北京地区中老年2型糖尿病患者少肌性肥胖的患病率和不同诊断方法一致性评估  

Sarcopenic obesity prevalence and diagnostic agreement with different definitions in middle-aged and elderly patients with type 2 diabetes mellitus in China

作　　者：何清华[1] 王秀芝 杨彩哲 赵冬[4] 黄薇[5] 胡景[6] 张婕[7] 孙明晓 郭立新[1] He Qinghua;Wang Xiuzhi;Yang Caizhe;Zhao Dong;Huang Wei;Hu Jing;Zhang Jie;Sun Mingxiao;Guo Lixin(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 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]北京怡德医院内分泌科,北京100195

出　　处：《中国医学前沿杂志(电子版)》2025年第1期28-34,共7页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

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：目的了解中老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者少肌性肥胖(sarcopenic obesity,SO)患病率及不同诊断方法之间的一致性。方法采用系统随机抽样法选取2016年1月至2018年3月于北京地区9家医院内分泌科就诊的≥50岁T2DM患者,使用生物阻抗法进行身体成分检测;根据2022年欧洲临床营养与代谢学会(European Society for Clinical Nutrition and Metabolism,ESPEN)和欧洲肥胖研究协会(European Association for the Study of Obesity,EASO)方法定义SO,另外3种方法通过肌少症和肥胖的组合进行诊断。肌少症使用2019年亚洲肌少症工作组(Asian Working Group for Sarcopenia,AWGS)建立的标准来定义,肥胖通过体脂(percent of body fat,PBF)、腰围(waist circumference,WC)和体质量指数(body mass index,BMI)来定义。卡方检验进行率的比较,Cohens kappa统计分析比较4种方法的诊断一致性。结果共纳入1125例T2DM受试者,男性586例,年龄[61.2(55.3,67.4)]岁;女性539例,年龄[62.0(56.3,68.1)岁]。使用ESPEN/EASO共识、AWGS+PBF、AWGS+WC和AWGS+BMI标准,中老年T2DM患者SO患病率分别为41.6%、20.4%、30.1%和18.8%。4种方法之间的诊断一致性存在异质性(κ:0.109~0.655)。ESPEN/EASO共识与AWGS+PBF诊断一致性良好(κ:0.655),AWGS+体脂与AWGS+BMI诊断一致性良好(κ:0.637),AWGS+WC与AWGS+BMI(κ:0.359)、与AWGS+PBF诊断一致性中等(κ:0.330)。结论中老年T2DM患者SO患病率高,患病率和诊断一致性在不同诊断方法中存在差异,ESPEN/EASO的共识诊断率最高,AWGS+BMI诊断率最低,ESPEN/EASO共识与AWGS+体脂具有良好的诊断一致性。Objective To identify the prevalence of sarcopenic obesity(SO)and the consistency of different diagnostic methods in a cohort of middle-aged and elderly type 2 diabetes mellitus(T2DM)patients.Methods A systematic random sampling method was used to select participants aged more than 50 years with T2DM from endocrinology departments of nine hospitals in Beijing from January 2016 to March 2018,China.Body composition was measured by bioimpedance analysis(BIA).SO was defined according to the consensus of the European Society for Clinical Nutrition and Metabolism(ESPEN)and the European Association for the Study of Obesity(EASO)in 2022,and the other 3 methods defined SO by a combination of sarcopenia and obesity.The criteria established by the Asian Working Group for Sarcopenia 2019(AWGS2019)were used to define sarcopenia.Obesity was defined by three widely used indicators:percent of body fat(PBF),waist circumference(WC),and body mass index(BMI).Chi-square test was used to compare rates,and Cohens kappa was used to analyze the diagnostic consistency of the above four diagnostic methods.Results A total of 1125 T2DM participants were included,consisting of 586 males[age 61.2(55.3,67.4)years]and 539 females[age 62.0(56.3,68.1)years].The prevalence of SO in middle-aged and elderly patients with T2DM was 41.6%,20.4%,30.1%,and 18.8%using the ESPEN/EASO consensus,AWGS+PBF,AWGS+WC,and AWGS+BMI criteria,respectively.There was heterogeneity in the diagnostic consistency among the four methods(κ:0.109-0.655).The ESPEN/EASO consensus had good diagnostic consistency with AWGS+PBF(κ:0.655),AWGS+PBF had good diagnostic consistency with AWGS+BMI(κ:0.637),and AWGS+WC had moderate diagnostic consistency with AWGS+BMI(κ:0.359)and AWGS+PBF(κ:0.330).Conclusions The prevalence of SO in middle-aged and elderly patients with T2DM is high,and there are differences in prevalence and diagnostic consistency among different diagnostic methods.The ESPEN/EASO consensus has the highest diagnostic rate,while AWGS+BMI has the lowest.The ESPEN/EASO

关 键 词：2型糖尿病 肌少症 少肌性肥胖 体质量指数 腰围 

分 类 号：R58[医药卫生—内分泌]