, articleId=1324078148354192113, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=心血管-肾脏-代谢综合征与中老年人跌倒风险的关系研究, columnId=1228016570119680182, journalTitle=现代预防医学, columnName=临床与预防, runingTitle=null, highlight=null, articleAbstract=
目的

探讨心血管-肾脏-代谢（cardiovascular-kidney-metabolic,CKM）综合征分期与我国中老年人跌倒风险的关系，为跌倒早期风险识别提供证据。

方法

利用中国健康与养老追踪调查2015和2018年两期纵向数据，排除基线体格测量、空腹血样检验及问卷信息缺失者后，最终纳入7 861名45岁及以上中老年人。依据美国心脏协会科学声明进行CKM综合征分期，以2018年随访自我报告的“近三年是否发生跌倒”为结局事件。采用修正Poisson回归模型，调整人口学特征、生活方式、躯体与感官功能、认知与精神健康、其他健康状况及居住环境等控制变量后，估计CKM综合征分期与跌倒风险的发生率比（incidence rate ratios,IRR）及95%置信区间，并对不同躯体功能和感官功能人群进行亚组和交互作用检验。

结果

三年随访，1 438名（18.3%）受访者报告至少一次跌倒事件。基线CKM 2期中老年人比例最高，为5 241人（66.7%），4期次之，为1 746人（22.2%），而3期和1期人数分别为472（6.0%）和402人（5.1 %），占比最小。与CKM 1期相比，CKM 3期受访者跌倒风险提升32%（IRR=1.32, 95% CI: 1.03～1.69）。CKM综合征与中老年发生跌倒关系在不同握力、平衡能力、听力和视力功能人群中未发现显著交互作用（P for interaction>0.05）。

结论

CKM综合征分期与中老年人跌倒风险呈正相关，CKM 3期可能是跌倒风险干预的关键窗口期。

, authors=张国倩1, 陈侠李2, authorsList=张国倩, 陈侠李, authorCompany=null, correspAuthors=陈侠李, authorNote=

张国倩（1985—），女，本科，主管护师，研究方向：重症医学与护理

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陈侠李，E-mail:
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张国倩（1985—），女，本科，主管护师，研究方向：重症医学与护理

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Definition criteria for CKM syndrome staging based on CHARLS data

, figureFileSmall=null, figureFileBig=null, tableContent=
CKM分期定义诊断标准
0期：无CKM风险因素无代谢风险因素（含代谢异常、CKD及心脑血管疾病）须同时满足：BMI<23 kg/m2；腰围<80/90 cm（女/男）；SBP<130和DBP<80 mm Hg，且未诊断高血压、未用降压药；TG<135 mg/dl；空腹血糖<100 mg/dl和HbA1c<5.7%，且未诊断糖尿病、未用降糖药；无代谢综合征；eGFR≥60 ml/（min·1.73m2）；10年CVD风险<20%；无临床CVD
1期：肥胖相关风险存在超重/肥胖、腹型肥胖或脂肪功能障碍，无其他代谢风险因素或CKD满足任一：超重/肥胖；腹型肥胖；糖尿病前期须同时满足：SBP<130 mm Hg、DBP<80 mm Hg，且未诊断高血压、未用降压药；TG<135 mg/dl；空腹血糖<126 mg/dl、HbA1c<6.5%，且未诊断糖尿病、未用降糖药；无代谢综合征；eGFR≥60 ml/（min·1.73m2）；10年CVD风险<20%；无临床CVD
2期：代谢风险与CKD存在代谢风险因素或中高危CKD满足任一：高甘油三酯血症；高血压；糖尿病；代谢综合征；中高危CKD：eGFR 30~59 ml/（min·1.73m2）须同时满足：无极高危CKD：eGFR≥30 ml/（min·1.73m2）; 10年CVD风险<20%;无临床CVD
3期：CKM合并亚临床CVD代谢风险/CKD伴亚临床CVD满足任一主要条件：极高危CKD：eGFR<30 ml/（min·1.73m2）；10年CVD风险≥20%且满足任一伴随条件：超重/肥胖；腹型肥胖；糖尿病前期；高甘油三酯血症；高血压；糖尿病；代谢综合征；中高危CKD且须满足：无临床CVD
4期：CKM合并临床CVD代谢风险/CKD伴临床CVD必须满足：临床心血管疾病且满足任一伴随条件：超重/肥胖；腹型肥胖；糖尿病前期；高甘油三酯血症；
高血压；糖尿病；代谢综合征；中高危CKD；极高危CKD
), ArticleFig(id=1324078152619799313, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078148354192113, language=CN, label=表1, caption=

