减重对2型糖尿病合并超重肥胖患者肌肉含量的临床观察  

Clinical observation on weight loss on muscle content in patients with type 2 diabetes mellitus complicated with overweight and obesity

作　　者：周淑晶 闫慧娴 夏雪培 陈芳[1] 黄薇[1] Zhou Shujing;Yan Huixian;Xia Xuepei;Chen Fang;Huang Wei(Department of Endocrinology,Beijing Haidian Hospital,Beijing 100080,China)

机构地区：[1]北京市海淀医院内分泌科,100080

出　　处：《北京医学》2023年第11期934-937,共4页Beijing Medical Journal

基　　金：北京市海淀医院2020年院级科研基金(KYQ2020004)。

摘　　要：目的探讨减重对2型糖尿病(type 2 diabetes mellitus,T2DM)合并超重肥胖患者肌肉含量的影响。方法选取2020年4月至2021年9月北京市海淀医院T2DM合并超重肥胖患者48例,给予糖尿病健康宣教,并采用饮食控制的方式减重12周,减重期可根据血糖水平调整降糖药物用量,但避免使用胰高糖素样肽-1(glucagon-like peptide-1,GLP-1)受体激动剂。比较减重前后患者的肌肉含量,采用Pearson相关分析法分析四肢骨骼肌质量指数(appendicular skeletal muscle mass index,ASMI)下降值与体成分各指标下降值的相关性。结果48例患者中男33例、女15例,年龄24~59岁,平均(43.5±9.8)岁。与基线相比,减重后的ASMI[(6.91±1.02)kg/m^(2)比(7.21±0.97)kg/m^(2)]、体质量[(81.85±13.13)kg比(88.45±13.70)kg]、腰围(waist circumference,WC)[(95.34±8.07)cm比(101.65±8.86)cm]、体脂百分比[36.9(32.7,42.2)%比38.7(36.2,43.2)%]、内脏脂肪面积(visceral fat area,VF)[(179.77±48.32)cm^(2)比(209.92±42.78)cm^(2)]均较低,但四肢骨骼肌百分比较高[(0.25±0.03)%比(0.24±0.03)%],差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,ASMI下降值与体质量(r=0.440,P=0.002)、BMI(r=0.426,P=0.003)、WC(r=0.340,P=0.018)、总肌肉质量(r=0.665,P<0.001)的下降值呈正相关。结论T2DM合并超重肥胖患者减重后代谢指标明显改善,但会造成肌肉含量下降,建议减重同时注意权衡减重的获益,在监测体成分变化的同时,酌情保留或加大运动量,并关注肌肉含量,减少肌少症的发生。Objective To explore the effect of weight loss on muscle content in patients with type 2 diabetes mellitus(T2DM)complicated with overweight and obesity.Methods A total of 48 patients with T2DM complicated with overweight and obesity in Beijing Haidian Hospital from April 2020 to September 2021 were selected and were given diabetes health education and lost weight control by diet for 12 weeks.During the weight loss period,hypoglycemic drugs could be adjusted by clinicians according to the blood sugar level,but the use of glucagon-like peptide-1(GLP-1)receptor agonists was avoided.The muscle content before and after weight loss were compared,and the correlation between the decreased values of appendicular skeletal muscle mass index(ASMI)and the decreased values of body composition were analyzed by Pearson correlation analysis.Results Among the 48 patients,there were 33 males and 15 females,aged from 24 to 59 years,with an average age of(43.5±9.8)years.Compared with the baseline,the ASMI[(6.91±1.02)kg/m^(2) vs.(7.21±0.97)kg/m^(2)],weight[(81.85±13.13)kg vs.(88.45±13.70)kg],waist circumference(WC)[(95.34±8.07)cm vs.(101.65±8.86)cm],body fat percentage[36.9(32.7,42.2)%vs.38.7(36.2,43.2)%]and visceral fat area(VF)[(179.77±48.32)cm^(2) vs.(209.92±42.78)cm^(2)]after weight loss were all lower,while the percentage of skeletal muscle in limbs was higher[(0.25±0.03)%vs.(0.24±0.03)%],and the differences were statistically significant(all P<0.05).Pearson correlation analysis showed that the decreased value of ASMI was related with body mass(r=0.440,P=0.002),BMI(r=0.426,P=0.003),WC(r=0.340,P=0.018)and total muscle mass(r=0.665,P<0.001).Conclusions Metabolic indicators of T2DM patients with overweight and obesity are obviously improved after weight loss,but the muscle content will decrease.It is suggested to weigh the benefits of weight loss at the same time,keep or increase the exercise as appropriate while monitoring the changes of body composition,and pay attention to the muscle content to reduce the occurrence of

关 键 词：减重 2型糖尿病 肌肉减少症 四肢骨骼肌质量指数 内脏脂肪面积 

分 类 号：R587.2[医药卫生—内分泌] R589.2[医药卫生—内科学]