早期2型糖尿病患者上肢下肢脂肪比、四肢躯干肌肉比与胰岛素抵抗的相关性研究  

Correlation between upper and lower limb fat ratio,limb and trunk muscle ratio and insulin resistance in patients with early type 2 diabetes mellitus

作　　者：张琳[1] 田梦园 王俊伟[2] 刘倩[1] 孟东[1] 张雅静[1] Zhang Lin;Tian Mengyuan;Wang Junwei;Liu Qian;Meng Dong;Zhang Yajing(National Health Commission Key Lab of Hormones and Development and Tianjin Key Lab of Metabolic Diseases,Tianjin Medical University Chu Hsien-I Memorial Hospital Metabolic Diseases Department and Institute of Endocrinology,Tianjin 300134,China;National Health Commission Key Lab of Hormones and Development and Tianjin Key Lab of Metabolic Diseases,Tianjin Medical University Chu Hsien-I Memorial Hospital Infection Management Department and Institute of Endocrinology,Tianjin 300134,China)

机构地区：[1]天津医科大学朱宪彝纪念医院代谢病科、天津市内分泌研究所、国家卫健委激素与发育重点实验室、天津市代谢性疾病重点实验室,天津300134 [2]天津医科大学朱宪彝纪念医院感染管理科、天津市内分泌研究所、国家卫健委激素与发育重点实验室、天津市代谢性疾病重点实验室,天津300134

出　　处：《中华糖尿病杂志》2025年第3期335-341,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：天津市教委科研计划项目(2023KJ103);天津市医学重点学科(专科)建设项目(TJYXZDXK-032A)。

摘　　要：目的探讨早期2型糖尿病(T2DM)患者上肢下肢脂肪比、四肢躯干肌肉比与胰岛素抵抗(IR)的相关性。方法该研究为横断面研究。选取2016年8月至2023年3月于天津医科大学朱宪彝纪念医院代谢病科住院的糖尿病病程在5年以内且资料齐全的成人T2DM患者作为研究对象。收集研究对象空腹血糖(FPG)、空腹胰岛素(FINS)、空腹C肽(FCP),测量四肢脂肪含量和肌肉量,以及躯干脂肪含量和肌肉量,根据测量结果计算上肢下肢脂肪比、四肢躯干肌肉比。根据FPG和FINS结果计算稳态模型评估的胰岛素抵抗指数(HOMA-IR),并根据HOMA-IR结果将研究对象分为IR组(HOMA-IR≥3.39)和非IR组(HOMA-IR<3.39)。2组间比较采用两独立样本t检验、Mann-WhitneyU检验或χ^(2)检验,采用二元logistic回归分析法分析IR的影响因素,利用受试者工作特征(ROC)曲线的曲线下面积(AUC)评价上肢下肢脂肪比、四肢躯干肌肉比对IR的预测价值。结果最终共纳入早期T2DM患者260例。其中,非IR组96例,IR组164例。差异性分析结果显示,与非IR组相比,IR组患者的FPG(t=5.425)、FCP(Z=8.439)、上肢下肢脂肪比(Z=5.267)均更高,四肢躯干肌肉比(Z=8.356)更低(均P<0.001)。二元logistic回归分析结果显示,FPG(OR=1.894,95%CI 1.451~2.472)、FCP(OR=10.759,95%CI 4.428~26.145)、上肢下肢脂肪比(OR=2.407,95%CI 1.478~3.918)、四肢躯干肌肉比(OR=0.422,95%CI 0.256~0.697)均是IR的影响因素。ROC曲线分析结果显示,上肢下肢脂肪比、四肢躯干肌肉比预测IR的AUC分别为0.712(95%CI 0.649~0.774)、0.809(95%CI 0.759~0.860)。结论人体成分分布和T2DM患者IR相关,上肢下肢脂肪比、四肢躯干肌肉比均是IR的影响因素,上肢下肢脂肪比、四肢躯干肌肉比对IR具有预测价值。Objective To analyze the correlation between upper and lower limb fat ratio,limb and trunk muscle ratio and insulin resistance(IR)in patients with early type 2 diabetes mellitus(T2DM).Methods A cross-sectional study was used to collect the patients of early-stage T2DM with complete data who were hospitalized in the Department of Metabolic Diseases,Chu Hsien-I Memorial Hospital of Tianjin Medical University from August 2016 to March 2023.The patients′fasting plasma glucose(FPG),fasting insulin(FINS),fasting C-peptide(FCP),upper limbs fat and muscle,lower limbs fat and muscle,trunk fat and muscle were collected,and the upper and lower limb fat ratio,the limb and trunk muscle ratio were calculated.The patients were divided into IR group[homeostasis model assessment of insulin resistance(HOMA-IR)≥3.39]and non-IR group(HOMA-IR<3.39)according to HOMA-IR which was calculated by FPG and FINS.Independent sample t test,Mann-Whitney U test orχ^(2) test were used for comparison between groups,binary logistic regression analysis was performed to evaluate influencing factors of IR,the area under curve(AUC)of receiver operating characteristic(ROC)was performed to test the predictive value of the upper and lower limb fat ratio,the limb and trunk muscle ratio for IR.Results A total of 260 patients with early stage T2DM were enrolled,with 96 patients in the IR group and 164 patients in the non-IR group.The differential analysis showed that compared with non-IR group,patients in IR group had higher FPG(t=5.425),FCP(Z=8.439),and upper and lower limb fat ratio(Z=5.267),and lower limb and trunk muscle ratio(Z=8.356)(P<0.001).Binary logistic regression analysis showed that FPG(OR=1.894,95%CI 1.451-2.472),FCP(OR=10.759,95%CI 4.428-26.145),upper and lower limb fat ratio(OR=2.407,95%CI 1.478-3.918),lower limb and trunk muscle ratio(OR=0.422,95%CI 0.256-0.697)were the influencing factors of IR.ROC curve showed that the AUC of upper and lower limb fat ratio,limb and trunk muscle ratio were 0.712(95%CI 0.649-0.774)and 0.809(95%CI 0.759-

关 键 词：糖尿病 2型 胰岛素抵抗 上肢下肢脂肪比 四肢躯干肌肉比 

分 类 号：R587.1[医药卫生—内分泌]