本文選題：體成分　切入點：生物電阻抗法　出處：《北京協(xié)和醫(yī)學(xué)院》2017年博士論文　論文類型：學(xué)位論文

【摘要】：背景當(dāng)前人體成分尤其是肌肉量已逐步作為診斷營養(yǎng)不良的客觀性指標(biāo)。尤其在病理狀況下,肌肉的消耗和修復(fù)與疾病的預(yù)后密切相關(guān)。準(zhǔn)確、迅速、簡便并具有良好性價比的測量體成分的方法,已成為臨床營養(yǎng)研究的重要課題。然而當(dāng)前被分別視為測定身體水、脂肪與去脂組織含量的“金標(biāo)準(zhǔn)”方法如稀釋性同位素法、雙能量X射線吸收法(DXA)和磁共振成像(MRI)均因各自方法學(xué)缺陷,無法直接測定肌肉量,只能依賴阿基米德定律以及尸體解剖得出,并依據(jù)水/脂肪的固定數(shù)學(xué)關(guān)系推算,且因檢測昂貴、放射損傷等可能原因不同人種也具有不同常數(shù)。近三十年迅速發(fā)展起來的生物電阻抗技術(shù)(BIA),以歐姆定律為基礎(chǔ)利用身體組分的不同電阻特性,結(jié)合水含量、體密度以及年齡、種族和性別等相關(guān)生物學(xué)特性,得出身體各組分構(gòu)成。因設(shè)計簡便、無創(chuàng)且快速、廉價而成為目前臨床應(yīng)用最為廣泛的體成分測量手段。但因受基于人群差異影響帶來的計算公式差異,其測量某一種體成分的直接精度無法與“金標(biāo)準(zhǔn)”方法相比,且其他BIA儀器的研究僅按與某一種標(biāo)準(zhǔn)方法對比得出全部體成分校正公式,從而限制了其精確臨床應(yīng)用。如何利用BIA技術(shù)將測定人體各測量組分綜合計算,反映相對真實的人體營養(yǎng)狀況,最終建立疾病營養(yǎng)不良和肌肉減少癥的診斷工具,已成為臨床營養(yǎng)研究最大難題。目的檢測BIA方法的測量精度并建立中國人BIA體成分測試校正方程組,用“金標(biāo)準(zhǔn)”方法驗證BIA的準(zhǔn)確性及可重復(fù)性;建立中國健康青年人和老年人的正常值參考范圍并為中國肌肉減少癥的診斷標(biāo)準(zhǔn)建立數(shù)據(jù)基礎(chǔ)。內(nèi)容本研究分三部分進(jìn)行:第一部分:以3種“金標(biāo)準(zhǔn)”研究方法為基礎(chǔ),得到健康人BIA體成份測量的標(biāo)準(zhǔn)校正公式。研究中納入30名健康成年同時采用稀釋性同位素法、MRI和DXA分別作為測定總體水(TBW)、脂肪以及骨質(zhì)的標(biāo)準(zhǔn)方法。分別得出BIA的TBW校正方程:y=4.06+0.80x(R2 = 0.917);脂肪量校正線性方程 y=1.02x+0.76(R2 = 0.854)以及骨質(zhì)校正方程y=0.76x+0.03(R2 = 0.897)。最終國內(nèi)首次采用數(shù)學(xué)微分方程為適合中國人BIA得出了匯集三種標(biāo)準(zhǔn)方法的“精確”方程。最終建立BIA體成分測試校正方程組。測試結(jié)果穩(wěn)定、重復(fù)性好,為BIA快速、精確評價人群TBW、脂肪組織(FM)、骨質(zhì)奠定了數(shù)據(jù)基礎(chǔ),并以此注冊兩種II類醫(yī)療器械成功。第二部分:為進(jìn)一步驗證BIA的檢測準(zhǔn)確性及可重復(fù)性。針對209名健康成年人進(jìn)行研究。所有數(shù)據(jù)按照BIA新的校正方程,準(zhǔn)確獲得人體成分結(jié)果。再與DXA測定的分節(jié)段肌肉進(jìn)行進(jìn)一步校對。發(fā)現(xiàn)DXA測定脂肪組織與BIA建立簡單線性方程為 y =0.9995x + 0.691(R2 = 0.874,P0.001)。研究發(fā)現(xiàn)瘦體組織(FFM)與握力呈顯著線性相關(guān),R2= 0.7181;p0.0001;骨骼肌指數(shù)與握力呈顯著線性相關(guān),R2= 0.7262;p0.0001。發(fā)現(xiàn)經(jīng)校正的BIA與臨床金標(biāo)準(zhǔn)DXA有極好的一致性,并以此建立中國首次應(yīng)用標(biāo)準(zhǔn)BIA測定的健康青年人的正常值參考范圍。第三部分:應(yīng)用經(jīng)校正的BIA測定400名65歲的社區(qū)常住老年人的肌肉狀況和營養(yǎng)狀況,并與歐洲、亞洲的肌肉減少癥診斷標(biāo)準(zhǔn)對比,為中國肌肉減少癥的診斷標(biāo)準(zhǔn)建立數(shù)據(jù)基礎(chǔ)。平均年齡71.98±5.34歲,BMI:24.93±3.13 kg/m2。采用BIA測定FFM均數(shù)43.56±7.63kg;骨骼肌含量均數(shù)23.55±4.54kg。肌肉質(zhì)量指數(shù)(SMI)中,男性9.16±0.55 kg/m2;女性7.08±0.52 kg/m2。最終參照國際標(biāo)準(zhǔn)得出中國老年人正常肌肉質(zhì)量范圍建議為男性:10.26～8.06 kg/mm2;女性:8.12～6.04 kg/m2。在營養(yǎng)不良的老年人中,獲得區(qū)分性別的BMI工作切點,但與肌肉數(shù)量尚無更好的相關(guān)性,提示在老年人群BMI并非很好的營養(yǎng)評估指標(biāo)。小樣本臨床應(yīng)用改善老年患者的肌肉質(zhì)量。結(jié)論本研究在國內(nèi)首次基于三種體成份測量“金標(biāo)準(zhǔn)”,提出并建立了多組分模型的BIA測量國人體成分的統(tǒng)一擬合方程,對于爭議中的BIA在臨床營養(yǎng)評估中應(yīng)用提供了重要的解決方案�；跀M合方程,在209例健康成年人國內(nèi)首次應(yīng)用臨床標(biāo)準(zhǔn)DXA方法和經(jīng)過校正的BIA方法測定人體成分,建立良好的相關(guān)性方程并依此結(jié)果在不同性別建立骨骼肌指數(shù)正常值范圍。最后,對比青年人數(shù)據(jù),在400名北京社區(qū)老年人中應(yīng)用亞洲、歐洲標(biāo)準(zhǔn)肌肉減少癥診斷方法,依次檢測握力、步速和肌肉質(zhì)量,國內(nèi)首次應(yīng)用校正后的BIA技術(shù)建立了社區(qū)老年人肌肉質(zhì)量和正常參考標(biāo)準(zhǔn),設(shè)立了不同性別的肌肉質(zhì)量的安全上限及下限值,填補了中國在此領(lǐng)域的空白,初步在臨床建立中國老年人肌肉減少癥的診斷標(biāo)準(zhǔn)。
[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.

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R151.42

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