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中华脑血管病杂志(电子版) ›› 2024, Vol. 18 ›› Issue (06) : 556 -563. doi: 10.11817/j.issn.1673-9248.2024.06.006

临床研究

脑小血管病患者体脂百分比与步态特征及跌倒的相关性分析
夏振西1, 谢鸿阳1, 夏翠俏1, 张楠1, 曹俊杰1, 赵弘轶1, 黄勇华1,()   
  1. 1.100700 北京,解放军总医院第七医学中心神经内科
  • 收稿日期:2024-06-05 出版日期:2024-12-01
  • 通信作者: 黄勇华
  • 基金资助:
    吴阶平医学基金会临床科研专项资助基金项目(320.6750.18456)

Relationship between body fat percentage, gait characteristics and falls in patients with cerebral small vessel disease

Zhenxi Xia1, Hongyang Xie1, Cuiqiao Xia1, Nan Zhang1, Junjie Cao1, Hongyi Zhao1, Yonghua Huang1,()   

  1. 1.Department of Neurology, Seventh Medical Center of PLA General Hospital, Beijing 100700, China
  • Received:2024-06-05 Published:2024-12-01
  • Corresponding author: Yonghua Huang
引用本文:

夏振西, 谢鸿阳, 夏翠俏, 张楠, 曹俊杰, 赵弘轶, 黄勇华. 脑小血管病患者体脂百分比与步态特征及跌倒的相关性分析[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(06): 556-563.

Zhenxi Xia, Hongyang Xie, Cuiqiao Xia, Nan Zhang, Junjie Cao, Hongyi Zhao, Yonghua Huang. Relationship between body fat percentage, gait characteristics and falls in patients with cerebral small vessel disease[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2024, 18(06): 556-563.

目的

探讨脑小血管病(CSVD)患者体脂百分比(BF)与单任务行走(STW)和双重任务行走(DTW)时步态参数之间的关联,并明确BF 与CSVD 患者跌倒风险是否存在关联。

方法

选择2022 年1 月1 日至2023 年6 月1 日于解放军总医院第七医学中心神经内科住院的95 例CSVD 患者,收集其脂肪质量、BF 等数据。男性中BF 超过25.7%被视为身体脂肪含量过高,女性患者中这一比例则为35.9%。以此为标准,将入组患者分为正常BF 组(46 例)和高BF 组(49 例)。同时在STW 及DTW 条件下,收集患者基本参数、时相协调指数(PCI)、变异系数(CV)以及步态不对称性(GA)等指标。此外,统计所有参与者的跌倒次数。采用广义估算方程(GEE)以及二元Logistic 回归分析验证上述参数的相互关联。

结果

GEE 结果提示,除GA 外其余步态参数在组间及组内均存在显著交互作用。事后分析验证参数在组间及组内的差异显示:组间比较,在STW 情况下,高BF 组患者仅在基础步态参数(STW、认知DTW、运动DTW 下的跨步长、跨步时间、步频、速度)和间接步态参数(STW、认知DTW、运动DTW 下的跨步时间CV)较正常BF 组差异有统计学意义(P 均<0.05);组内比较,在DTW 情况下,尤其是认知DTW,正常BF 组和高BF 组所有基础步态参数及间接步态参数相较于STW 时均呈现出明显恶化,差异均有统计学意义(P 均<0.05)。此外,不论性别如何,BF 是跌倒发生的独立危险因素(男性:OR=1.132,95%CI:1.009~1.270;女性:OR=1.145,95%CI:1.058~1.239)。

结论

CSVD 患者中,STW 及DTW 条件下的步态参数与BF 之间存在显著关联,BF 亦是跌倒发生的独立危险因素。

Objective

To investigate the correlation between body fat percentage (BF) and gait parameters during single task walking (STW) and dual task walking (DTW) in patients with cerebral small vessel disease (CSVD), and to determine whether BF is associated with the risk of falls in CSVD patients.

