老年2型糖尿病患者脂肪肌肉质量比与认知障碍的相关研究  

Correlation between fat-to-muscle mass ratio and cognitive impairment in elderly patients with type 2 diabetes mellitus

作　　者：毋帆 李静波[1] 林辰莹 陈彤[1] 林静娜[1] Wu Fan;Li Jingbo;Lin Chenying;Chen Tong;Lin Jingna(Department of Endocrinology,Tianjin Union Medical Center,Tianjin 300121,China)

机构地区：[1]天津市人民医院内分泌科,天津300121

出　　处：《中华内分泌代谢杂志》2024年第12期1024-1031,共8页Chinese Journal of Endocrinology and Metabolism

基　　金：天津市科技计划(18ZXDBSY00120)。

摘　　要：目的探讨脂肪肌肉质量比(fat-to-muscle mass ratio,FMR)与老年2型糖尿病患者认知障碍之间的关系,并揭示是否存在性别差异。方法采用横断面研究纳入2018年7月至2022年5月在天津市人民医院内分泌科病区住院老年2型糖尿病患者(≥60岁)768例。利用生物电阻抗分析法(bioelectrical impedance analysis,BIA)测量人体成分,并应用简易精神状态检查(mini mental state examination,MMSE)及蒙特利尔认知评估(Montreal cognitive assessment,MoCA)认知量表对患者进行认知功能筛查。根据认知量表的筛查将2型糖尿病患者分为认知功能正常组及认知功能减退组,并依据性别进行分层分析。基于BIA测量构建FMR新指标:脂肪质量(fat mass,FM)/四肢骨骼肌质量(appendicular skeletal muscle mass,ASM)、FM/骨骼肌质量(skeletal muscle mass,SMM)、FM/去脂体重(fat free mass,FFM)。采用二元logistic回归以性别分层对各指标与认知障碍的风险关系进行分析。结果女性FMR指标均与认知功能减退无关。经多因素校正,男性中FMR升高均与认知功能减退风险增加相关(FM/FFM:OR=1.722,95%CI 1.230~2.409,P=0.002;FM/SMM:OR=1.337,95%CI 1.118~1.599,P=0.001;FM/ASM:OR=1.240,95%CI 1.077~1.427,P=0.003),且独立于体重指数。其中作用最强的FM/FFM每增加0.1,认知功能减退的风险可增加77.2%。体重指数分层分析显示,与超重肥胖(体重指数≥25 kg/m^(2))组比较,体重正常(体重指数<25 kg/m^(2))组FMR与认知功能的风险系数更高。随着FMR水平逐渐增加,认知障碍患病率逐渐升高。结论60岁以上男性2型糖尿病患者,FMR可能是认知功能独立危险因素。ObjectiveTo investigate the relationship between fat-to-muscle mass ration(FMR)and cognitive impairment in older adults with type 2 diabetes mellitus and to further explore the gender difference.MethodsA cross-sectional study was conducted on 768 elderly type 2 diabetes mellitus patients(≥60 years old)who were hospitalized in the Endocrinology Ward of Tianjin Union Medical Center from July 2018 to May 2022.The body composition was measured by bioelectrical impedance analysis(BIA),and the cognitive function was assessed using mini mental state examination(MMSE)and Montreal cognitive assessment(MoCA).According to the cognitive scale screening,type 2 diabetes mellitus patients were divided into normal cognitive function group and cognitive impairment group with stratified analysis by gender.New FMR indicators were developed based on BIA measurements,including fat mass(FM)/appendicular skeletal muscle mass(ASM),FM/skeletal muscle mass(SMM),and FM/fat free mass(FFM).Binary logistic regression was used to analyze the relationship between FMRs and cognitive impairment risk,stratified by gender.ResultsFMR indicators were not associated with cognitive impairment in females.In males,after adjusting for multiple factors,higher FMR values were significantly associated with an increased risk of cognitive impairment(FM/FFM:OR=1.722,95%CI 1.230-2.409,P=0.002;FM/SMM:OR=1.337,95%CI 1.118-1.599,P=0.001;FM/ASM:OR=1.240,95%CI 1.077-1.427,P=0.003)and was independent of body mass index.For FM/FFM,every 0.1-unit increase raised the risk of cognitive impairment by 77.2%.FMR had a stronger association with cognitive impairment in the normal-weight group(body mass index<25 kg/m^(2))than in the overweight/obese group(body mass index≥25 kg/m^(2)).The prevalence of cognitive impairment increased progressively with higher FMR.ConclusionIn men over 60 years with type 2 diabetes mellitus,FMR may be an independent risk factor for cognitive function.

关 键 词：认知障碍 脂肪肌肉质量比 糖尿病 2型 性别 人体成分 

分 类 号：R74[医药卫生—神经病学与精神病学]