利用CHARLS数据对CKM综合征分期的定义标准[9,12]

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CKM分期定义诊断标准
0期：无CKM风险因素无代谢风险因素（含代谢异常、CKD及心脑血管疾病）须同时满足：BMI<23 kg/m2；腰围<80/90 cm（女/男）；SBP<130和DBP<80 mm Hg，且未诊断高血压、未用降压药；TG<135 mg/dl；空腹血糖<100 mg/dl和HbA1c<5.7%，且未诊断糖尿病、未用降糖药；无代谢综合征；eGFR≥60 ml/（min·1.73m2）；10年CVD风险<20%；无临床CVD
1期：肥胖相关风险存在超重/肥胖、腹型肥胖或脂肪功能障碍，无其他代谢风险因素或CKD满足任一：超重/肥胖；腹型肥胖；糖尿病前期须同时满足：SBP<130 mm Hg、DBP<80 mm Hg，且未诊断高血压、未用降压药；TG<135 mg/dl；空腹血糖<126 mg/dl、HbA1c<6.5%，且未诊断糖尿病、未用降糖药；无代谢综合征；eGFR≥60 ml/（min·1.73m2）；10年CVD风险<20%；无临床CVD
2期：代谢风险与CKD存在代谢风险因素或中高危CKD满足任一：高甘油三酯血症；高血压；糖尿病；代谢综合征；中高危CKD：eGFR 30~59 ml/（min·1.73m2）须同时满足：无极高危CKD：eGFR≥30 ml/（min·1.73m2）; 10年CVD风险<20%;无临床CVD
3期：CKM合并亚临床CVD代谢风险/CKD伴亚临床CVD满足任一主要条件：极高危CKD：eGFR<30 ml/（min·1.73m2）；10年CVD风险≥20%且满足任一伴随条件：超重/肥胖；腹型肥胖；糖尿病前期；高甘油三酯血症；高血压；糖尿病；代谢综合征；中高危CKD且须满足：无临床CVD
4期：CKM合并临床CVD代谢风险/CKD伴临床CVD必须满足：临床心血管疾病且满足任一伴随条件：超重/肥胖；腹型肥胖；糖尿病前期；高甘油三酯血症；
高血压；糖尿病；代谢综合征；中高危CKD；极高危CKD
), ArticleFig(id=1324078154268160786, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078148354192113, language=EN, label=Table 2, caption=

