中国健康成人体成分评估方法的建立与应用研究

发布时间：2018-03-05 06:13

本文选题：体成分　切入点：生物电阻抗法　出处：《北京协和医学院》2017年博士论文　论文类型：学位论文

【摘要】：背景当前人体成分尤其是肌肉量已逐步作为诊断营养不良的客观性指标。尤其在病理状况下,肌肉的消耗和修复与疾病的预后密切相关。准确、迅速、简便并具有良好性价比的测量体成分的方法,已成为临床营养研究的重要课题。然而当前被分别视为测定身体水、脂肪与去脂组织含量的“金标准”方法如稀释性同位素法、双能量X射线吸收法(DXA)和磁共振成像(MRI)均因各自方法学缺陷,无法直接测定肌肉量,只能依赖阿基米德定律以及尸体解剖得出,并依据水/脂肪的固定数学关系推算,且因检测昂贵、放射损伤等可能原因不同人种也具有不同常数。近三十年迅速发展起来的生物电阻抗技术(BIA),以欧姆定律为基础利用身体组分的不同电阻特性,结合水含量、体密度以及年龄、种族和性别等相关生物学特性,得出身体各组分构成。因设计简便、无创且快速、廉价而成为目前临床应用最为广泛的体成分测量手段。但因受基于人群差异影响带来的计算公式差异,其测量某一种体成分的直接精度无法与“金标准”方法相比,且其他BIA仪器的研究仅按与某一种标准方法对比得出全部体成分校正公式,从而限制了其精确临床应用。如何利用BIA技术将测定人体各测量组分综合计算,反映相对真实的人体营养状况,最终建立疾病营养不良和肌肉减少症的诊断工具,已成为临床营养研究最大难题。目的检测BIA方法的测量精度并建立中国人BIA体成分测试校正方程组,用“金标准”方法验证BIA的准确性及可重复性;建立中国健康青年人和老年人的正常值参考范围并为中国肌肉减少症的诊断标准建立数据基础。内容本研究分三部分进行:第一部分:以3种“金标准”研究方法为基础,得到健康人BIA体成份测量的标准校正公式。研究中纳入30名健康成年同时采用稀释性同位素法、MRI和DXA分别作为测定总体水(TBW)、脂肪以及骨质的标准方法。分别得出BIA的TBW校正方程:y=4.06+0.80x(R2 = 0.917);脂肪量校正线性方程 y=1.02x+0.76(R2 = 0.854)以及骨质校正方程y=0.76x+0.03(R2 = 0.897)。最终国内首次采用数学微分方程为适合中国人BIA得出了汇集三种标准方法的“精确”方程。最终建立BIA体成分测试校正方程组。测试结果稳定、重复性好,为BIA快速、精确评价人群TBW、脂肪组织(FM)、骨质奠定了数据基础,并以此注册两种II类医疗器械成功。第二部分:为进一步验证BIA的检测准确性及可重复性。针对209名健康成年人进行研究。所有数据按照BIA新的校正方程,准确获得人体成分结果。再与DXA测定的分节段肌肉进行进一步校对。发现DXA测定脂肪组织与BIA建立简单线性方程为 y =0.9995x + 0.691(R2 = 0.874,P0.001)。研究发现瘦体组织(FFM)与握力呈显著线性相关,R2= 0.7181;p0.0001;骨骼肌指数与握力呈显著线性相关,R2= 0.7262;p0.0001。发现经校正的BIA与临床金标准DXA有极好的一致性,并以此建立中国首次应用标准BIA测定的健康青年人的正常值参考范围。第三部分:应用经校正的BIA测定400名65岁的社区常住老年人的肌肉状况和营养状况,并与欧洲、亚洲的肌肉减少症诊断标准对比,为中国肌肉减少症的诊断标准建立数据基础。平均年龄71.98±5.34岁,BMI:24.93±3.13 kg/m2。采用BIA测定FFM均数43.56±7.63kg;骨骼肌含量均数23.55±4.54kg。肌肉质量指数(SMI)中,男性9.16±0.55 kg/m2;女性7.08±0.52 kg/m2。最终参照国际标准得出中国老年人正常肌肉质量范围建议为男性:10.26～8.06 kg/mm2;女性:8.12～6.04 kg/m2。在营养不良的老年人中,获得区分性别的BMI工作切点,但与肌肉数量尚无更好的相关性,提示在老年人群BMI并非很好的营养评估指标。小样本临床应用改善老年患者的肌肉质量。结论本研究在国内首次基于三种体成份测量“金标准”,提出并建立了多组分模型的BIA测量国人体成分的统一拟合方程,对于争议中的BIA在临床营养评估中应用提供了重要的解决方案。基于拟合方程,在209例健康成年人国内首次应用临床标准DXA方法和经过校正的BIA方法测定人体成分,建立良好的相关性方程并依此结果在不同性别建立骨骼肌指数正常值范围。最后,对比青年人数据,在400名北京社区老年人中应用亚洲、欧洲标准肌肉减少症诊断方法,依次检测握力、步速和肌肉质量,国内首次应用校正后的BIA技术建立了社区老年人肌肉质量和正常参考标准,设立了不同性别的肌肉质量的安全上限及下限值,填补了中国在此领域的空白,初步在临床建立中国老年人肌肉减少症的诊断标准。
[Abstract]:The background of the current human body composition especially muscle mass has been gradually as the objective index diagnosis of malnutrition. Especially in pathological conditions, the prognosis of muscle repair and consumption and disease are closely related. The accurate, rapid, simple method for measuring body composition and has a good performance, has become an important topic in clinical nutrition research. However, current are regarded as a measurement of body water, fat and fat content of the "gold standard" methods such as isotope dilution method, dual energy X ray absorptiometry (DXA) and magnetic resonance imaging (MRI) because of their methodological flaws, cannot measure the amount of muscle directly, can only rely on Archimedes's law and the autopsy results, and on the basis of fixed mathematical relationship between water / fat projections, and due to the detection of expensive, radiation injury may cause different types have different constants. The biological resistance developed rapidly in recent thirty years of anti Technology (BIA), different resistance characteristics based on body composition by Ohm's law, combined with the water content, density, age, race and gender related biological characteristics, the physical components. Because of the design is simple, non-invasive and fast, cheap and become the most current clinical application of body composition measurement means. But due to differences in impact formula based on population differences, the precision measurement of a body composition can not be compared with the "gold standard" method, and on the other BIA instruments only according to a standard method of all body than that correction formula, which limits the accuracy of clinical how to determine human applications. Each measuring component of the composite is calculated by using the BIA technology, reflect the nutritional status relatively true, the eventual establishment of disease, malnutrition and muscle disease reduce diagnostic tool, has become a clinical nutrition The biggest problem in the research. The accuracy detecting method of BIA and the establishment of body composition Chinese BIA test correction equations, with the "gold standard" BIA method to verify the accuracy and repeatability; reference