Correlation Analysis Between Serum Homocysteine Levels In The Elderly And Degeneration Of Lumbar Paraspinal Muscles

Objective:Sarcopenia is a disease that affects skeletal muscles and commonly presents as reduced physical function and quality of life in older adults.With the accelerating aging population in China,the incidence of sarcopenia is gradually increasing,making it a significant challenge to the health of older adults in the future.Homocysteine is a sulfur-containing amino acid,and its serum levels increase with age.Hyperhomocysteinemia may lead to adverse consequences such as fractures,disability,weakness,slow gait,balance disorders,and poor physical function.Meanwhile,an increasing amount of research is focusing on the relationship between homocysteine and sarcopenia,decreased muscle strength,and decreased muscle mass.However,there is still a lack of in-depth research on the relationship between serum homocysteine levels in older adults and the characteristics of paraspinal muscles.Therefore,this study aims to use imaging techniques to specifically evaluate the correlation between serum homocysteine levels and paraspinal muscle degeneration in older adults.Method:In this study,107 patients aged 65 and above who visited our hospital between January 2021 and June 2022 were selected as study subjects.Plasma samples and lumbar spine MRI imaging data were collected from these patients.We collected basic information of the patients and measured the cross-sectional area,functional crosssectional area,and fat infiltration value of the multifidus and erector spinae muscles at the L4-L5 level on T2-weighted lumbar spine MRI images using Image J software.Using linear mixed-effects models,we estimated the associations between homocysteine and muscle fat infiltration value and functional cross-sectional area.Additionally,we used single-factor and multiple-factor regression analyses to evaluate the relationship between homocysteine and muscle fat infiltration value and functional cross-sectional area.Results:In this study,the subjects were divided into four groups based on quartiles of homocysteine levels: Q1(≤11.66μ/L),Q2(11.66～15.79μ/L),Q3(15.79～22.52μ/L)and Q4(≥22.52μ/L).The results showed that with the increase of homocysteine levels,there were differences in smoking history and the fat infiltration values of the multifiidus and erector spinae muscles among the four groups of patients.Univariate and multivariate linear correlation analysis showed that ln Hcy was positively correlated with the fat infiltration values of the multifiidus and erector spinae muscles(r=0.529,p<0.001;r=0.399,p<0.001).Compared to quartile 1(Q1)of homocysteine,quartiles 3 and 4(Q3 and Q4)were positively correlated with fat infiltration values of the multifiidus muscle after adjusting for confounding factors(adjustedβ=0.081,SE=0.017,P<0.001;adjusted β=0.097,SE=0.016,P<0.001),and Q4 was positively correlated with fat infiltration values of the erector spinae muscle(adjusted β=0.069,SE=0.015,P<0.001).However,after adjusting for confounding factors such as age,gender,and blood lipids,linear regression analysis did not find any statistically significant results for the functional cross-sectional area of the multifiidus and erector spinae muscles.Conclusion:There is a correlation between serum homocysteine levels and fatty infiltration index of the multifidus and erector spinae muscles in elderly people.Using homocysteine quartile 1(Q1)as a reference,both univariate and multivariate linear regression analyses showed that high homocysteine levels were a risk factor for fatty infiltration of the paraspinal muscles,indicating that elderly patients with high serum homocysteine levels had a more severe degree of fatty infiltration on lumbar spine MRI.