Baseline characteristics of middle-aged and older adults stratified by fall status ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
基线特征总人数未跌倒 (n=6 423)跌倒 (n=1 438)χ2值P 值
CKM综合征分期29.487<0.001
1期402 (5.1)337 (5.2)65 (4.5)
2期5 241 (66.7)4 356 (67.8)885 (61.5)
3期472 (6.0)361 (5.6)111 (7.7)
4期1 746 (22.2)1 369 (21.3)377 (26.2)
性别50.915<0.001
女4 443 (56.5)3 509 (54.6)934 (65.0)
男3 418 (43.5)2 914 (45.4)504 (35.0)
年龄 （岁）34.111<0.001
45~594 157 (52.9)3 483 (54.2)674 (46.9)
60~743 321 (42.2)2 657 (41.4)664 (46.2)
≥75383 (4.9)283 (4.4)100 (7.0)
婚姻状况37.579<0.001
已婚或同居7 065 (89.9)5 836 (90.9)1 229 (85.5)
单身796 (10.1)587 (9.1)209 (14.5)
受教育程度32.273<0.001
文盲1 648 (21.0)1 268 (19.7)380 (26.4)
小学或初中5 247 (66.7)4 345 (67.6)902 (62.7)
高中及以上966 (12.3)810 (12.6)156 (10.8)
饮酒11.6930.009
每月饮酒≥1次5 108 (65.0)4 152 (64.6)956 (66.5)
每月饮酒<1次732 (9.3)586 (9.1)146 (10.2)
从不2 013 (25.6)1 681 (26.2)332 (23.1)
缺失8 (0.1)4 (0.1)4 (0.3)
体育活动0.2340.628
是7 106 (90.4)5 811 (90.5)1 295 (90.1)
否755 (9.6)612 (9.5)143 (9.9)
视力功能28.742<0.001
较差4 325 (55.0)3 444 (53.6)881 (61.3)
较好3 456 (44.0)2 915 (45.4)541 (37.6)
缺失80 (1.0)64 (1.0)16 (1.1)
听力功能11.1980.004
较差4 652 (59.2)3 747 (58.3)905 (62.9)
较好3 132 (39.8)2 615 (40.7)517 (36.0)
缺失值77 (1.0)61 (0.9)16 (1.1)
居住地区3.2610.196
城镇2 160 (27.5)1 790 (27.9)370 (25.7)
农村5 544 (70.5)4 509 (70.2)1 035 (72.0)
缺失值157 (2.0)124 (1.9)33 (2.3)
无障碍设施0.0120.913
存在6 513 (82.9)5 323 (82.9)1 190 (82.8)
不存在1 348 (17.1)1 100 (17.1)248 (17.2)
握力23.525<0.001
正常6 710 (85.4)5 538 (86.2)1 172 (81.5)
低下775 (9.9)586 (9.1)189 (13.1)
缺失值376 (4.8)299 (4.7)77 (5.4)
平衡能力27.197<0.001
较差1 205 (15.3)927 (14.4)278 (19.3)
较好6 216 (79.1)5 151 (80.2)1 065 (74.1)
缺失值440 (5.6)345 (5.4)95 (6.6)
认知功能21.182<0.001
较差4 148 (52.8)3 320 (51.7)828 (57.6)
较好3 521 (44.8)2 954 (46.0)567 (39.4)
缺失值192 (2.4)149 (2.3)43 (3.0)
抑郁症状103.326<0.001
否5 120 (65.1)4 349 (67.7)771 (53.6)
是2 190 (27.9)1 651 (25.7)539 (37.5)
缺失值551 (7.0)423 (6.6)128 (8.9)
药物服用48.315<0.001
否6 610 (84.1)5 488 (85.4)1 122 (78.0)
是1 251 (15.9)935 (14.6)316 (22.0)
骨关节疾病51.056<0.001
无5 663 (72.0)4 737 (73.8)926 (64.4)
有2 198 (28.0)1 686 (26.2)512 (35.6)
), ArticleFig(id=1324078154356241171, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078148354192113, language=CN, label=表2, caption=

