肌酸激酶对老年男性共病患者肌少症的预测价值：冠心病、血糖控制的协同作用

Predictive value of creatine kinase for sarcopenia in elderly male patients with comorbidities and synergistic effects of creatine kinase with coronary heart disease and glycemic control

摘要:

目的 探讨肌酸激酶（CK）对老年男性共病患者肌少症的预测价值，并分析其与血糖控制、冠心病的协同作用。方法 选取2022年3月—2023年10月解放军第九六〇医院收治住院的122例老年男性共病患者，根据肌少症筛查、骨骼肌量测定结果分为无肌少症组（80例）和肌少症组（42例）。统计老年男性共病患者肌少症患病率，比较肌少症组与无肌少症组的临床指标、合并症、老年综合评估结果，通过多因素逐步Logistic回归分析影响老年男性共病患者发生肌少症的独立危险因素，绘制受试者工作特征（ROC）曲线评估预测价值。结果 老年男性共病患者肌少症患病率为34.43%，且随年龄增长递增（P <0.05）。肌少症组年龄、糖化血红蛋白（HbA1c）、N末端B型钠尿肽前体、尿素氮、冠心病及高血压患病率均高于无肌少症组（P <0.05），体质量指数、血红蛋白、白蛋白、血清CK、25-羟维生素D、游离三碘甲腺原氨酸水平均低于无肌少症组（P <0.05）。肌少症组营养风险率、衰弱率、认知障碍率和睡眠障碍率均高于无肌少症组（P <0.05）；多因素逐步Logistic回归分析结果显示：冠心病［O^R=5.820（95% CI：2.179，14.560）］、HbA1c水平高［O^R=4.281（95% CI：1.483，9.643）］、血清CK水平低［O^R=0.954（95% CI：0.923，0.985）］均为老年男性共病患者发生肌少症的危险因素（P <0.05）；ROC曲线结果显示，血清CK水平预测老年男性共病患者肌少症的曲线下面积为0.795（95% CI：0.703，0.886），敏感性为83.6%（95% CI：0.785，0.897），特异性为68.6%（95% CI：0.592，0.777）。结论 血清CK水平低是老年男性共病患者发生肌少症的独立预警指标，且冠心病、血糖控制对该预测有协同作用。

Abstract:

Objective To investigate the predictive value of creatine kinase (CK) for sarcopenia in elderly male patients with comorbidities, and to analyze its synergistic effects with glycemic control and coronary heart disease.Methods A total of 122 elderly male patients with comorbidities admitted to our hospital between March 2022 and October 2023 were enrolled. Based on sarcopenia screening and skeletal muscle mass assessment results, they were categorized into a non-sarcopenic group (n = 80) and a sarcopenic group (n = 42). The prevalence of sarcopenia in elderly patients with comorbidities was calculated. Clinical indicators, comorbidities, and geriatric assessment scores were compared between sarcopenic and non-sarcopenic groups. Multivariable stepwise logistic regression analysis was performed to identify independent risk factors for sarcopenia in elderly male patients with comorbidities, with receiver operating characteristic (ROC) curves plotted to assess their predictive value.Results The prevalence of sarcopenia among elderly male patients with comorbidities was 34.43%, increasing with advancing age (P < 0.05). The sarcopenic group exhibited higher average age, body mass index, glycated hemoglobin (HbA1c) levels, N-terminal pro-B-type natriuretic peptide levels, blood urea nitrogen levels, and proportions of coronary heart disease and hypertension compared to the non-sarcopenic group (P < 0.05). The hemoglobin, albumin, serum CK, 25-hydroxyvitamin D and free triiodothyronine levels were lower in the sarcopenic group (P < 0.05). The rates of nutritional risk, frailty, cognitive impairment, and sleep disturbance were higher in the sarcopenic group than in the non-sarcopenic group (P < 0.05). Multivariable stepwise logistic regression analysis revealed that coronary heart disease [O^R = 5.820 (95% CI: 2.179, 14.560) ], elevated HbA1c levels [O^R = 4.281 (95% CI: 1.483, 9.643) ], and low serum CK levels [O^R = 0.954 (95% CI: 0.923, 0.985) ] were risk factors for sarcopenia in elderly male patients with comorbidities (P < 0.05). The ROC curve analysis showed that the area under the curve (AUC) of serum CK for predicting sarcopenia in elderly male patients with comorbidities was 0.795 (95% CI: 0.703, 0.886), with a sensitivity of 83.6% (95% CI: 0.785, 0.897) and a specificity of 68.6% (95% CI: 0.592, 0.777). Results indicated an area under the curve of 0.795 (95% CI: 0.703, 0.886), with a sensitivity of 83.6% (95% CI: 78.5, 89.7) and specificity of 68.6% (95% CI: 59.2, 77.7).Conclusion Low serum CK levels are an independent predictive indicator of sarcopenia in elderly male patients with comorbidities, and coronary heart disease and glycemic control exert synergistic effects.