WagnerⅡ级糖尿病足患者肌肉减少症发生的影响因素分析

Risk factors of sarcopenia in Wagner grade 2 diabetic foot ulcer

目的 观察WagnerⅡ级糖尿病足患者肌肉减少症的发生及相关影响因素.方法 选取2016年1至12月于东南大学附属中大医院糖尿病足病中心就诊的273例WagnerⅡ级糖尿病足患者为研究对象,根据多频生物电阻抗法、四肢骨骼肌质量指数、JAMAR握力测功器、简短肌肉功能测试等检测指标分成肌肉减少症组（38例）和非肌肉减少症组（235例）.检测2组患者的空腹血糖和餐后2 h血糖、糖化血红蛋白（HbA1c）、总胆固醇、甘油三酯、踝肱指数（ABI）、神经传导速度（NCV）、经皮氧分压（TcPO2）;计算机X线体层摄影计算肌肉面积及密度,分析肌肉减少症发生的相关影响因素.两样本比较采用t检验.结果 研究中肌肉减少症发生率为13.97%（38/273）.2组间在年龄、体质指数（BMI）、HbA1c以及糖尿病病程、NCV、TcPO2、ABI、肌肉面积和密度方面差异有统计学意义（t=0.791-6.196,P〈0.05）.多因素Logistic回归分析发现,年龄、HbA1c、糖尿病病程、NCV、TcPO2、ABI是WagnerⅡ级糖尿病足患者肌肉减少症发生的危险因素（分别为OR=4.281、6.114、2.895、1.093、5.460、1.160,95%CI：1.751-10.543、1.202-31.094、1.185-5.846、1.012-1.180、1.793-16.624、1.020-1.300,均P〈0.05）.结论 高龄、糖尿病病程长且长期血糖控制不佳者,肢体血管、神经功能差的WagnerⅡ级糖尿病足患者易发生肌肉减少症.

Objective To investigate the prevalence and risk factors of sarcopenia in Wagner grade 2 diabetic foot ulcer （DFU）. Methods A total of 273 patients with Wagner grade 2 DFU were recruited from diabetic foot center of Zhongda Hospital, Southeast University in 2016, and divided into sarcopenia group （n=38） and non-sarcopenia group （n=235） according to bioelectrical impedance analysis, appendicular skeletal mass index, short physical performance battery and handgrip strength. Parameters of fasting plasma glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin （HbA1c）, total cholesterol, triglyceride, ankle brachial index （ABI）, nerve conduction velocity （NCV） and transcutaneous oxygen partial pressure （TcPO2） were compared between these 2 groups;muscle area and density were calculated by computed tomography. Results The prevalence of sarcopenia was 13.97% （38/273）. Age, body mass index （BMI）, HbA1c, NCV, diabetic course were significantly different between these two groups （P〈0.05）. Multivariate Logistic regression analysis indicated that age, diabetic course, NCV, TcPO2 and ABI were risk factors of sarcopenia in patients with Wagner grade 2 DFU （OR=4.281, 6.114, 2.895, 1.093, 5.460, 1.160,95%CI：1.751-10.543, 1.202-31.094, 1.185-5.846, 1.012-1.180, 1.793-16.624, 1.020-1.300,all P〈0.05）. Conclusion Sarcopenia tends to present in Wagner grade 2 DFU with advanced age, long diabetic course, long-term poor glucose control and poor vascular and nerval function of extremities.