跌倒和未跌倒中老年人基线特征［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
基线特征总人数未跌倒 (n=6 423)跌倒 (n=1 438)χ2值P 值
CKM综合征分期29.487<0.001
1期402 (5.1)337 (5.2)65 (4.5)
2期5 241 (66.7)4 356 (67.8)885 (61.5)
3期472 (6.0)361 (5.6)111 (7.7)
4期1 746 (22.2)1 369 (21.3)377 (26.2)
性别50.915<0.001
女4 443 (56.5)3 509 (54.6)934 (65.0)
男3 418 (43.5)2 914 (45.4)504 (35.0)
年龄 （岁）34.111<0.001
45~594 157 (52.9)3 483 (54.2)674 (46.9)
60~743 321 (42.2)2 657 (41.4)664 (46.2)
≥75383 (4.9)283 (4.4)100 (7.0)
婚姻状况37.579<0.001
已婚或同居7 065 (89.9)5 836 (90.9)1 229 (85.5)
单身796 (10.1)587 (9.1)209 (14.5)
受教育程度32.273<0.001
文盲1 648 (21.0)1 268 (19.7)380 (26.4)
小学或初中5 247 (66.7)4 345 (67.6)902 (62.7)
高中及以上966 (12.3)810 (12.6)156 (10.8)
饮酒11.6930.009
每月饮酒≥1次5 108 (65.0)4 152 (64.6)956 (66.5)
每月饮酒<1次732 (9.3)586 (9.1)146 (10.2)
从不2 013 (25.6)1 681 (26.2)332 (23.1)
缺失8 (0.1)4 (0.1)4 (0.3)
体育活动0.2340.628
是7 106 (90.4)5 811 (90.5)1 295 (90.1)
否755 (9.6)612 (9.5)143 (9.9)
视力功能28.742<0.001
较差4 325 (55.0)3 444 (53.6)881 (61.3)
较好3 456 (44.0)2 915 (45.4)541 (37.6)
缺失80 (1.0)64 (1.0)16 (1.1)
听力功能11.1980.004
较差4 652 (59.2)3 747 (58.3)905 (62.9)
较好3 132 (39.8)2 615 (40.7)517 (36.0)
缺失值77 (1.0)61 (0.9)16 (1.1)
居住地区3.2610.196
城镇2 160 (27.5)1 790 (27.9)370 (25.7)
农村5 544 (70.5)4 509 (70.2)1 035 (72.0)
缺失值157 (2.0)124 (1.9)33 (2.3)
无障碍设施0.0120.913
存在6 513 (82.9)5 323 (82.9)1 190 (82.8)
不存在1 348 (17.1)1 100 (17.1)248 (17.2)
握力23.525<0.001
正常6 710 (85.4)5 538 (86.2)1 172 (81.5)
低下775 (9.9)586 (9.1)189 (13.1)
缺失值376 (4.8)299 (4.7)77 (5.4)
平衡能力27.197<0.001
较差1 205 (15.3)927 (14.4)278 (19.3)
较好6 216 (79.1)5 151 (80.2)1 065 (74.1)
缺失值440 (5.6)345 (5.4)95 (6.6)
认知功能21.182<0.001
较差4 148 (52.8)3 320 (51.7)828 (57.6)
较好3 521 (44.8)2 954 (46.0)567 (39.4)
缺失值192 (2.4)149 (2.3)43 (3.0)
抑郁症状103.326<0.001
否5 120 (65.1)4 349 (67.7)771 (53.6)
是2 190 (27.9)1 651 (25.7)539 (37.5)
缺失值551 (7.0)423 (6.6)128 (8.9)
药物服用48.315<0.001
否6 610 (84.1)5 488 (85.4)1 122 (78.0)
是1 251 (15.9)935 (14.6)316 (22.0)
骨关节疾病51.056<0.001
无5 663 (72.0)4 737 (73.8)926 (64.4)
有2 198 (28.0)1 686 (26.2)512 (35.6)
), ArticleFig(id=1324078154452710164, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078148354192113, language=EN, label=Table 3, caption=

Association between CKM syndrome stages and fall risk in middle-aged and older adults: crude model

, figureFileSmall=null, figureFileBig=null, tableContent=
CKM综合征分期β标准误Z值P值IRR (95%CI)
1期1.00 (Ref.)
2期0.040.110.4050.6851.04 (0.85~1.29)
3期0.370.132.9480.0031.45 (1.13~1.87)
4期0.290.122.4960.0131.34 (1.06~1.68)
), ArticleFig(id=1324078154532401941, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078148354192113, language=CN, label=表3, caption=

CKM综合征分期与中老年人跌倒风险关联分析的粗模型

, figureFileSmall=null, figureFileBig=null, tableContent=
CKM综合征分期β标准误Z值P值IRR (95%CI)
1期1.00 (Ref.)
2期0.040.110.4050.6851.04 (0.85~1.29)
3期0.370.132.9480.0031.45 (1.13~1.87)
4期0.290.122.4960.0131.34 (1.06~1.68)
), ArticleFig(id=1324078154599510806, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078148354192113, language=EN, label=Table 4, caption=

