老年2型糖尿病住院患者肌少症危险因素分析

目的研究肌少症筛查评分在老年2型糖尿病(type 2 diabetes mellitus, T2DM)住院患者中的临床应用，以及肌少症患者的危险因素。方法选取2020年1月—2020年12月同济大学附属同济医院收治的住院T2DM患者共170例，本研究计算了患者的肌少症评分，根据公式得分高低，将所有参与者分为肌少症高风险患者组(n=92)和肌少症低风险患者组(n=78)。分别记录患者的年龄、性别、生活方式；计算患者的腰臀比(waist-to-hip ratio, WHR)、体质量指数(body mass index, BMI)，测量患者的小握力、腿围；检测患者的总蛋白(total protein, TP)、白蛋白(albumin, Alb)、前白蛋白(prealbumin, PA)、空腹血糖(fasting plasma glucose, FPG)、糖化血红蛋白(glycosylated hemoglobin, HbA1c)、胆固醇(total cholesterol, TC)、三酰甘油(triglycerides, TG)、血尿素氮(blood urea nitrogen, BUN)、肌酐(creatinine, Cr)、尿酸(uric acid, UA)、维生素D(vitamin D, Vit D)和淋巴细胞计数(lymphocyte， Ly)。比较两组患者一般情况、营养代谢指标、Vit D水平，并分析老年T2DM肌少症高风险患者的影响因素分析。χ2检验进行率的比较，多因素Logistic回归进行相关性分析。结果两组患者的Ishii评分、年龄、性别、BMI、握力、小腿围、ALB、BUN、Cr、FPG比较，差异均有统计学意义(P＜0.01)。两组患者的WHR比较，差异均有统计学意义(P＜0.05)；相关性分析结果表明: 老年T2DM患者的肌少症评分与年龄、FPG呈正相关(P＜0.05)，与BMI、握力和小腿围呈负相关(P＜0.05)。多因素非条件Logistic回归结果表明，性别、高水平的FPG是老年T2DM肌少症高风险患者的独立危险因素，较高的BMI是肌少症的保护因素。结论对于老年T2DM患者来说，肌少症评分与FPG、BMI均有一定相关性。性别、高水平的FPG是肌少症高风险患者的明确危险因素，较高的BMI是肌少症的保护因素。

Risk factors of sarcopenia in hospitalized elderly patients with type 2 diabetes

ObjectiveTo investigate the risk factors of sarcopenia in elderly hospitalized patients with type 2 diabetes mellitus(T2DM). MethodsA total of 170 elderly T2DM patients admitted to our hospital from January 2020 to December 2020 were enrolled. The of the patients was calculated in this study. According to the sarcopenia scores, there were 92 cases with high risk of sarcopenia(high-risk group) and 78 cases with low risk of sarcopenia(low-risk group). Age, gender and lifestyle of patients were recorded; body mass index(BMI) and waist-to-hip ratio(WHR) were calculated; grasp strength and leg circumference were measured. The fastening blood glucose(FPG), glycosylated hemoglobin(HbA1c), total protein(TP), albumin(Alb), prealbumin(PA), total cholesterol(TC), triglyceride(TG), blood urea nitrogen(BUN), creatinine(Cr), uric acid, vitamin D(Vit D) and lymphocyte count(Ly) were measured. The general condition, nutritional metabolism index and Vit D level of the two groups were compared, and the influencing factors for high risk of sarcopenia in elderly T2DM patients were analyzed with multivariate Logistic regression. ResultsThere were significant differences in Ishii score, age, gender, BMI, grip strength, calf circumference, WHR, Alb, BUN, Cr and FPG between high and low risk groups(P<0.01 or 0.05). Correlation analysis showed that sarcopenia score of elderly T2DM patients was positively correlated with age and FPG(P<0.05); negatively correlated with BMI, grip strength and calf circumference(P<0.05). Multivariate non-conditional Logistic regression showed that gender and high level of FPG were independent risk factors for sarcopenia in elderly T2DM patients, while high BMI was a protective factor for sarcopenia. ConclusionFor elderly T2DM patients, sarcopenia score is correlated with FPG and BMI. Gender and high level of FPG are independent risk factors for sarcopenia, while high BMI is a protective factor.