老年2型糖尿病患者肌少症与早期肾功能减退的关系

The relationship between sarcopenia and early renal dysfunction in elderly with type 2 diabetes mellitus

目的探讨老年2型糖尿病患者肌少症与早期肾功能减退的关系。方法回顾性病例对照研究,选取2018年7月至2019年7月在北京医院老年医学科就诊的60岁及以上2型糖尿病患者198例,根据CKD-EPICr-Cys公式计算的估计肾小球滤过率分为肾功能正常组(CKD 1期)63例和轻度肾功能减退组(CKD 2-3a期)135例。所有受试者均行体格检查、实验室检查和双能X线骨密度检查。结果肾功能正常组患者年龄、体重、体质指数、腹围、肌酐、胱抑素C、尿酸、舒张压、糖尿病和高血压的比例均低于轻度肾功能减退组患者(P<0.05或P<0.01);高密度脂蛋白胆固醇、四肢骨骼肌质量(ASM)、骨骼肌质量指数(SMI)均高于轻度肾功能减退组(P<0.05或P<0.01)。Spearman相关分析结果显示,估计肾小球滤过率与SMI呈正相关(r=0.343,P<0.01)。Logistic回归分析结果显示,体重(OR=1.318,95%CI:1.091~1.594)、尿酸(OR=1.007,95%CI:1.001~1.012)、舒张压(OR=1.072,95%CI:1.033~1.112)、糖尿病(OR=1.075,95%CI:1.013~1.142)均是老年2型糖尿病患者发生早期肾功能减退的危险因素,ASM(OR=0.136,95%CI:0.047~0.392)、SMI(OR=0.778,95%CI:0.703~0.860)为保护因素。结论老年2型糖尿病患者常合并肌少症,肌少症可能与老年2型糖尿病患者早期肾功能减退有关。

Objective To investigate the relationship between sarcopenia and early renal dysfunction in elderly patients with type 2 diabetes mellitus(T2DM).Methods A total of 198 elderly patients with T2DM aged over 60 years undergoing treatment in the Geriatric Department of Beijing Hospital from July 2018 to July 2019 were enrolled in this retrospective case-control study.The estimated glomerular filtration rate(eGFR)is calculated according to the CKD-EPICr-Cys formula.Based on the eGFR,the patients were divided into normal renal function group(n=63,in CKD 1 stage)and mild renal dysfunction group(n=135,in CKD 2-3a stage).All subjects underwent physical examination,laboratory examination and dual energy X-ray bone density examination.Results The age,weight,body mass index,abdominal circumference,serum creatinine,cystatin C,uric acid,diastolic pressure,the proportions of diabetes and hypertension were lower,and the high-density lipoprotein cholesterol,appendicular skeletal muscle mass(ASM)and skeletal muscle mass index(SMI)were higher,in the normal renal function group than in the mild renal dysfunction group(P<0.05 or 0.01).Spearman correlation analysis showed that eGFR was positively correlated with SMI(r=0.343,P<0.01).Logistic regression analysis showed that body weight(OR=1.318,95%CI:1.091-1.594),uric acid(OR=1.007,95%CI:1.001-1.012),diastolic blood pressure(OR=1.072,95%CI:1.033-1.112),years of diabetes(OR=1.075,95%CI:1.013-1.142)were risk factors,and the LSM(OR=0.136,95%CI:0.047-0.392)and SMI(OR=0.778,95%CI:0.703-0.860)were protective factors for the early renal dysfunction in elderly patients with T2DM.Conclusions Elderly patients with T2DM are often co-existed with sarcopenia.Sarcopenia is associated with early renal dysfunction in elderly patients with T2DM.