Association between CKM syndrome stages and fall risk in middle-aged and older adults: adjusted model

, figureFileSmall=null, figureFileBig=null, tableContent=
CKM综合征分期β标准误Z值P值IRR (95%CI)
1期1.00 (Ref.)
2期0.060.110.6000.5491.07 (0.86~1.31)
3期0.280.132.1950.0281.32 (1.03~1.69)
4期0.150.111.3310.1831.16 (0.93~1.45)
), ArticleFig(id=1324078154695979799, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078148354192113, language=CN, label=表4, caption=

CKM综合征分期与中老年人跌倒风险关联分析的完全调整模型

, figureFileSmall=null, figureFileBig=null, tableContent=
CKM综合征分期β标准误Z值P值IRR (95%CI)
1期1.00 (Ref.)
2期0.060.110.6000.5491.07 (0.86~1.31)
3期0.280.132.1950.0281.32 (1.03~1.69)
4期0.150.111.3310.1831.16 (0.93~1.45)
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心血管-肾脏-代谢综合征与中老年人跌倒风险的关系研究
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张国倩 1 , 陈侠李 2
现代预防医学 | 临床与预防 2026,53(3): 564-569
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现代预防医学 |临床与预防 2026 , 53 (3) : 564 -569
心血管-肾脏-代谢综合征与中老年人跌倒风险的关系研究
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张国倩1, 陈侠李2
作者信息
  • 1.山西医科大学附属运城市中心医院重症医学科，山西 运城 044000
  • 2.山西医科大学附属运城市中心医院医务科，山西 运城 044000
通讯作者:
陈侠李，E-mail:
作者简介:

张国倩（1985—），女，本科，主管护师，研究方向：重症医学与护理

Association between Cardiovascular-Kidney-Metabolic syndrome and risk of falls among middle-aged and older adults
Guo-qian ZHANG1, Xia-li CHEN2
Affiliations
  • Department of Intensive Care Medicine, Yuncheng Central Hospital Affiliated to Shanxi Medical University, Yuncheng, Shanxi 044000, China
出版时间: 2026-02-10 doi: 10.20043/j.cnki.MPM.202508030
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摘要
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目的

探讨心血管-肾脏-代谢（cardiovascular-kidney-metabolic,CKM）综合征分期与我国中老年人跌倒风险的关系，为跌倒早期风险识别提供证据。

方法

利用中国健康与养老追踪调查2015和2018年两期纵向数据，排除基线体格测量、空腹血样检验及问卷信息缺失者后，最终纳入7 861名45岁及以上中老年人。依据美国心脏协会科学声明进行CKM综合征分期，以2018年随访自我报告的“近三年是否发生跌倒”为结局事件。采用修正Poisson回归模型，调整人口学特征、生活方式、躯体与感官功能、认知与精神健康、其他健康状况及居住环境等控制变量后，估计CKM综合征分期与跌倒风险的发生率比（incidence rate ratios,IRR）及95%置信区间，并对不同躯体功能和感官功能人群进行亚组和交互作用检验。

结果

三年随访，1 438名（18.3%）受访者报告至少一次跌倒事件。基线CKM 2期中老年人比例最高，为5 241人（66.7%），4期次之，为1 746人（22.2%），而3期和1期人数分别为472（6.0%）和402人（5.1 %），占比最小。与CKM 1期相比，CKM 3期受访者跌倒风险提升32%（IRR=1.32, 95% CI: 1.03～1.69）。CKM综合征与中老年发生跌倒关系在不同握力、平衡能力、听力和视力功能人群中未发现显著交互作用（P for interaction>0.05）。

结论

CKM综合征分期与中老年人跌倒风险呈正相关，CKM 3期可能是跌倒风险干预的关键窗口期。

跌倒  /  心血管-肾脏-代谢综合征  /  中老年人  /  中国
Objective

To investigate the relationship between Cardiovascular-Kidney-Metabolic (CKM) syndrome stages and fall risk among middle-aged and older Chinese adults, providing evidence for early risk identification.