Methods

A total of 95 hospitalized patients diagnosed with CSVD in Neurology Department of Seventh Medical Center of PLA General Hospital from January 1, 2022, to June 1, 2023,were collected.Data on their fat mass and BF were collected.High BF was defined as exceeding 25.7% in males and 35.9% in females.Based on this criterion, the enrolled patients were categorized into a normal BF group (46 cases)and a high BF group (49 cases).Additionally, gait parameters such as cadence, stride time, speed, and stride length, as well as phase coordination index (PCI), coefficient of variation (CV), and gait asymmetry (GA)were measured during both STW and DTW conditions.The number of falls was also recorded.Generalized estimating equations (GEE) and binary Logistic regression analyses were conducted to explore the relationship among these parameters.

Results

The GEE results indicate significant interaction effects for all gait parameters except for GA, both between and within groups.Therefore, post-hoc analyses were conducted to further investigate these differences: between-group comparison showed that during STW, the high BF group had significant differences in the basal gait parameters (STW, cognitive DTW, motor DTW) and indirect gait parameters (STW, cognitive DTW, motor DTW CV) compared to the normal BF group (all P<0.05);within-group comparison indicated that during DTW, particularly cognitive DTW, all basal and indirect gait parameters in normal BF and high BF groups compared with STW, the differences were significant (all P<0.05).Additionally, regardless of gender, BF was identified as an independent risk factor for falls (male:odds ratio=1.132, 95% confidence interval: 1.009-1.270; female: odds ratio=1.145, 95% confidence interval:1.058-1.239).

Conclusion

There is a significant correlation between BF and gait parameters during STW and DTW in patients with CSVD.Additionally, BF has been identified as an independent risk factor for fall accidents in this patient population.

