不同方法校正的肌肉质量与老年2型糖尿病躯体功能的相关性比较

目的 探索不同方法校正的肌肉质量与老年2型糖尿病(type 2 diabetes mellitus, T2DM)躯体功能的相关性。方法 纳入首都医科大学宣武医院内分泌科≥60岁的T2DM患者248例,测定血红蛋白(hemoglobin, Hb),糖化血红蛋白(glycosylated hemoglobin A1c, HbA1c)、空腹血糖(fasting plasma glucose, FPG),维生素D、握力、步速、起立行走计时(timed go and up, TUG)测试时间,计算体质量指数(body mass index, BMI)。并用双能X线吸收检测仪测定四肢骨骼肌肌肉质量(appendicular skeletal muscle mass, ASM),分别用身高(height, ht)的平方(ASM/ht²)和BMI(ASM/BMI)两种方法对肌肉质量校正,分析躯体功能的影响因素。结果 偏相关分析结果显示, ASM/BMI均与握力、步速、TUG时间显著相关(分别为r=0.636, P<0.001;r=0.191, P=0.003;r=- 0.143, P=0.026),而ASM/ht²仅与握力相关(r=0.513, P<0.001)。多元Logistic回归分析结果显示,低ASM/BMI显著影响患者的步速和TUG时间(分别为OR=4.73,95%CI: 1.54~14.60,P=0.007; OR=2.92,95%CI: 1.12~7.63,P=0.029),而ASM/ht²对患者躯体功能无显著影响。结论 低ASM/BMI而不是低ASM/ht²与老年T2DM患者差的躯体功能相关,ASM/BMI可能是更适合于T2DM患者的肌肉质量校正方法。

Comparison of the correlation between muscle mass corrected by different methods and physical function in older adults with type 2 diabetes mellitus

Objective To explore effects of muscle mass modified by different methods on physical function in old people with type 2 diabetes mellitus (T2DM). Methods A total of 248 old people with T2DM aged more than 60 years were included in the study. Levels of hemoglobin(Hb), glycosylated hemoglobin A1c(HbA1c), fasting plasma glucose (FPG), vitamin D were measured and grip strength, gait speed, timed go and up (TUG) time were assessed. Body mass index (BMI) was calculated. Furthermore, appendicular skeletal muscle mass(ASM) was assessed by dual energy X-ray absorptiometry (DXA) and were adjusted by height square (ASM/ht²) and BMI (ASM/BMI) accordingly. The influencing factors for physical function were evaluated. Results The partial correlation analysis showed that ASM/BMI was associated with grip strength, gait speed and TUG time (r=0.636, P<0.001;r=0.191, P=0.003;r=- 0.143, P=0.026; respectively), while ASM/ht² was only associated with grip strength (r=0.513, P<0.001). In a multiple logistic analysis, low ASM/BMI was associated with increased risk of low gait speed and long TUG time (OR=4.73,95%CI: 1.54-14.60,P=0.007; OR=2.92,95%CI: 1.12-7.63,P=0.029, respectively), while ASM/ht² had no significant effect on physical function. Conclusion Low ASM/BMI but not low ASM/ht² was significantly associated with poor physical function in older adults with T2DM. ASM/BMI may be a more suitable method of muscle mass correction for T2DM patients.