中老年2型糖尿病患者血糖目标范围内时间和肌肉质量减少的相关性  

Correlation between time within blood glucose target range and muscle mass reduction in middle-aged and elderly patients with type 2 diabetes

作　　者：马国翠 邹玲玲[1] 戴武[1] 曹永红[1] Ma Guocui;Zou Lingling;Dai Wu;Cao Yonghong(Department of Endocrinology,the Second People′s Hospital of Hefei,Hefei 230011,China)

机构地区：[1]合肥市第二人民医院内分泌科,合肥230011

出　　处：《中国医师杂志》2023年第9期1349-1354,共6页Journal of Chinese Physician

基　　金：合肥市卫健委应用医学研究项目(合卫科教〔2019〕172号);安徽医科大学校科研基金项目(2020xkj247);合肥市二院2021年度青年基金项目(院科教〔2021〕124号)。

摘　　要：目的研究中老年2型糖尿病(T2DM)患者血糖目标范围内时间和肌肉质量减少的相关性。方法选取2020年12月至2021年12月合肥市第二人民医院收治的中老年T2DM患者245例。所有入组患者佩戴美奇动态血糖监测系统获取血糖目标范围内时间(TIR)、血糖高于目标范围内时间(TAR)、血糖低于目标范围内时间(TBR)、平均血糖波动幅度(MAGE)、血糖变异系数(CV)、平均血糖水平(MG)、血糖标准差(SD)、血糖最大波动幅度(LAGE)等指标用于评估血糖波动。统计分析肌肉质量减少及肌少症的患病率,比较肌肉质量减少组、非肌肉质量减少组各项观察指标的差异,采用Spearman相关性分析临床各项指标与四肢骨骼肌质量指数(ASMI)的相关性,logistic回归分析中老年T2DM患者肌肉质量减少的影响因素。结果245例T2DM患者中肌肉质量减少患病率25.71%(63/245),肌少症患病率13.06%(32/245)。肌肉质量减少组和非肌肉质量减少组年龄、性别、BMI、血磷、HOMA-IR、ACR、25羟维生素D、DN患者比例、ASMI、握力及5次起坐试验时间差异有统计学意义(均P<0.05)。肌肉质量减少组的TIR低于非肌肉质量减少组,TAR及MG高于非肌肉质量减少组,差异有统计学意义(均P<0.05)。ASMI与年龄、男性、HOMA-IR呈负相关(均P<0.05),与BMI、25羟维生素D呈正相关(均P<0.05)。ASMI与SD、TIR呈正相关(均P<0.05),与CV、LAGE、TAR及MG呈负相关(均P<0.05)。单因素回归分析结果显示,年龄、男性、DN及TAR是肌肉质量减少的危险因素,BMI、25羟维生素D和TIR是肌肉质量减少的保护因素(均P<0.05)。校正其他相关因素后,TIR仍是肌肉质量减少的保护因素(P<0.05)。结论TIR是中老年T2DM患者肌肉质量减少的独立保护因素,临床上可通过提高TIR水平来降低肌肉质量减少的发生率。Objective To study the correlation between the time within the target range of blood glucose and the reduction of muscle mass in middle-aged and elderly patients with type 2 diabetes(T2DM).Methods A total of 245 middle-aged and elderly T2DM patients admitted to the Second People′s Hospital of Hefei from December 2020 to December 2021 were selected.All enrolled patients wore MeiQi blood glucose monitor to obtain time in range(TIR),time above range(TAR),time below range(TBR),mean amplitude of glycemic excursions(MAGE),coefficient of variation(CV),blood glucose standard deviation(SD),largest amplitude of glycemic excursions(LAGE),which was for assessing blood sugar fluctuation.The incidence of muscle mass reduction and sarcopenia was statistically analyzed,and the differences invarious observation indicators between the muscle mass reduction group and the non muscle mass reduction group were compared.Spearman correlation analysis was used to investigate the correlation between clinical indicators and limb skeletal muscle mass index(ASMI),and logistic regression was used to analyze the influencing factors of muscle mass reduction in middle-aged and elderly T2DM patients.Results The prevalence of muscle mass loss in 245 T2DM patients was 25.71%(63/245),and the prevalence of sarcopenia was 13.06%(32/245).There were statistically significant differences in age,gender,body mass index(BMI),blood phosphorus,homeostatic model assessment of insulin resistance(HOMA-IR),urine albumin creatine ratio(ACR),25 hydroxyvitamin D,diabetes nephropathy(DN)patient proportion,ASMI,grip strength,and 5 sit up test times between the muscle mass reduction group and the non muscle mass reduction group(all P<0.05).The TIR of the muscle mass reduction group was lower than that of the non muscle mass reduction group,while the TAR and mean blood glucose(MG)were higher than those of the non muscle mass reduction group,with statistically significant differences(all P<0.05).ASMI was negatively correlated with age,males,and HOMA-IR(all P<0.05),but

关 键 词：糖尿病 2型 动态血糖监测 血糖目标范围内时间 肌减少症 

分 类 号：R587.1[医药卫生—内分泌]