上臂围用于评估老年2型糖尿病患者低肌肉含量的临床价值  

Clinical value of upper arm circumference as a surrogate screening marker of low muscle mass in older patients with type 2 diabetes mellitus

作　　者：何清华[1] 王秀芝 杨彩哲 赵冬[4] 黄薇[5] 胡景[6] 张婕[7] 张田[8] 孙明晓 郭立新[1] Qinghua He;Xiuzhi Wang;Caizhe Yang;Dong Zhao;Wei Huang;Jing Hu;Jie Zhang;Tian Zhang;Mingxiao Sun;Lixin Guo(Department of Endocrinology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Endocrinology,Pinggu Hospital,Beijing Traditional Chinese Medicine Hospital,Beijing 101200,China;Department of Endocrinology,Air Force Characteristic Medical Center,Beijing 100142,China;Department of Endocrinology,Luhe Hospital Affiliated to Capital Medical University,Beijing 101199,China;Department of Endocrinology,Haidian Hospital,Third Hospital of Peking University,Beijing 100080,China;Department of Nutrition,Fuxing Hospital Affiliated to Capital Medical University,Beijing 100038,China;Department of Endocrinology,South Area of Guanganmen Hospital of Chinese Academy of Chinese Medical Sciences,Beijing 102618,China;Department of Nutriology,Aviation General Hospital,Chinese Medical Sciences University,Beijing 100101,China;Department of Endocrinology,Beijing Yide Hospital,Beijing 100195,China)

机构地区：[1]北京医院内分泌科国家老年医学中心中国医学科学院老年医学研究院,北京100730 [2]北京中医医院平谷医院内分泌科,北京101200 [3]空军特色医学中心内分泌科,北京100142 [4]首都医科大学附属北京潞河医院内分泌科,北京101199 [5]北京大学第三医院海淀院区内分泌科,北京100080 [6]首都医科大学附属复兴医院营养科,北京100038 [7]中国中医科学院广安门医院南区内分泌科,北京102618 [8]中国医科大学航空总医院营养科,北京100101 [9]北京怡德医院内分泌科,北京100195

出　　处：《中华糖尿病杂志》2023年第1期14-19,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：北京市科委“糖尿病特定人群诊疗规范和临床路径研究”(D141107005314005)。

摘　　要：目的探讨上臂围用于评估老年2型糖尿病(T2DM)患者低肌肉含量的临床价值。方法选择2016年1月至2018年3月在北京地区9家医院就诊的年龄≥60岁的652例T2DM患者作为研究对象。检测上臂围及握力。采用生物阻抗法(BIA)测量受试者四肢骨骼肌含量,并计算四肢骨骼肌质量(ASM)和四肢骨骼肌质量指数(ASMI)。低肌肉含量的诊断标准为ASMI男性<7.18 kg/m^(2),女性<5.73 kg/m^(2),根据此标准将不同性别受试者分为正常肌肉含量组和低肌肉含量组。根据体重指数(BMI)值,将不同性别受试者分为BMI≤25 kg/m^(2)组和BMI>25 kg/m^(2)组。组间比较采用t检验或秩和检验;采用Pearson相关分析法探究上臂围与肌肉含量之间的相关性,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)来评估上臂围对于低肌肉含量的诊断能力,根据最大约登指数计算最佳诊断切点,同时选取2019年在北京医院住院的60岁以上T2DM患者336例作为验证集样本进行诊断效力验证。结果652例T2DM患者中,男性327例,其中低肌肉含量组82例,正常肌肉含量组245例;女性325例,其中低肌肉含量组34例,正常肌肉含量组291例。无论男性还是女性,低肌肉含量组的上臂围[男性分别为(29.6±2.3)和(32.5±2.3)cm,女性分别为(27.9±1.7)和(31.3±2.3)cm]及握力[男性分别为(28±6)和(32±6)kg,女性分别为(23±6)和(26±4)kg]均显著低于正常肌肉含量组(P<0.001)。Pearson相关分析结果显示,上臂围与ASMI呈正相关(男性r=0.637,女性r=0.662,均P<0.01)。上臂围诊断低肌肉含量的AUC(95%CI)男性为0.812(0.760~0.863),女性为0.881(0.834~0.929),均具有统计学意义(P<0.001),根据最大约登指数计算上臂围诊断低肌肉含量的截值男性为30.3 cm,灵敏度为85.3%,特异度为61.0%;女性为29.8 cm,灵敏度为86.6%,特异度为88.2%。在BMI≤25 kg/m^(2)组中,男性162例,上臂围评估低肌肉含量诊断截值为30.3 cm,灵敏度为83.5%,特异度为74.2%;女�Objective To evaluate the suitability of upper arm circumference as a surrogate marker of low muscle mass for the diagnosis of sarcopenia in older Chinese patients with type 2 diabetes mellitus(T2DM).Methods A total of 652 patients with T2DM aged over 60 years from Department of Endocrinology of nine different hospitals in Beijing were involved in this study.The maximum upper arm circumference and grip strength were measured.Appendicular skeletal muscle mass(ASM)and appendicular skeletal muscle mass index(ASMI)was calculated by using bioimpedance analysis(BIA).The diagnostic criteria for low muscle mass are ASMI<7.18 kg/m^(2) for men and<5.73 kg/m^(2) for women.According to these criteria,the patients of different genders were divided into normal muscle mass group and low muscle mass group.According to body mass index(BMI),the participants of different genders were divided into BMI≤25 kg/m^(2) group and BMI>25 kg/m^(2) group.The t test or rank sum test was used for comparison between groups.Pearson correlation analysis was used to explore the correlation between upper arm circumference and muscle mass,and the receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated to evaluate the diagnostic ability of upper arm circumference for low muscle mass.The optimal cut-off point was calculated by determining the shortest distance between the ROC curve and upper left corner of the graph.An external validation was performed in another population including 336 hospitalized diabetes patients aged over 60 years from Beijing Hospital in 2019.Results There were 327 males and 325 females in all 652 participants.There were 82 and 245 male participants,34 and 291 female participants in low muscle mass group and normal muscle mass group,respectively.Upper arm circumference[male:(29.6±2.3)vs.(32.5±2.3)cm,respectively;female:(27.9±1.7)vs.(31.3±2.3)cm,respectively]and grip strength[male:(28±6)vs.(32±6)kg,respectively;female:(23±6)vs.(26±4)kg,respectively]were lower significantly i

关 键 词：糖尿病 老年人 肌少症 上臂围 肌肉含量 

分 类 号：R587.1[医药卫生—内分泌]