Methods

Utilising longitudinal data from the China Health and Retirement Longitudinal Study (2015 and 2018), 7 861 participants aged 45 and older were included after excluding those with missing baseline anthropometric, blood, or key questionnaire data. CKM syndrome was staged according to the American Heart Association scientific statement. The outcome was self-reported falls within the past three years assessed in 2018. Modified Poisson regression models estimated incidence rate ratios (IRR) and 95%confidence intervals (CI), adjusting for demographics, lifestyle, physical and sensory function, cognitive and mental health,other health conditions, and the living environment. Subgroup analyses tested interactions with physical and sensory functions.

Results

During 3 years follow-up, 1 438 (18.3%) participants reported at least one fall. At baseline, CKM Stage 2 was the most prevalent (5 241; 66.7%), followed by Stage 4 (1 746; 22.2%), Stage 3 (472; 6.0%), and Stage 1 (402; 5.1%). Compared with Stage 1, CKM Stage 3 was associated with a 32% increased risk of falls (IRR=1.32, 95% CI: 1.03-1.69). No significant interactions were observed between CKM stages and grip strength, balance, hearing, and visual function (P for interaction >0.05).

Conclusion

CKM syndrome staging is positively associated with fall risk in middle-aged and older adults. CKM Stage 3 may represent a critical window for fall prevention interventions.