表1 不同BF 的CSVD 患者人口学及认知功能参数比较
表2 GEE 下不同BF 的CSVD 患者的基本步态参数差异
表3 不同BF 的CSVD 患者在不同行走条件下的基本步态参数比较(x± s
表4 GEE 下不同BF 的CSVD 患者的间接步态参数差异
表5 不同BF 的CSVD 患者在不同行走条件下的间接步态参数比较[MQR)]
表6 男性患者跌倒事件的二元Logistic 回归
表7 女性患者跌倒事件的二元Logistic 回归
1
Judge JO, Davis RB, Ounpuu S.Step length reductions in advanced age: the role of ankle and hip kinetics [J].J Gerontol A Biol Sci Med Sci, 1996, 51(6): M303-312.
2
Toebes MJ, Hoozemans MJ, Furrer R, et al.Local dynamic stability and variability of gait are associated with fall history in elderly subjects [J].Gait Posture, 2012, 36(3): 527-531.
3
Ganz DA, Latham NK.Prevention of falls in community-dwelling older adults [J].N Engl J Med, 2020, 382(8): 734-743.
4
Mortaza N, Abu Osman NA, Mehdikhani N.Are the spatiotemporal parameters of gait capable of distinguishing a faller from a non-faller elderly? [J].Eur J Phys Rehabil Med, 2014, 50(6): 677-691.
5
Clark DJ.Automaticity of walking: functional significance,mechanisms, measurement and rehabilitation strategies [J].Front Hum Neurosci, 2015, 9: 246.
6
Duering M, Biessels GJ, Brodtmann A, et al.Neuroimaging standards for research into small vessel disease-advances since 2013 [J].Lancet Neurol, 2023, 22(7): 602-618.
7
叶瑾怡, 陈玮琪, 王伊龙.脑小血管病国际影像标准2 更新要点解读 [J].中国卒中杂志, 2023, 18(10): 1175-1180.
8
Hilal S, Mok V, Youn YC, et al.Prevalence, risk factors and consequences of cerebral small vessel diseases: data from three Asian countries [J].J Neurol Neurosurg Psychiatry, 2017, 88(8): 669-674.
9
Wardlaw JM, Debette S, Jokinen H, et al.ESO Guideline on covert cerebral small vessel disease [J].Eur Stroke J, 2021, 6(2): CXⅠ-CLXⅡ.
10
Xia C, Xie H, Huang Y, et al.Spatiotemporal gait characteristics during single- and dual-task walking are associated with the burden of cerebral small vessel disease [J].Front Neurol, 2023, 14: 1285947.
11
Xie H, Xia C, Zhao H, et al.Variability, asymmetry and bilateral coordination of gait during single- and dual-task walking of patients with cerebral small vessel disease [J].Int J Neurosci, 2024: 1-10.
12
Lee Y, Shin S.The effect of body composition on gait variability varies with age: interaction by hierarchical moderated regression analysis [J].Int J Environ Res Public Health, 2022, 19(3): 1171.
13
LaRoche DP, Kralian RJ, Millett ED.Fat mass limits lower-extremity relative strength and maximal walking performance in older women [J].J Electromyogr Kinesiol, 2011, 21(5): 754-761.
14
Bani Hassan E, Phu S, Vogrin S, et al.Diagnostic value of mid-thigh and mid-calf bone, muscle, and fat mass in osteosarcopenia: a pilot study [J].Calcif Tissue Int, 2019, 105(4): 392-402.
15
胡文立, 杨磊, 李譞婷, 等.中国脑小血管病诊治专家共识2021 [J].中国卒中杂志, 2021, 16(7): 716-726.
16
王伊龙.脑小血管病的诊治现状及未来探索之路 [J].中国卒中杂志, 2024, 19(4): 363-374.
17
Swanson CW, Fling BW.Associations between gait coordination,variability and motor cortex inhibition in young and older adults [J].Exp Gerontol, 2018, 113: 163-172.
18
Kim MK, Han K, Kwon HS, et al.Normal weight obesity in Korean adults [J].Clin Endocrinol (Oxf), 2014, 80(2): 214-220.
19
Kim DH, Lim H, Chang S, et al.Association between body fat and bone mineral density in normal-weight middle-aged Koreans [J].Korean J Fam Med, 2019, 40(2): 100-105.
20
Plotnik M, Giladi N, Hausdorff JM.A new measure for quantifying the bilateral coordination of human gait: effects of aging and Parkinson's disease [J].Exp Brain Res, 2007, 181(4): 561-570.
21
Swanson CW, Fling BW.Associations between gait coordination,variability and motor cortex inhibition in young and older adults [J].Exp Gerontol, 2018, 113: 163-172.
22
Richmond SB, Swanson CW, Peterson DS, et al.A temporal analysis of bilateral gait coordination in people with multiple sclerosis [J].Mult Scler Relat Disord, 2020, 45: 102445.
23
Kalron A.Gait variability across the disability spectrum in people with multiple sclerosis [J].J Neurol Sci, 2016, 361: 1-6.
24
Kim JH, Chon J, Soh Y, et al.Trunk fat mass correlates with balance and physical performance in a community-dwelling elderly population:results from the Korean frailty and aging cohort study [J].Medicine(Baltimore), 2020, 99(9): e19245.
25
Moon Y, Wajda DA, Motl RW, et al.Stride-time variability and fall risk in persons with multiple sclerosis [J].Mult Scler Int, 2015, 2015:964790.
26
Lim J, Kim J, Seo K, et al.The effects of mobile texting and walking speed on gait characteristics of normal weight and obese adults [J].Motor Control, 2020, 24(4): 588-604.
27
Shaik AR, Al Qahtani M, Ahmad F, et al.Impacts of adiposity on the attentional cost of sensory-motor performance associated with mobility in a dual-task paradigm [J].Int J Environ Res Public Health, 2022,19(20): 13118.
28
Yang Y, Shields GS, Guo C, et al.Executive function performance in obesity and overweight individuals: a meta-analysis and review [J].Neurosci Biobehav Rev, 2018, 84: 225-244.
29
Hilal S, Mok V, Youn YC, et al.Prevalence, risk factors and consequences of cerebral small vessel diseases: data from three Asian countries [J].J Neurol Neurosurg Psychiatry, 2017, 88(8): 669-674.
30
Beavers KM, Beavers DP, Houston DK, et al.Associations between body composition and gait-speed decline: results from the Health,Aging, and Body Composition study [J].Am J Clin Nutr, 2013, 97(3):552-560.
31
Visser M, Goodpaster BH, Kritchevsky SB, et al.Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons [J].J Gerontol A Biol Sci Med Sci, 2005, 60(3): 324-333.
32
Merchant RA, Chan YH, Ling N, et al.Association of physical function and body composition with falls in pre-frail older adults with poor physical performance: a cross-sectional study [J].Arch Gerontol Geriatr, 2023, 109: 104957.
33
Neri SGR, Tiedemann A, Gadelha AB, et al.Body fat distribution in obesity and the association with falls: a cohort study of Brazilian women aged 60 years and over [J].Maturitas, 2020, 139: 64-68.
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