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研究生:郭卜瑄
研究生(外文):Pu-HsianGuo
論文名稱:社區中老年人骨骼肌減少症盛行率與相關危險因子探討
論文名稱(外文):Prevalence and associated risk factors of sarcopenia in middle-aged and old people lived in community
指導教授:吳至行吳至行引用關係
指導教授(外文):Chih-Hsing Wu
學位類別:碩士
校院名稱:國立成功大學
系所名稱:老年學研究所
學門:其他學門
學類:其他不能歸類之各學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:104
中文關鍵詞:骨骼肌量體脂率老化身體質量指數身體活動量
外文關鍵詞:skeletal muscle massbody fatagingBMIphysical activity
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隨著年紀增長和老化,身體活動力下降、運動量減少、反應變遲鈍、肌肉無活動而流失萎縮,衍伸出一老年議題:骨骼肌減少症,一種與人體衰老有關的漸進式綜合變化徵狀。當年齡增加,身體組成中骨骼肌肌纖維萎縮、肌量減少、肌力減低、肌耐力和代謝能力下降,當神經肌肉組織系統和功能的持續下降,進而引起各種共病症等退化性病變。因應台灣社會高齡化,然回顧台灣地區骨骼肌減少症盛行率及相關之研究仍相當不足,故本研究針對40歲以上之社區中老年民眾進行橫斷式調查,以了解中台灣地區中老年人骨骼肌減少症和骨骼肌減少症前期之盛行率以及探討可能之相關危險因子。
針對雲林縣斗六市與古坑鄉分層隨機抽樣1200位四十歲以上中老年人進行橫斷式調查。問卷調查內容包括了基本資料、抽菸、飲酒、茹素習慣及健康相關資料(如骨折史、慢性疾病等)等自填或由訓練訪員詢問;體位測量包括身體質量指數並使用生物電阻抗分析儀(BIA)測量體脂率及骨骼肌量。以骨骼肌量低於年輕參考族群的肌肉量兩個標準差,則判定為骨骼肌減少症;骨骼肌減少症前期則為骨骼肌量介於年輕參考族群的肌肉量一個標準差到兩個標準差之間。
本研究結果共取得40歲以上1191位受測者之完整資料,平均年齡59.5±11.4歲。骨骼肌減少症盛行率於全體、男性、女性分別為3.0%、4.6%、1.8%;若以65歲以上老年人來看,骨骼肌減少症之盛行率於全體、男性、女性分別為5.3%、8.6%、1.5%。骨骼肌減少症前期於全體、男性、女性分別為19.0%、27.9%、 12.2%;以65歲以上老年人來看,骨骼肌減少症前期之盛行率在全體、男性、女性分別為29.7、41.1%、16.7%。以單變項分析發現年齡、性別、身體質量指數與骨骼肌減少症具有相關性;經邏輯斯複迴歸分析發現性別、年齡、身體質量指數和體脂率為骨骼肌減少症和骨骼肌減少症前期的獨立危險因子。
整體而言,以1191名40歲以上之受測者之骨骼肌減少症盛行率因不同年齡與性別約介於1.8%-8.6%之間。老年男性、年齡越高、較低的身體質量指數和高體脂率易出現骨骼肌減少症的問題。若能針對高危險個案早期篩檢,適時介入的預防,將可減少骨骼肌減少症後續衍伸出的健康問題。

