老年2型糖尿病病人肌少症的发生情况及影响因素研究  

Prevalence and relative factors of sarcopenia in elderly T2DM patients

作　　者：张恬[1] 顾一航 王琳 沙江明[1] 殷泉忠[1] 丁国宪 ZHANG Tian;GU Yi-hang;WANG Lin;SHA Jiang-ming;YIN Quan-zhong;DING Guo-xian(Department of Gerontology,Jiangyin People’s Hospital,Wuxi 214400,China;Department of Gerontology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]江阴市人民医院老年医学科,江苏省无锡市214400 [2]南京医科大学第一附属医院老年内分泌科,江苏省南京市210029

出　　处：《实用老年医学》2019年第8期772-775,779,共5页Practical Geriatrics

摘　　要：目的分析老年2型糖尿病(type 2 diabetes mellitus,T2DM)病人肌少症(sarcopenia)的发生情况及其影响因素。方法选取280例老年T2DM病人(T2DM组)及258例健康老年人(对照组),测定2组血生化指标、糖化血红蛋白(HbA1c)、血清25羟基维生素D[25(OH)D]水平以及步速、握力、身体成分及四肢骨骼肌质量指数(skeletal muscle mass index,ASMI)。将老年T2DM病人分为肌少症组与非肌少症组,比较2组25(OH)D水平;根据25(OH)D水平将老年T2DM病人与对照组分为维生素D充足组、维生素D不足组、维生素D缺乏组、维生素D严重缺乏组,分别比较不同维生素D水平下T2DM组与对照组ASMI水平差异。采用相关分析、回归分析探讨老年T2DM病人ASMI与年龄、病程、HbA1c、血清25(OH)D水平之间的关系。结果(1)老年T2DM病人肌少症的发生率为30.4%,明显高于对照组的10.9%(χ^2=30.786,P<0.001)。(2)老年T2DM合并肌少症病人血清25(OH)D水平较非肌少症组显著下降(t=-2.945,P=0.013)。(3)维生素D充足组中,老年T2DM病人与对照组相比,ASMI差异无统计学意义(P>0.05)。维生素D不足组、缺乏组、严重缺乏组中,老年T2DM病人与对照组相比,ASMI显著下降,差异有统计学意义(P<0.05)。(4)相关分析发现,老年T2DM病人ASMI与年龄(r=-0.404,P=0.008)、HbA1c(r=-0.382,P=0.013)、病程(r=-0.418,P=0.006)呈负相关,与血清25(OH)D水平(r=0.366,P=0.017)呈正相关。Logistic回归分析发现,年龄(OR=1.208,P=0.006)、HbA1c水平(OR=1.851,P=0.015)、病程(OR=1.482,P<0.001)、血清25(OH)D缺乏(OR=2.853,P<0.001)是肌少症发生的危险因素。结论老年T2DM病人常合并肌少症,年龄增加、糖尿病病程长、糖尿病控制差、维生素D缺乏是肌少症的危险因素。Objective To explore the prevalence and risk factors of sarcopenia in elderly patients with type 2 diabetes mellitus(T2DM).Methods We recruited 280 elderly T2DM patients and 258 matched controls.The general situation and laboratory features such as glycosylated hemoglobin(HbA1c)and serum 25(OH)D levels of all subjects were collected in detail.The appendicular skeletal muscle mass index(ASMI),walk speed,grip strength and body composition of all subjects were tested.Elderly patients with T2DM were divided into sarcopenia group and non-sarcopenia group,and the level of 25(OH)D was compared.According to the level of 25(OH)D,the subjects were divided into 25(OH)D sufficient group,insufficient group,deficiency group and severe deficiency group,and the levels of ASMI were further compared between the T2DM group and control group by different level of 25(OH)D.Correlation analysis and regression analysis were used to identify the impact factors of elderly T2DM with sarcopenia.Results The incidence rate of sarcopenia in T2DM group(30.4%)was significantly higher than that of control group(10.9%)(χ^2=30.786,P<0.001).Compared with the elderly T2DM patients without sarcopenia,the serum 25(OH)D level was significantly lower in elderly T2DM patients with sarcopenia(t=-2.495,P=0.013).In vitamin D sufficiency group,the difference of ASMI between T2DM group and control group was not significant(P>0.05).In vitamin D insufficiency,deficiency and severe deficiency group,the differences of ASMI between T2DM and control group were significant(P<0.05).ASMI was negatively correlated with age,HbA1c,the course of diabetes,and positively correlated with the level of 25(OH)D.Logistic analysis revealed that age(OR=1.208,P=0.006),HbA1c(OR=1.482,P=0.021),lower serum 25(OH)D level(OR=2.853,P<0.001)were the risk factors of sarcopenia in elderly T2DM patients.Conclusions Increased age,long course of diabetes,poor control of diabetes and low serum 25(OH)D level are relative factors of elderly T2DM patients complicated with sarcopenia.

关 键 词：2型糖尿病 25羟基维生素D 肌少症 老年人 

分 类 号：R685[医药卫生—骨科学]