Falls  /  Cardiovascular-Kidney-Metabolic syndrome  /  Middle-aged and older adults  /  China
张国倩, 陈侠李. 心血管-肾脏-代谢综合征与中老年人跌倒风险的关系研究. 现代预防医学, 2026 , 53 (3) : 564 -569 . DOI: 10.20043/j.cnki.MPM.202508030
Guo-qian ZHANG, Xia-li CHEN. Association between Cardiovascular-Kidney-Metabolic syndrome and risk of falls among middle-aged and older adults[J]. Modern Preventive Medicine, 2026 , 53 (3) : 564 -569 . DOI: 10.20043/j.cnki.MPM.202508030
正文
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全球人口老龄化进程加速，其中跌倒已成为威胁中老年人健康寿命的危险因素[1]。跌倒损伤谱系广泛，除髋部骨折、创伤性脑损伤等急性损伤外，还会造成活动能力受限和跌倒恐惧，降低社会参与度、增加抑郁风险并加速功能依赖[2]。因此，识别跌倒高危人群并实施预防干预，对实现健康老龄化战略目标具有现实意义。
跌倒风险因素呈多维特征[3]，其中心血管疾病（cardiovasoular diseases,CVD）、慢性肾脏病（chronic kidney disease,CKD）和2型糖尿病等代谢性疾病是跌倒的独立危险因素[4-6]。研究表明，CVD伴发体位性低血压和心律失常，会增加跌倒风险[6-7]。CKD通过电解质紊乱、骨代谢异常削弱机体稳定性[5]。2型糖尿病引发的周围神经病变和视网膜微血管损害，会干扰本体感觉与空间定位[7]。这些疾病通过系统性炎症、交感神经兴奋、氧化应激及糖脂代谢紊乱等共同病理生理通路相互关联[8]。心血管-肾脏-代谢（cardiovascular -kidney-metabolism,CKM）综合征由美国心脏协会于2023年提出，指肥胖、糖尿病、CKD和CVD病理生理相互作用形成的全身性疾病[8]，其0～4期分期系统可整合评估疾病从代谢风险到终末期的发展过程[9]，为复杂慢病管理提供整体视角[8]。既往研究已从单一疾病拓展至多重共病、疾病集群与跌倒风险的关联[4,10]。但统计驱动的集群分析（如潜在类别分析）[11]中部分模式缺乏生物学解释；系统别计数（如统计心血管代谢性疾病数量）[4]证实“剂量-反应关系”，却无法评估疾病严重程度；且两类研究以已发生的临床疾病为分析起点，风险评估存在滞后性[10]。CKM优势在于提供连续疾病发生发展分期系统，为评估跌倒风险演变提供工具[8]。基于此，本研究利用中国健康与养老追踪调查（CHARLS）2015—2018年纵向队列数据，探讨CKM综合征分期与中老年人跌倒风险的关联，为跌倒的早期识别和管理提供依据。
1　对象与方法
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1.1　研究设计与数据来源
CHARLS旨在收集45岁及以上中老年人的社会、经济和健康信息。本研究利用CHARLS 2015—2018年两轮调查数据。2015年调查包含体格检查和血液检测，为CKM分期提供数据支撑。排除标准：（1）未参与2018年随访或跌倒信息缺失者；（2）2015年调查中缺失CKM综合征分期核心变量者；（3）基线患有严重神经系统疾病（如老年痴呆症、脑萎缩、帕金森症）、身体残疾或严重感官障碍者。经上述筛选，纳入7 861名45岁及以上参与者进行分析。
1.2　研究内容
1.2.1　结局变量
结局变量为跌倒经历，信息源于CHARLS 2018年随访问卷。通过询问“自2015年调查以来，你有没有摔倒过？”界定，回答“是”者定义为存在跌倒经历。
1.2.2　暴露变量
暴露变量为2015年调查时中老年人CKM综合征分期。依据美国心脏协会2023年的指导原则进行操作化定义，各分期见表1[9,12]。
1.2.3　协变量
本研究调整基线潜在混杂因素[3,14]，具体包括：（1）人口学特征：年龄（45～59岁、60～74岁、≥75岁）、性别、婚姻状况（在婚/同居、单身）、受教育程度（文盲、小学及中学、高中及以上）。（2）生活方式：饮酒频率（从不、每月<1次、每月≥1次）和体力活动（是/否在近一个月参与跳舞、健身等活动）。（3）感官与躯体功能：视力与听力功能（较好、较差）、握力低下（左右手各两次测量最大握力值的平均值，男性<27 kg，女性<16 kg 定义为低下[15]）、平衡功能（串联站立测试：≥70岁站立30 s，<70岁站立60 s，未达标者为平衡受损[16]）。（4）认知与精神健康：认知功能（整合计算力、短时记忆、延时记忆和画图等，总分0～21分，≤10分定义为较差[17]）、抑郁症状（10项流调中心抑郁量表，总分0～30分，≥10分定义为存在抑郁症状[18]）。（5）其他健康状况与用药：是否患骨关节疾病（关节炎或风湿病）、是否服用抗抑郁药、镇静/安眠药或止痛药等。（6）居住环境：居住地区（城市、农村）和无障碍设施（是/否有无障碍通道或电梯）。
1.3　统计分析
