老年2型糖尿病患者骨骼肌质量的检测分析

Detection of skeletal muscle mass in elderly patients with type 2 diabetes

目的检测和分析老年2型糖尿病患者的骨骼肌质量情况。方法回顾性分析浙江大学医学院附属第一医院及其分院自2019年5月1日至2019年9月1日期间接收的85例年龄≥65岁2型糖尿病患者的临床资料,其中男性29例,女性56例,并同期选择老年(年龄≥65岁)健康体检者作为对照,将数据进行1∶1倾向性评分匹配(最终选取男性29例和女性56例纳入对照组)。收集两组老年人的一般资料,分别检测并比较不同性别下两组老年人的四肢骨骼肌质量指数(ASMI)。同时,根据糖化血红蛋白(HbA1c)将糖尿病组患者分为血糖控制良好组(HbA1c<7%)及血糖控制不佳组(HbA1c≥7%),对不同性别下两组患者间ASMI进行比较,并采用Pearson相关分析探究不同性别下2型糖尿病患者HbA1c与ASMI的相关性。结果不同性别下,糖尿病组与对照组老年人的年龄、文化程度、吸烟及饮酒的比较,差异均无统计学意义(P均>0.05)。男性糖尿病组老年人的ASMI较男性对照组明显减低[(8.1±1.0)kg/m^(2) vs.(9.0±0.9)kg/m^(2),t=3.556,P<0.001],女性糖尿病组老年人的ASMI也较女性对照组明显低[(6.5±1.0)kg/m^(2) vs.(7.6±0.9)kg/m^(2),t=6.210,P<0.001]。但是,无论男性2型糖尿病[(8.0±0.8)kg/m^(2) vs.(8.1±1.1)kg/m^(2),t=0.154,P=0.879]还是女性2型糖尿病[(6.5±1.0)kg/m^(2) vs.(6.6±0.9)kg/m^(2),t=0.593,P=0.556]患者,血糖控制良好组与血糖控制不佳组患者ASMI的比较,差异均无统计学意义。且Pearson相关分析显示,男性2型糖尿病(r=-0.081,P=0.677)及女性2型糖尿病(r=-0.079,P=0.564)患者的HbA1c与ASMI均无相关性。结论老年2型糖尿病患者的四肢骨骼肌质量较老年健康人群有所降低。糖尿病可能会损害骨骼肌质量,而血糖控制情况与骨骼肌质量是否相关仍需进一步探讨。

Objective To detect and analyze skeletal muscle mass in elderly patients with type 2 diabetes.Methods Clinical data of the elderly aged≥65 years with type 2 diabetes in the First Affiliated Hospital,Zhejiang University School of Medicine and its branch hospital between May 1st,2019 and September 1st,2019 were retrospectively analyzed.There were 29 male patients and 56 female patients with type 2 diabetes.The healthy elderly at the same time were included in the control group.The data were matched by the 1∶1 propensity score,so 29 males and 56 females were included in the control group finally.Then the appendicular skeletal muscle mass index(ASMI)and clinical data were collected and compared between the two groups under different genders.According to hemoglobin A1c(HbA1c),the patients with type 2 diabetes were divided into the well glycemic controlled group(HbA1c<7%)and the poorly glycemic controlled group(HbA1c≥7%).Then,ASMI was compared between the two groups under different genders.The correlation between HbA1c and ASMI in patients with type 2 diabetes under different genders was investigated by Pearson correlation analysis.Results There were no significant differences in age,degree of education,smoking and drinking habits between the diabetes group and the control group under different genders(all P>0.05).The ASMI was lower in the male diabetes group than in the male control group[(8.1±1.0)kg/m^(2) vs.(9.0±0.9)kg/m^(2),t=3.556,P<0.001].The ASMI was also lower in the female diabetes group comparing with the female control group[(6.5±1.0)kg/m^(2) vs.(7.6±0.9)kg/m^(2),t=6.210,P<0.001].But either in male[(8.0±0.8)kg/m^(2) vs.(8.1±1.1)kg/m^(2),t=0.154,P=0.879]or female[(6.5±1.0)kg/m^(2) vs.(6.6±0.9)kg/m^(2),t=0.593,P=0.556]diabetic patients,there was no significant difference in ASMI between the well glycemic controlled group and the poorly glycemic controlled group.In addition,Pearson correlation analysis showed that there was no correlation between HbA1c and ASMI in male type 2 diabetes(r=-0.081,P=0.677)and female type 2 diabetes(r=-0.079,P=0.564).Conclusions ASMI is lower in patients with type 2 diabetes than in the healthy elderly.Diabetes might reduce muscle mass,while the glycemic control might not be associated with ASMI.