老年2型糖尿病患者肌量水平与胰岛B细胞功能的相关性研究

Relationship between skeletal muscle mass and pancreatic B cell function in elderly patients with type 2 diabetes

目的探讨老年2型糖尿病(T2DM)患者肌量水平与胰岛B细胞功能的关系。方法收集2017年10月至2018年12月南通大学附属医院内分泌科收治的147例老年T2DM患者的临床资料。根据男性骨骼肌质量指数(skeletal muscle index,SMI)<7.0 kg/m2,女性SMI<5.4 kg/m2,即认为存在肌量减少,将147例患者分为肌量减少组(n=54)和肌量正常组(n=93)。比较两组患者的一般资料,检测患者的空腹胰岛素(FINS)、空腹C肽(FCP)、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-B)、胰岛素生成指数30(IGI30)、处置指数30(DI30),并分析肌量与上述指标之间的相关性。结果肌量减少组男性比例63.0%,显著高于肌量正常组(30.1%),P<0.05;肌量减少组患者FINS、FCP、HOMA-IR、HOMA-B、IGI30、DI30水平均低于肌量正常组(P<0.05)。控制了混杂因素后,男性SMI与FCP、HOMA-B呈显著正相关(r=0.324,P=0.014;r=0.301,P=0.024)。女性SMI与胰岛B细胞功能各指标无明显相关性(P>0.05)。结论在老年T2DM患者中,低肌量水平的男性,更容易导致胰岛B细胞功能的丢失,因此临床上分析胰岛B细胞功能减退与其他并发症相关的时候,也不能忽视其与肌量丢失的相关性。

Objective To investigate the relationship between skeletal muscle mass and pancreatic B cell function in elderly patients with type 2 diabetes mellitus(T2DM).Methods Clinical data of 147 elderly T2DM patients,who were treated in the Department of Endocrinology,the Affiliated Hospital of Nantong University from October 2017 to December 2018,were collected.Men with skeletal muscle index(SMI)<7.0 kg/m2 and women with SMI<5.4 kg/m2 were considered to have muscle wasting,and the 147 patients were divided into reduced muscle mass group(n=54)and normal muscle mass group(n=93).The general data of the two groups were compared,and the fasting insulin(FINS),fasting c-peptide(FCP),insulin resistance index(HOMA-IR),insulin secretion index(HOMA-B),insulinogenic index 30(IGI30),and disposal index 30(DI30)were detected,then the correlation between muscle mass and the above indexes were analyzed.Results The proportion of males in the reduced muscle mass group was 63.0%,significantly higher than that in the normal muscle mass group(30.1%),P<0.05.The levels of FINS,FCP,HOMA-IR,HOMA-B,IGI30 and DI30 in the reduced muscle mass group were all lower than those in the normal muscle mass group(P<0.05).After controlling for several confounders,SMI was positively correlated with FCP and HOMA-B(r=0.324,P=0.014;r=0.301,P=0.024),and there was no significant correlation between SMI and pancreatic B cell function in women(P>0.05).Conclusions In elderly patients with T2DM,men with low skeletal muscle mass are more likely to lose the function of pancreatic B cell,thus we can not ignore the relationship between pancreatic B cell function and muscle mass when we analyzing the correlation between decreased pancreatic B cell function and other complications.