2型糖尿病患者肌肉量减少的多因素分析  

Multivariate analysis of muscle mass loss in patients with type 2 diabetes

作　　者：段明 张欣欣 孔悠然 孙晓方[1] 董冰子 王颜刚[1] 袁鹰[1] Duan Ming;Zhang Xinxin;Kong Youran;Sun Xiaofang;Dong Bingzi;Wang Yangang;Yuan Ying(Department of Endocrinology and Metabolism,the Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院内分泌与代谢病科,266003

出　　处：《中华内分泌代谢杂志》2020年第9期778-782,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金(81800769)。

摘　　要：目的探究2型糖尿病患者肌肉量减少的相关影响因素,为2型糖尿病患者预防肌少症提供依据。方法采用横断面调查方法,选取2019年1月至2019年8月青岛大学附属医院内分泌科收治的2型糖尿病患者为研究对象,所有研究对象均进行双能X线骨密度仪检查。根据亚洲肌少症工作组(AWGS)的诊断标准将研究对象分为肌量减少组与非肌量减少组,收集年龄、性别、体重指数、病程、血液指标、尿微量白蛋白/肌酐比值(UACR)、四肢骨骼肌指数(ASMI)、内脏脂肪/皮下脂肪(VAT/SAT)、腹部脂肪百分比/臀部脂肪百分比(A/G)、握力及步速等相关临床资料,对2型糖尿病患者发生肌量减少的相关影响因素进行分析。结果共调查2型糖尿病患者369例,其中合并肌少症患者42例(患病率为11.38%),合并肌量减少患者155例(患病率为42.01%)。肌量减少组的年龄、收缩压、高密度脂蛋白胆固醇、UACR、VAT/SAT及A/G均高于非肌量减少组(P<0.05)。肌量减少组的体重指数、稳态模型评估的胰岛素抵抗指数、估算的肾小球滤过率(eGFR)、ASMI及握力均低于非肌量减少组(P<0.05)。多因素logistic回归分析结果显示,年龄、UACR、A/G及VAT/SAT为肌量减少的危险因素,体重指数、eGFR及握力为肌量减少的保护因素。结论对2型糖尿病患者,尤其是高龄、中心型肥胖、低体重指数、低握力、低肾小球滤过率、高UACR者实施肌少症早期筛查并及早进行干预,具有重要的现实意义。Objective To explore the related factors of muscle mass loss in patients with type 2 diabetes mellitus,and to provide evidence for prevention of sarcopenia in type 2 diabetic patients.Methods A cross-sectional survey was used to select type 2 diabetic patients admitted to the Department of Endocrinology,Affiliated Hospital of Qingdao University from January 2019 to August 2019.All subjects underwent dual-energy X-ray absorptiometry check.According to the diagnostic criteria of the Asian Working Group for Sarcopenia(AWGS),the subjects were divided into a muscle reduction group and a non-muscle reduction group.Data including age,gender,body mass index,course of disease,blood index,urinary albumin-creatinin ration(UACR),and appendicular skeletal muscle index(ASMI)were collected.The relevant clinical data of viscera fat/subcutaneous fat(VAT/SAT),percentage of abdominal fat/percentage of hip fat(A/G),grip strength,and pace were analyzed for the related factors of muscle mass loss in type 2 diabetic patients.Results A total of 369 patients with type 2 diabetes were enrolled,including 42 patients with sarcopenia(an incidence rate of 11.38%),and 155 patients with reduced muscle mass(an incidence of 42.01%).Age,systolic blood pressure,high density lipoprotein-cholesterol,UACR,VAT/SAT,and A/G in the muscle reduction group were higher than those in the non-muscle reduction group(P<0.05).The parameter of body mass index,homeostasis model assessment for insulin resistance,estimated glomerular filtration rate(eGFR),ASMI,and grip strength were lower in the muscle reduction group than in the non-muscle reduction group(P<0.05).Multivariate logistic regression analysis showed age,UACR,A/G,and VAT/SAT were risk factors for muscle loss,body mass index,eGFR,and grip strength were protective factors for muscle mass reduction.Conclusion It is of great practical significance for type 2 diabetic patients,especially those with advanced age,central obesity,low body mass index,low grip strength,low glomerular filtration rate,and high UACR t

关 键 词：糖尿病 2型 肌少症 四肢骨骼肌指数 影响因素 

分 类 号：R587.2[医药卫生—内分泌] R685[医药卫生—内科学]