2型糖尿病患者甘油三酯与高密度脂蛋白胆固醇比值与肌量减少的关系

Association between serum triglyceride to high-density lipoprotein cholesterol ratio and sarcopenia in patients with type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)患者甘油三酯(TG)与高密度脂蛋白胆固醇(HDL-C)比值与肌量减少的关系。方法选取2013年6月至2015年12月于重庆医科大学附属第一医院内分泌内科就诊的1104例T2DM住院患者为研究对象进行回顾性横断面研究。收集所有患者的基本信息、既往史及糖尿病慢性并发症和生化指标。根据2014年亚洲肌少症工作组最新共识诊断标准,肌量减少定义男性为骨骼肌指数(SMI)<7.0 kg/m2,女性为SMI<5.4 kg/m2。经筛选排除后纳入1002例并通过TG/HDL-C比值四分位数分为四组:Q1:≤0.80(250例),Q2:0.81~1.23(250例),Q3:1.24~2.11(253例),Q4:≥2.12(249例)。组间比较采用单因素方差分析、χ²检验和K-W检验。通过TG/HDL-C比值四分位数的二元logistic回归分析计算肌量减少的优势比。结果T2DM患者中,随着TG/HDL-C比值增加,肌量减少检出率逐渐降低,分别为27.6%(69/250)、19.2%(48/250)、18.2%(46/253)、12.0%(30/249),组间差异有统计学意义(χ²=19.22,P<0.01)。TG/HDL-C比值的最低四分位数人群的低密度脂蛋白胆固醇(H=46.239,P<0.01)、总胆固醇(H=37.949,P<0.01)、SMI(F=13.059,P<0.01)最低。与TG/HDL-C比值的最低四分位数相比,校正多个混杂因素后,TG/HDL-C比值的最高四分位数的优势比为0.39(95%可信区间:0.22~0.70),P=0.016。结论较低的TG/HDL-C比值与T2DM患者肌量减少的风险增加相关,且在校正多个混杂因素后,这种趋势仍然存在。

Objective To investigate the association between triglyceride (TG) to high-density lipoprotein-cholesterol (HDL-C) ratio and sarcopenia in patients with type 2 diabetes mellitus (T2DM).Methods A total of 1 104 inpatients with T2DM admitted to Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University from June 2013 to December 2015 were enrolled in this retrospective cross-sectional study. The basic information, medical history, chronic complications of diabetes and biochemical indicators of all patients were collected. According to the latest consensus diagnostic criteria of the Asian sarcopenia working group in 2014, sarcopenia was defined as skeletal muscle index (SMI)<7.0 kg/m2 for males and <5.4 kg/m2 for females. After exclusion, 1 002 cases were enrolled and divided into four groups according to the quartiles of TG/HDL-C ratio: Q1: ≤0.80 (n=250), Q2: 0.81-1.23 (n=250), Q3: 1.24-2.11 (n=253), Q4: ≥2.12(n=249). The detection rate of sarcopenia in each quantile group was measured by Chi-square test, the clinical characteristics of the population were tested by one-way ANOVA, Chi-square test and K-W test. Odds ratio of muscle mass reduction was calculated by binary logistic regression analysis of the quartile of TG/HDL-C ratio.Results In patients with T2DM, with the increase of TG/HDL-C ratio, the detection rate of sarcopenia gradually decreased, which were 27.6% (69/250), 19.2% (48/250), 18.2% (46/253) and 12.0% (30/249) respectively. There was a significant difference between the quartile arrays (χ²=19.22, P<0.01). People with the lowest quartile of TG/HDL-C ratio had the lowest low-density lipoprotein cholesterol (H=46.239, P<0.01), total cholesterol (H=37.949, P<0.01), skeletal muscle index (F=13.059, P<0.01). Compared with the lowest quartile of TG/HDL-C ratio, the odds ratio value (95% confidence interval) of the highest quartile of the TG/HDL-C ratio for muscle mass reducing was 0.39 (0.22-0.70, P=0.016) after adjusting multiple confounding factors.Conclusion The lower TG/HDL-C ratio is associated with increased risk of muscle mass reducing in patients with T2DM, and this trend persists after adjusting for multiple confounding factors.