老年2型糖尿病患者肌少症与非乙醇性脂肪肝的相关性  

Correlation between sarcopenia and nonalcoholic fatty liver disease in elderly patients with type 2 diabetes mellitus

作　　者：穆志静[1] 孙丽娜[1] 修双玲[1,2] MU Zhi-jing;SUN Li-na;XIU Shuang-ling(Department of Endocrinology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Geriatrics,Capital Meidca University,Beijing 100069,China)

机构地区：[1]首都医科大学宣武医院内分泌科,北京100053 [2]首都医科大学老年医学系,北京100069

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2021年第3期230-236,共7页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：北京市属医院科研培育计划项目(PX2020034)。

摘　　要：目的分析60岁以上老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者肌少症与非乙醇性脂肪肝(nonalcoholic fatty liver disease,NAFLD)的相关性。方法选取2015年10月至2019年10月在首都医科大学宣武医院内分泌科住院的老年T2DM患者共计533例,采用双能X线吸收测量仪(dual-energy X-ray absorptiometry,DXA)测量四肢骨骼肌肌肉质量(appendicular skeletal muscle mass,ASM)。四肢骨骼肌质量指数(appendicular skeletal muscle index,ASMI)以ASM(kg)/身高2(m^(2))作为计算公式,以男性<7.26 kg/m^(2),女性<5.45 kg/m^(2)作为肌少症的诊断标准,将入组患者分为肌少症组(116例)及非肌少症组(417例),进行相应的体格检查及实验室检查。结果老年2型糖尿病肌少症组年龄(P<0.01)、性别(P<0.001)、体质量指数(body mass index,BMI)(P<0.001)、糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)(P<0.01)与非肌少症组相比差异有统计学意义;肌少症组NAFLD患病率显著低于非肌少症组(39.13%vs.57.83%,P<0.001)。多因素Logistic回归分析显示肌少症与性别,年龄,HbA1c及BMI≥25 kg/m^(2)独立相关(分别为OR=0.128,95%CI:0.073~0.224,P<0.01;OR=1.060,95%CI:1.024~1.097,P<0.01;OR=1.137,95%CI:1.004~1.286,P<0.05;OR=0.131,95%CI:0.078~0.222,P<0.01)。多因素回归未显示肌少症与脂肪肝相关。结论女性及BMI≥25 kg/m^(2)为老年T2DM患者肌少症的保护因素;HbA1c升高,增龄为肌少症的危险因素。脂肪肝既不是肌少症的保护因素,也不是危险因素。Objective To explore the correlation between nonalcoholic fatty liver disease(NAFLD)and sarcopenia in elderly patients with type 2 diabetes mellitus(T2DM).Methods A total of 533 elderly patients with T2DM hospitalized in the Department of Endocrinology of Xuanwu Hospital from October 2015 to October 2019 were selected.Skeletal muscle mass of both upper and lower limbs was measured by dual-energy X-ray absorptiometry(DXA).Appendicular skeletal muscle mass(ASM)was calculated.According to the recommendations for sarcopenia using cutoff values for ASM/height2(7.26 kg/m^(2) for men and 5.45 kg/m^(2) for women),we divided the patients into sarcopenia group(116 cases)and nonsarcopenia group(417 cases).The data of physical examination and laboratory tests were collected.Results The age(P<0.01),sex(P<0.001),body mass index(P<0.001)and glycosylated hemoglobin A1c(HbA1c)(P<0.01)in the sarcopenia group were significantly different compared with those in the nonsarcopenia group.The prevalence of NAFLD in the sarcopenia group was significantly lower than that in the non-sarcopenia group(39.13%vs.57.83%,P<0.001).Multivariate logistic regression analysis showed that sarcopenia was independent correlation with gender,age,HbA1c,and BMI≥25 kg/m^(2)(OR=0.128,95%CI:0.073-0.224,P<0.01;OR=1.060,95%CI:1.024-1.097,P<0.01;OR=1.137,95%CI:1.004-1.286,P<0.05;OR=0.131,95%CI:0.078-0.222,P<0.01).Multivariate logistic regression do not show that sarcopenia was associated with fatty liver disease.ConclusionsFemale and BMI≥25 kg/m^(2) are protective factors for sarcopenia in elderly patients with type 2 diabetes.HbA1c and age are risk factors for sarcopenia.NAFLD is not associated with sarcopenia.

关 键 词：2型糖尿病 肌少症 非乙醇性脂肪肝 骨骼肌肌肉质量 

分 类 号：R681[医药卫生—骨科学]