range and diagnostic criteria of China sarcopenia establish data base value China establish normal healthy young people and the elderly. The content of this study is divided into three parts: the first part: the 3 "gold standard" of research methods, the healthy people BIA body composition measurement standard correction formula. In the study included 30 healthy adults using isotope dilution method at the same time, MRI and DXA were selected as determination of total water (TBW), and fat standard method for bone BIA were obtained. TBW correction equation: y=4.06+0.80x (R2 = 0.917); the amount of fat corrected linear equation y=1.02x+0.76 (R2 = 0.854) and bone correction equation y=0.76x+0.03 (R2 = 0.897) in the final. For the first time in the mathematical equations for Chinese BIA that brings together three standard methods of the "exact" equation. We set up BIA body composition test correction equations. The test results of stability, good repeatability, BIA fast, accurate evaluation of population TBW, adipose tissue (FM), with the data base, and in order to register two class II medical devices successfully. The second part: to further validate the BIA detection accuracy and repeatability. Research on 209 healthy adults. All of the data in accordance with the correction of the new BIA equation, obtain accurate results. The determination of body composition with DXA segmental muscles for further proofreading. Found by DXA adipose tissue and BIA to build a simple linear equation is y =0.9995x + 0.691 (R2 = 0.874, P0.001). The study found that lean tissue (FFM) showed a significant linear correlation with grip strength R2= 0.7181; P0.0001; skeletal muscle index and grip strength There was a significant linear correlation, R2= 0.7262; p0.0001. found consistency corrected BIA and DXA has an excellent clinical gold standard, and to establish the normal reference range of healthy young people for the first time Chinese using standard BIA determination. The third part: the application of the corrected BIA determination of muscle health and nutritional status of 400 65 year old community among the elderly, and Europe, Asia muscle reduced contrast diagnostic criteria and diagnostic criteria for China muscle disease reduce the establishment of data base. The average age was 71.98 + 5.34, BMI:24.93 + 3.13 kg/m2. was determined by BIA FFM were 43.56 + 7.63kg; skeletal muscle were 23.55 + 4.54kg. muscle mass index (SMI), male 9.16 female 7.08 + 0.55 kg/m2 + 0.52 kg/m2.; finally according to the international standard that Chinese elderly normal muscle mass range for men: 10.26 ~ 8.06 kg/mm2; female: 8.12 ~ 6.04 kg/m2. in the camp Keep the elderly poor, for gender BMI work sites, but there is no better correlation with the number of muscles, suggesting that nutritional evaluation index in the elderly population of BMI is not very good. The small sample clinical application for elderly patients with muscle mass. The conclusion of this study for the first time in China based on the three body measurements of the composition of the "gold standard" and put forward and established a unified equation of BIA measurement of body composition in the multicomponent model, for the dispute of BIA in the clinical application of nutritional assessment provides an important solution. Based on the fitting equation, in 209 healthy adults at home for the first time the clinical application of standard DXA method and BIA method after correction determination of body composition good, the correlation equation is established and then result in different gender based skeletal muscle index range of normal values. Finally, comparative youth data, application in 400 Beijing community elderly In Asia, the European standard sarcopenia diagnosis method, followed by detection of grip strength, walking speed and muscle mass, the first application of the corrected BIA technology to establish the community elderly muscle quality and normal reference standard, set up safety of the upper and lower limit of different gender values of muscle mass, fill the blank Chinese in this field, the initial establishment of China the elderly reduce muscle disorders in clinical diagnostic criteria.

【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R151.42

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