2型糖尿病患者骨骼肌质量与胰岛功能相关性研究  

Correlation between skeletal muscle mass and islet function in patients with type 2 diabetes mellitus

作　　者：陈姝 储爱卉 卞文轩 付麒[1] 杨涛[1] 郑旭琴[1] 何云强 CHEN Shu;CHU Aihui;BIAN Wenxuan;FU Qi;YANG Tao;ZHENG Xuqin;HE Yunqiang(Department of Endocrinology,The First Affiliated Hospital with Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京医科大学第一附属医院内分泌科,江苏南京210029

出　　处：《中国临床研究》2024年第7期1045-1050,共6页Chinese Journal of Clinical Research

基　　金：国家自然科学基金资助项目(82100838);江苏省自然科学基金青年项目(BK20210960)。

摘　　要：目的探讨2型糖尿病(T2DM)患者骨骼肌质量与胰岛功能及胰岛素抵抗的相关性,阐述其在血糖稳态中的临床意义。方法选择2023年8月至2024年2月于南京医科大学第一附属医院内分泌科住院治疗的成年T2DM患者共274例进行回顾性分析,收集患者基本信息,测定患者握力水平并留取血液及尿液进行生化检测,通过生物电阻抗分析法(BIA)测定患者上下肢骨骼肌含量、内脏脂肪面积(VFA)及腰围等,分别计算骨骼肌质量指数(SMI)及四肢骨骼肌质量指数(ASMI)。采用Pearson相关法分析患者握力值、SMI及ASMI水平与血糖、胰岛素及C肽水平、胰岛β细胞功能指标[胰岛β细胞功能(HOMA-β)、校正胰岛素反应性(CIR)、胰岛素生成指数(IGI)]、稳态模型胰岛素抵抗指数(HOMA-IR)和胰岛素敏感指数(ISI)的相关性,进一步用多重线性回归分析不同VFA、不同BMI水平T2DM患者骨骼肌质量与胰岛功能的相关性。结果T2DM患者空腹血糖及胰岛素、餐后120 min血糖及HOMA-IR与握力水平呈显著负相关(P<0.05),而餐后120 min胰岛素与握力水平呈正相关(P<0.05)。SMI及ASMI与T2DM患者糖耐量不同时点血糖分别呈负相关(P<0.01),与血清C肽水平及HOMA-β、CIR、IGI分别呈正相关(P<0.05)。下肢SMI水平与T2DM患者糖耐量不同时点血糖均呈负相关(P<0.01),与不同时点胰岛素、不同时点C肽及HOMA-β、IGI和CIR均呈正相关(P<0.05);但上肢SMI水平除与120 min血糖存在负相关(P=0.019)外,与上述其他指标无相关性(P>0.05)。校正性别和年龄后BMI分层分析显示,SMI水平与IOMA-β、IGI、CIR的相关性在BMI正常亚组显著(P_(adj)<0.05),在超重、肥胖亚组不显著(P_(adj)>0.05);而SMI水平与HOMA-IR、ISI的相关性却在BMI正常亚组不显著(P_(adj)>0.05),在超重、肥胖亚组显著(P_(adj)<0.05)。结论骨骼肌质量与T2DM患者血糖、胰岛功能及胰岛素抵抗密切相关,提高全身骨骼肌尤其是下肢骨骼肌含量及相�Objective To investigate the correlation between skeletal muscle mass and islet function,skeletal muscle mass and insulin resistance in patients with type 2 diabetes mellitus(T2DM),and to elaborate on the clinical significance of skeletal muscle mass in the maintenance of blood glucose homeostasis.Methods A total of 274 adult T2DM patients hospitalized in the Department of Endocrinology,the First Affiliated Hospital with Nanjing Medical University from August 2023 to February 2024 were retrospectively analyzed.The basic information of patients was collected,the grip strength of patients was measured,and the blood and urine samples were taken for biochemical detection.Bioelectrical impedance analysis(BIA)was used to measure the skeletal muscle content of the upper and lower limbs,visceral fat area(VFA)and waist circumference.The skeletal muscle mass index(SMI)and appendicular skeletal muscle mass index(ASMI)were calculated,respectively.Pearson correlation method was used to analyze the correlation of grip strength,SMI and ASMI levels with blood glucose,insulin and C-peptide levels,isletβcell function indicators[isletβcell function(HOMA-β),corrected insulin reactivity(CIR),insulinogenic index(IGI)],and homeostasis model assessment of insulin resistance(HOMA-IR)and insulin sensitivity index(ISI).Multirariable linear regression was further used to analyze the correlation between skeletal muscle mass and islet function in T2DM patients with different VFA and BMI.Results In T2DM patients,fasting blood glucose and insulin,120-minute postprandial blood glucose,and HOMA-IR were negatively correlated with grip strength levels(P<0.05),while 120-minte postprandial insulin was positively correlated with grip strength levels(P<0.05).SMI and ASMI were negatively correlated with blood glucose levels at different time points of glucose tolerance in T2DM patients(P<0.01),and positively correlated with serum C-peptide levels,HOMA-β,CIR,and IGI,respectively(P<0.05).The level of SMI in lower limbs was negatively correlated with b

关 键 词：2型糖尿病 骨骼肌质量 胰岛功能 胰岛素抵抗 血糖稳态 

分 类 号：R587.1[医药卫生—内分泌]