老年2型糖尿病患者甲状腺功能与肌少症的关系  

Thyroid function and sarcopenia in geriatric type 2 diabetic population

作　　者：付俊玲 穆志静[1] 孙丽娜[1] 赵蕾[1] 修双玲[1] Fu Junling;Mu Zhijing;Sun Lina;Zhao Lei;Xiu Shuangling(Department of Endocrinology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院内分泌科,北京100053

出　　处：《中华糖尿病杂志》2021年第12期1155-1159,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：北京市属医院科研培育计划项目(PX2020034);2021年度宣武医院国自然青年培育项目(QNPY2020014)。

摘　　要：目的探讨老年2型糖尿病(T2DM)患者甲状腺功能与肌少症的关系。方法收集2017年4月至2019年4月于首都医科大学宣武医院内分泌科住院的年龄>60岁的T2DM患者。测定患者的四肢骨骼肌质量(ASM)、握力、步速等, 并计算四肢骨骼肌质量指数(ASMI);测定患者的游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)的浓度, 并计算FT3/FT4比值。依据亚洲肌少症诊断标准将纳入患者分成肌少症组和非肌少症组。采用t检验或χ^(2)检验对两组患者间的一般临床资料进行比较;采用偏相关分析和多因素logistic回归分析法探讨老年T2DM患者甲状腺功能与肌少症的关系。结果共纳入535例60岁以上的T2DM患者, 肌少症组和非肌少症组患者分别为490例和45例。相比于非肌少症组, 肌少症组患者的FT3及FT3/FT4比值更低(均P<0.05)。在老年T2DM患者中, FT3/FT4比值与ASMI、握力及步速均呈正相关(r值分别为0.240、0.242和0.227;均P<0.01), FT3与ASMI、握力及步速也均呈正相关(r值分别为0.300、0.366和0.296, 均P<0.01)。多因素logistic回归分析结果显示, FT3/FT4比值降低是肌少症发病的独立风险因素(OR=0.396, 95%CI 0.158~0.992, P=0.048)。结论在老年T2DM患者中, FT3及FT3/FT4比值与肌少症各组分(ASMI、握力及步速)呈正相关, FT3/FT4比值是肌少症发病的独立预测因子。Objective To investigate the relationship between thyroid function and sarcopenia in Chinese geriatric patients with type 2 diabetes mellitus(T2DM).Methods Patients with T2DM aged over 60 years old were recruited from department of endocrinology,Xuanwu Hospital,Capital Medical University,from April 2017 to April 2019.Appendicular skeletal muscle mass,grip strength,and walking speed were measured,appendicular skeletal muscle mass index(ASMI)was calculated.Concentrations of free triiodothyronine(FT3),free thyroxine(FT4)and thyroid-stimulating hormone(TSH)were determined,FT3/FT4 ratio was calculated.Sarcopenia was defined based on the standard of the Asian Working Group of Sarcopenia.The included patients were divided into sarcopenia group and non-sarcopenia group.The t test orχ²test was used to compare general characteristics between the two groups;correlation analysis and multivariate logistic regression analysis were used to explore the relationship between thyroid function and sarcopenia.Results A total of 535 patients with T2DM aged over 60 years old were enrolled.There were 490 patients in sarcopenia group and 45 patients in non-sarcopenia group,respectively.Compared with non-sarcopenia patients,patients with sarcopenia demonstrated lower levels of FT3 and FT3/FT4 ratio(all P<0.05).In geriatric patients with T2DM,FT3/FT4 ratio was significant positively correlated with ASMI,grip strength and walking speed(r=0.240,0.242 and 0.227,respectively,all P<0.01),the same with FT3 levels(r=0.300,0.366 and 0.296,respectively,all P<0.01).Multivariate logistic regression analysis showed that FT3/FT4 ratio(OR=0.396,95%CI 0.158-0.992,P=0.048)was independent risk factor for sarcopenia.Conclusions In geriatric patients with T2DM,the concentrations of FT3 and FT3/FT4 ratio are significant positively correlated with the components of sarcopenia,and FT3/FT4 ratio is an independent predictor of sarcopenia.

关 键 词：糖尿病 2型 甲状腺功能 肌少症 

分 类 号：R685[医药卫生—骨科学] R587.2[医药卫生—外科学]