采用频数和百分比描述基线特征，χ2检验比较不同CKM分期组间分布差异。采用社区聚类的修正Poisson回归模型[19-20]，探究CKM综合征分期与跌倒风险的关联，估计发生率比（incidence rate ratio, IRR）和95%置信区间（confidence interval，CI），并控制所有协变量。以躯体（握力、平衡能力）和感官功能（听力和视力功能）为分组进行亚组分析和交互作用检验。
针对饮酒频率、听力和视力功能、握力和平衡能力等变量（缺失率均<8%），采用基于链式方程的多重插补技术处理，插补模型纳入所有分析变量[21]。生成10个插补数据集。诊断性检查显示，插补数据集与原始数据分布一致，插补效果良好。采用mi命令分析并依据鲁宾规则合并结果。多重共线性诊断显示所有变量的方差膨胀因子（variance inflation factor，VIF）<5，无严重共线性。统计检验为双侧检验，检验水准α=0.05，数据分析采用Stata 17.0。
2　结果
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2.1　调查对象基本特征
本研究纳入7 861名45岁及以上参与者。女性4 443人（56.5%），45～59岁年龄组4 157人（52.9%）。89.9%的参与者处于在婚或同居状态，超过半数（66.7%）的受教育程度为小学或初中。
三年随访期间，共1 438名参与者（18.3%）报告至少一次跌倒。跌倒组与未跌倒组在CKM分期、性别、年龄、婚姻状况、受教育程度、饮酒、视力、听力、握力、平衡能力、认知功能、抑郁状况、药物服用以及骨关节疾病等特征的分布差异有统计学意义（P均<0.05）。见表2。
2.2　CKM综合征分期与中老年人跌倒的关系
在未经调整的粗模型中，与CKM 1期中老年相比，CKM 3期和4期与跌倒风险升高相关。对所有协变量调整后，与处于CKM 1期的参与者相比，CKM 3期参与者跌倒风险升高32%；而处于CKM 4期的参与者跌倒风险升高16%，但未达到统计学显著性水平。见表3、4。
2.3　CKM综合征分期与中老年人跌倒的亚组及交互作用分析
CKM分期与中老年握力、平衡能力、听力功能和视力功能之间均未发现显著的交互作用（P for interaction>0.05）。见图1。
3　讨论
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随访三年，18.3%的中老年人发生至少一次跌倒。2015年CKM 2期和4期人群合计占88.9%。与CKM 1期相比，CKM 3期中老年人在三年内跌倒风险升高32%。CKM分期与中老年人跌倒风险的关联在握力、平衡能力、视力和听力功能方面不存在交互作用。
在CKM分期分布中，CKM 2期占比高，反映代谢风险在中老年中相当普遍，与以往研究一致[8,12]。CKM 3期占比低、4期高的特征，可能与疾病非线性进展有关，CKM从代谢风险阶段至临床CVD阶段发展较快，导致“亚临床”阶段（3期）窗口期缩短[22]。同时，常规筛查对亚临床器官损伤（如eGFR轻度下降或微量白蛋白尿）识别不足，易漏检3期个体。未发现CKM 0期个体，可能因选择偏倚（健康个体参与体检意愿低）及研究人群平均年龄较高（59岁），该年龄段维持无风险状态难度大。
随访期跌倒发生率近20%，且随年龄增长升高，这是神经肌肉退化、肌肉减少症、平衡与视力下降及多病共存等生理衰退因素累积的结果[23]。2021年全球疾病负担研究显示，中国是全球老年新发跌倒数量最高的国家之一，与印度、美国等共同承载全球过半跌倒负担[24]。对此，我国将老年跌倒预防纳入《“健康中国2030”规划纲要》等国家战略，社区正推广多因素风险评估、太极拳等平衡训练、居家改造以及健康教育等。
与CKM 1期相比，3期人群跌倒风险升高，与该阶段亚临床CVD、CKD及代谢紊乱引发的系统性损害相关，包括血流动力学不稳定[6]、神经肌肉功能受损[5,7]及高血压致中枢平衡调控网络损伤[25]。此阶段个体尚未出现严重活动受限，正常活动暴露下生理风险累积致跌倒风险升高。而CKM 4期跌倒风险未显著升高，可能与心力衰竭等疾病限制活动暴露、照料者监护加强等因素有关。此外，CKM分期与跌倒风险的关联在不同躯体及感官功能亚组中无交互作用，提示CKM相关负担对跌倒风险的影响具有同质性。
本研究存在局限性。跌倒信息依赖自我报告，存在回忆偏倚。虽调整多种协变量，但仍存在残余混杂。CKM分期基于CHARLS数据操作化，未完全匹配美国心脏协会声明的诊断细节（如缺少特定心脏影像学或生物标志物）。
综上，与CKM 1期个体相比，CKM 3期会增加跌倒风险。CKM综合征与中老年跌倒的关系在不同握力、平衡能力、听力和视力功能的亚组人群中不存在差异。

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doi: 10.20043/j.cnki.MPM.202508030
  • 接收时间：2025-08-03
  • 首发时间：2026-11-02
  • 出版时间：2026-02-10
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  • 收稿日期：2025-08-03
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    1.山西医科大学附属运城市中心医院重症医学科，山西 运城 044000
    2.山西医科大学附属运城市中心医院医务科，山西 运城 044000

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