2型糖尿病患者肌少症的相关因素分析
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摘要
目的探讨2型糖尿病患者肌少症的发生情况及其相关因素的关系。方法采用横断面调查方法,选取2015年4月至2015年11月在贵州医科大学附属医院内分泌代谢科住院的2型糖尿病患者450例(男性256例,女性194例)。年龄31～86岁(59.99±11.75)岁。调查一般情况、血液指标及身体成分指标。肌少症根据亚洲肌少症工作组的诊断标准,即以四肢肌肉指数为参照指标:四肢肌量(kg)/身高~2(m~2)(relative skeletal muscle mass index,RASM),男性<7.00 kg/m~2、女性<5.40 kg/m~2。结果肌少症患者有64人,总患病率为14.22%。男女患病率分别为19.14%和7.73%(P<0.05)。肌少症组的年龄和肌酐均高于非肌少症组(P<0.05)。肌少症组的体质指数(body mass index,BMI)、A/G脂肪比值(Android/Gynoid fat ratio)及甘油三酯均低于非肌少症组(P<0.05)。多因素Logistic回归分析显示,校正年龄、性别的混杂因素后,吸烟[OR=2.156,95%CI(1.226～3.790)]为肌少症的危险因素,BMI[OR=0.529,95%CI(0.448～0.625)]、A/G脂肪比值[OR=0.007,95%CI(0.001～0.046)]为肌少症的保护因素。结论吸烟是2型糖尿病患者肌少症的危险因素,BMI和A/G脂肪比值可能是肌少症的保护因素。
Objective To investigate the occurrence of sarcopenia in the patients with type 2 diabetes mellitus(T2 DM) and the relationship of its related factors. Methods Cross-sectional survey was adopted to select 450 T2DM patients(256 males and 194 females) who were hospitalized in the Department of Endocrinology and Metabolism of Affiliated Hospital of Guizhou Medical University from April 2015 to November 2015. Their general conditions, blood indexes, and body composition indexes were investigated. According to the diagnostic criteria of the Asian Working Group on Sarcopenia, sarcopenia was diagnosed with relative skeletal muscle mass index(RASM) described as appendicular muscle mass divided by height square, with male <7.00 kg/m~2 and female <5.40 kg/m~2. Results There were 64 patients suffering from sarcopenia, with a total prevalence rate of 14.22%. The prevalence rate of males and females was 19.14% and 7.73%, respectively(P<0.05). The age was older and creatinine level was higher in the sarcopenia group than the non-sarcopenia group(P<0.05). The body mass index(BMI), android/gynoid(A/G) fat ratio and triglyceride level were significantly lower in the sarcopenia group compared with the non-sarcopenia group(P<0.05). Multivariate logistic regression analysis showed that after correcting confounding factors including age and gender, smoking(OR=2.156, 95%CI: 1.226～3.790) was a risk factor, while BMI(OR=0.529, 95%CI: 0.448～0.625) and A/G fat ratio(OR=0.007, 95%CI: 0.001～0.046) were protective factors for sarcopenia. Conclusion Smoking is a risk factor for sarcopenia in type 2 diabetic patients. BMI and A/G fat ratio may be protective factors for sarcopenia.
Objective To investigate the occurrence of sarcopenia in the patients with type 2 diabetes mellitus(T2 DM) and the relationship of its related factors. Methods Cross-sectional survey was adopted to select 450 T2DM patients(256 males and 194 females) who were hospitalized in the Department of Endocrinology and Metabolism of Affiliated Hospital of Guizhou Medical University from April 2015 to November 2015. Their general conditions, blood indexes, and body composition indexes were investigated. According to the diagnostic criteria of the Asian Working Group on Sarcopenia, sarcopenia was diagnosed with relative skeletal muscle mass index(RASM) described as appendicular muscle mass divided by height square, with male <7.00 kg/m~2 and female <5.40 kg/m~2. Results There were 64 patients suffering from sarcopenia, with a total prevalence rate of 14.22%. The prevalence rate of males and females was 19.14% and 7.73%, respectively(P<0.05). The age was older and creatinine level was higher in the sarcopenia group than the non-sarcopenia group(P<0.05). The body mass index(BMI), android/gynoid(A/G) fat ratio and triglyceride level were significantly lower in the sarcopenia group compared with the non-sarcopenia group(P<0.05). Multivariate logistic regression analysis showed that after correcting confounding factors including age and gender, smoking(OR=2.156, 95%CI: 1.226～3.790) was a risk factor, while BMI(OR=0.529, 95%CI: 0.448～0.625) and A/G fat ratio(OR=0.007, 95%CI: 0.001～0.046) were protective factors for sarcopenia. Conclusion Smoking is a risk factor for sarcopenia in type 2 diabetic patients. BMI and A/G fat ratio may be protective factors for sarcopenia.
引文
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[15] 孙博喻,张冰,林志健,等.腹型肥胖的研究进展[J].中华中医药学刊,2015(1):80-83.DOI:10.13193/j.issn.1673-7717.2015.01.025 SUN B Y,ZHANG B,LIN Z J,et al.Advances in Abdominal Obesity[J].Chin Arch Tradit Chin Med,2015(1):80-83.DOI:10.13193/j.issn.1673-7717.2015.01.025.
[16] SHUSTER A,PATLAS M,PINTHUS J H,et al.The clinical importance of visceral adiposity:A critical review of methods for visceral adipose tissue analysis[J].Br J Radiol,2012,85(1009):1-10.DOI:10.1259/bjr/38447238.
[17] ALBANESE C V,DIESSEL E,GENANT H K.Clinical applications of body composition measurements using DXA[J].J Clin Densitom,2003,6(2):75-85.
