老年2型糖尿病患者血清Metrnl、E-FABP水平与肌少症的相关性分析

Correlation between serum Metrnl,E-FABP levels and myopenia in elderly patients with type 2 diabetes

目的探究血清镍纹样蛋白(Metrnl)、上皮型脂肪酸结合蛋白(E-FABP)水平与老年2型糖尿病(T2DM)患者合并肌少症的相关性。方法选取2020年5月—2023年7月武汉市汉阳医院老年病科治疗T2DM患者241例为研究对象,根据是否合并肌少症分为肌少症组55例和无肌少症组186例。采用酶联免疫吸附法检测血清Metrnl水平,化学发光免疫分析法检测血清E-FABP水平;比较2组患者血清Metrnl、E-FABP水平;Pearson相关性分析血清Metrnl、E-FABP水平与T2DM合并肌少症特征的相关性;受试者工作特征(ROC)曲线分析血清Metrnl、E-FABP水平预测T2DM合并肌少症的价值;Logistic多因素回归分析T2DM合并肌少症的影响因素。结果肌少症组血清E-FABP、T2DM病程、胰岛素抵抗指数(HOMA-IR)、肌少症-5(SARC-F)评分高于无肌少症组,血清Metrnl、体质量指数(BMI)、步速、握力、四肢骨骼肌质量指数(ASMI)显著低于无肌少症组(t/P=8.839/<0.001、5.723/<0.001、6.116/<0.001、28.237/<0.001、8.825/<0.001、3.605/<0.001、2.814/0.005、15.449/<0.001、8.111/<0.001)。血清Metrnl水平与肌少症患者BMI、步速、握力、ASMI呈正相关(r/P=0.512/<0.001、0.509/<0.001、0.524/<0.001、0.498/<0.001),与T2DM病程、HOMA-IR、SARC-F评分呈负相关(r/P=-0.486/<0.001、-0.497/<0.001、-0.527/<0.001);E-FABP水平与BMI、步速、握力、ASMI呈负相关(r/P=-0.510/<0.001、-0.519/<0.001、-0.496/<0.001、-0.494/<0.001),并且与T2DM病程、HOMA-IR、SARC-F评分呈正相关(r/P=0.501/<0.001、0.504/<0.001、0.492/<0.001)。血清Metrnl、E-FABP及二者联合评估T2DM合并肌少症的AUC分别为0.816、0.822、0.896,二者联合预测AUC高于Metrnl、E-FABP单独预测AUC(Z/P=1.960/0.015、1.976/0.022)。E-FABP升高为T2DM发生肌少症的独立危险因素,Metrnl升高为T2DM发生肌少症的保护因素[OR(95%CI)=2.932(1.347~6.384)、0.755(0.623~0.915),均P<0.01]。结论老年T2DM合并肌少症患者血清Metrnl水平降低,E-FABP水平升高,二者与肌少症的发生密切相关。

Objective To explore the correlation between serum nickel striated protein(Metrnl),epithelial fatty acid binding protein(E-FABP)levels and myopenia in elderly patients with type 2 diabetes(T2DM).Methods Two hundred and forty-one patients with T2DM treated in the geriatric department of Hanyang Hospital in Wuhan from May 2020 to July 2023 were selected as the research subjects.They were divided into a sarcopenia group of 55 cases and a non sarcopenia group of 186 cases based on whether they were complicated with sarcopenia.Enzyme linked immunosorbent assay was used to detect serum Metrnl levels,and chemiluminescence immunoassay was used to detect serum E-FABP levels;Compare the serum Metrnl and E-FABP levels between two groups of patients;Pearson correlation analysis of the correlation between serum Metrnl,E-FABP levels and the characteristics of T2DM with sarcopenia;The value of Receiver Operating Characteristic(ROC)curve analysis of serum Metrnl and E-FABP levels in predicting T2DM with sarcopenia;Logistic multiple regression analysis of the influencing factors of T2DM with sarcopenia.Results The serum E-FABP,T2DM course,HOMA-IR,and SARC-F scores in the sarcopenia group were higher than those in the non sarcopenia group,while serum Metrnl,body mass index(BMI),gait speed,grip strength,and limb skeletal muscle mass index(ASMI)were lower than those in the non sarcopenia group(t/P=8.839/<0.001,5.723/<0.001,6.116/<0.001,28.237/<0.001,8.825/<0.001,3.605/<0.001,2.814/0.005,15.449/<0.001,8.111/<0.001).The serum Metrnl level is positively correlated with BMI,walking speed,grip strength,and ASMI in patients with sarcopenia(r/P=0.512/<0.001,0.509/<0.001,0.524/<0.001,0.498/<0.001);It is negatively correlated with the course of T2DM,HOMA-IR,and SARC-F scores(r/P=-0.486/<0.001,-0.497/<0.001,-0.527/<0.001);The level of E-FABP is negatively correlated with BMI,walking speed,grip strength,and ASMI(r/P=-0.510/<0.001,-0.519/<0.001,-0.496/<0.001,-0.494/<0.001);There is a positive correlation between the course of T2DM,HOMA-IR,and SARC-F scores(r/P=0.501/<0.001,0.504/<0.001,0.492/<0.001).The AUC of T2DM with sarcopenia evaluated by serum Metrnl,E-FABP,and their combination were 0.816,0.822,and 0.896,respectively.The combined prediction of AUC was higher than that of Metrnl and E-FABP alone(Z=1.960,1.976,P=0.015,0.022).Elevated E-FABP is an independent risk factor for sarcopenia in T2DM,while elevated Metrnl is a protective factor for sarcopenia in T2DM[OR(95%CI)=2.932(1.347-6.384),0.755(0.623-0.915),all P<0.01].Conclusion The serum Metrnl levels decrease and E-FABP levels increase in elderly T2DM patients with sarcopenia,which are closely related to the occurrence of sarcopenia.