With the aging process, the decreased physical activity along with disused muscle atrophy and slow in reaction were developed and derived the issue of sarcopenia- a progressive and complex syndrome. The aging phenomenon of body composition were reflected by skeletal muscle fiber atrophy, declined muscle strength, muscular endurance and metabolic ability. The sustained deterioration of neuromuscular system and function might result in kinds of comorbidities and degenerative changes subsequently. In response to the aging society, surveys of prevalence and associated risk factors of sarcopenia were still insufficient in Taiwan. For this reason, this cross-sectional study was designed to evaluate the prevalence and associated risk factors of pre-sarcopenia and sarcopenia in community-dwelling subjects aged 40 years old and over in mid-Taiwan.
Twelve hundred subject aged 40 and over were stratified random sampled from Douliou/Gukeng, Yunlin County in 2010. The structured questionnaires included basic characteristics, smoking and drinking habit, habit of vegetarian and health related information ( fracture history, chronic disease, etc) were self-reported or inquired by well-trained faculty. The body mass index (BMI) and body composition ( percent body fat and skeletal muscle mass) derived from bioimpedance analysis (BIA) were measured accordingly. Sarcopenia was defined statistically as a reduction in muscle mass of two standard deviations or more below the normal means for young people. Presarcopenia was defined statistically between one standard deviations and two standard deviations of normal means of muscle mass for young people.
A total of 1191 subjects (mean age was 59.5 ± 11.4 years) with completed data were collated for final analysis. The prevalences of sarcopenia/presarcopenia in total, males and females were 3.0%/19.0%, 4.6%/27.9% and 1.8%/12.2%, respectively. In terms of subjects aged 65 and over, the prevalences of sarcopenia/presarcopenia in total, males and females were 5.3%/29.7%, 8.6%/41.1% and 1.5%/16.7%, respectively. In univariate analysis, the age, gender and BMI were significantly correlated with sarcopenia. Using the multiple logistic regression analysis, the sex, age, BMI and percent body fat were independent risk factors for both sarcopenia and presarcopenia.
In conclusion, the prevalence of sarcopenia were ranged from 1.8% to 8.6% across different gender and age in the 1191 aged 40 and over subjects. The older, males, low BMI and high percent body fat have higher risk for sarcopenia. To provide early screening and on-time intervention for the high risk groups would prevent the sarcopenia and the subsequent health hazards.

第一章、研究背景及動機 1
第一節、人口老化現況 1
第二節、骨骼肌減少症之背景發展 1
第三節、骨骼肌減少症的重要性 2
第四節、研究目的 2
第二章、文獻回顧 4
第一節、骨骼肌減少症的定義 4
一、定義 4
二、常用判定標準 4
三、最新判定標準 5
四、參考族群標準 7
第二節、骨骼肌減少症的測量方式 7
第三節、骨骼肌減少症的盛行率 14
第四節、骨骼肌減少症的相關因子 16
第三章、研究方法 24
第一節、研究架構 24
第二節、研究地點與對象 25
一、研究地點 25
二、收案對象 25
第三節、研究流程 28
第四節、測試方法 30
一、體位測量 30
二、身體組成分析 30
三、結構式問卷 30
四、血液檢查 32
第四節、資料處理與統計分析 33
第四章、結果 34
第一節、受測者之基本資料 34
第二節、骨骼肌減少症與骨骼肌減少症前期之盛行率 38
一、男性 38
二、女性 39
三、整體 39
四、不同身體質量指數分類之比例 40
第三節、相關危險因子 43
一、單變項分析 43
二、多變項分析 47
第五章、討論 61
第一節、骨骼肌減少症之盛行率 61
一、與國內盛行率比較 61
二、與國外盛行率比較 63
第二節、相關危險因子 64
一、基本資料 64
(一)年齡 64
(二)性別 64
(三)社經地位 65
(四)居住地 65
二、生活習慣 65
(一)抽菸習慣、飲酒習慣 65
(二)茹素習慣 66
三、身體組成 66
(一)身體質量指數 66
(二)體脂率 66
四、健康狀態 67
(一)慢性疾病 67
(二)骨折史 67
五、體能活動 67
(一)身體活動量 67
第三節、研究限制 69
第六章、結論與建議 70
一、骨骼肌減少症之盛行率 70
二、骨骼肌減少症之相關危險因子 70
三、對骨骼肌減少症之建議 70
四、未來研究之建議 70
附錄一 結構式問卷 72
附錄二 人體試驗委員會(IRB)同意書 97
附錄三 Inbody SMM 輸出單 98
參考文獻 99

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