[18] FUKUDA T,BOUCHI R,TAKEUCHI T,et al.Sarcopenic obesity assessed using dual energy X-ray absorptiometry (DXA) can predict cardiovascular disease in patients with type 2 diabetes:A retrospective observational study[J].Cardiovasc Diabetol,2018,17(1):55.DOI:10.1186/s12933-018-0700-5.
[2] GOODPASTER B H,PARK S W,HARRIS T B,et al.The loss of skeletal muscle strength,mass,and quality in older adults:the health,aging and body composition study[J].J Gerontol A Biol Sci Med Sci,2006,61(10):1059-1064.DOI:10.1093/gerona/61.10.1059.
[3] TRIERWEILER H,KISIELEWICZ G,HOFFMANN JONASSON T,et al.Sarcopenia:a chronic complication of type 2 diabetes mellitus[J].Diabetol Metab Syndr,2018,10:25.DOI:10.1186/s13098-018-0326-5.
[4] CHEN L K,LIU L K,WOO J,et al.Sarcopenia in asia:consensus report of the Asian working group for sarcopenia[J].J Am Med Dir Assoc,2014,15(2):95-101.DOI:10.1016/j.jamda.2013.11.025.
[5] LEE J J,FREELAND-GRAVES J H,PEPPER M R,et al.Prediction of android and gynoid body adiposity via a three-dimensional stereovision body imaging system and dual-energy X-ray absorptiometry[J].J Am Coll Nutr,2015,34(5):367-377.DOI:10.1080/07315724.2014.966396.
[6] CHENG Q,ZHU X Y,ZHANG X M,et al.A cross-sectional study of loss of muscle mass corresponding to sarcopenia in healthy Chinese men and women:reference values,prevalence,and association with bone mass[J].J Bone Miner Metab,2014,32(1):78-88.DOI:10.1007/s00774-013-0468-3.
[7] HAN P P,KANG L,GUO Q,et al.Prevalence and factors associated with sarcopenia in suburb-dwelling older Chinese using the Asian working group for sarcopenia definition[J].GERONA,2016,71(4):529-535.DOI:10.1093/gerona/glv108.
[8] KIM T N,CHOI K M.Sarcopenia:definition,epidemiology,and pathophysiology[J].J Bone Metab,2013,20(1):1.DOI:10.11005/jbm.2013.20.1.1.
[9] LANDI F,ONDER G,BERNABEI R.Sarcopenia and diabetes:two sides of the same coin[J].J Am Med Dir Assoc,2013,14(8):540-541.DOI:10.1016/j.jamda.2013.05.004.
[10] STEFFL M,BOHANNON R W,SONTAKOVA L,et al.Relationship between sarcopenia and physical activity in older people:A systematic review and meta-analysis[J].CIA,2017,12:835-845.DOI:10.2147/cia.s132940.
[11] 王茜婷,刘梅林.老年冠心病患者合并肌肉减少症的相关性研究[J].临床心血管病杂志,2018,34,(12):1182-1186.DOI:10.13201/j.issn.1001-1439.2018.12.008.WANG X T,LIU M L.Relationship between coronary heart disease and sarcopenia in the elderly[J].J Clin Cardiol,2018,34,(12):1182-1186.DOI:10.13201/j.issn.1001-1439.2018.12.008.
[12] ROM O,KAISARI S,AIZENBUD D,et al.Sarcopenia and smoking:A possible cellular model of cigarette smoke effects on muscle protein breakdown[J].Ann N Y Acad Sci,2012,1259:47-53.DOI:10.1111/j.1749-6632.2012.06532.x.
[13] 张艳,谈玉婷,黄夕夏,张紫欢,白姣姣,张敏,黄一沁,陈洁,王姣锋,保志军.上海市社区老年人肌少症患病率及相关危险因素分析[J].老年医学与保健,2018,24(06):608-613.ZHANG Y,TAN Y T,HUANG X X,et al.Prevalence of sarcopenia and the associated risk factors in community elderly in shanghai[J].Geriatrics & Health Care,2018,24(6)::608-613.
[14] 修双玲,孙丽娜,穆志静,等.老年男性2型糖尿病患者肌少症的相关因素[J].山西医科大学学报,2018,49(12):1479-1482.DOI:10.13753 /j.issn.1007- 6611.2018.12.015.XIU S L,SUN L N,MU Z J,et al.Related factors of sarcopenia in elderly male patients with type 2 diabetes[J].J Shanxi Med Univ,2018,49(12):1479-1482.DOI:10.13753 /j.issn.1007- 6611.2018.12.015.
[15] 孙博喻,张冰,林志健,等.腹型肥胖的研究进展[J].中华中医药学刊,2015(1):80-83.DOI:10.13193/j.issn.1673-7717.2015.01.025 SUN B Y,ZHANG B,LIN Z J,et al.Advances in Abdominal Obesity[J].Chin Arch Tradit Chin Med,2015(1):80-83.DOI:10.13193/j.issn.1673-7717.2015.01.025.
[16] SHUSTER A,PATLAS M,PINTHUS J H,et al.The clinical importance of visceral adiposity:A critical review of methods for visceral adipose tissue analysis[J].Br J Radiol,2012,85(1009):1-10.DOI:10.1259/bjr/38447238.
[17] ALBANESE C V,DIESSEL E,GENANT H K.Clinical applications of body composition measurements using DXA[J].J Clin Densitom,2003,6(2):75-85.
[18] FUKUDA T,BOUCHI R,TAKEUCHI T,et al.Sarcopenic obesity assessed using dual energy X-ray absorptiometry (DXA) can predict cardiovascular disease in patients with type 2 diabetes:A retrospective observational study[J].Cardiovasc Diabetol,2018,17(1):55.DOI:10.1186/s12933-018-0700-5.