2型糖尿病人群中非酒精性脂肪性肝病与肌少症的相关性研究

Study on the relationship between non-alcoholic fatty liver disease and sarcopenia in type 2 diabetes mellitus

目的探究2型糖尿病患者中非酒精性脂肪性肝病(NAFLD)与肌少症的相关性。方法该横断面研究纳入了从2013年6月到2015年12月在重庆医科大学附属第一医院内分泌科住院的792例2型糖尿病患者,均完善肝脏超声检查并采用双能X射线吸收测定法检查身体组分。根据性别及是否合并NAFLD将患者进行分组,收集患者的年龄、糖尿病病程、体质量指数、腰围、生化指标、骨骼肌质量指数(SMI)、肌少症患病率、用药情况等指标。对数据进行独立样本t检验、两样本Kolmogorov-Smirnov检验或χ^(2)检验;用logistic回归模型分析不同性别糖尿病患者中NAFLD与肌少症及SMI的相关性。结果792例患者的年龄为(64.54±9.61)岁,NAFLD患者301例(38%)。男性和女性NAFLD患者中肌少症的患病率均显著高于非NAFLD患者(男性20.2%与9.9%,χ^(2)=9.67,P=0.002;女性12.2%与5.1%,χ^(2)=5.64,P=0.018)。NAFLD患者中男性SMI(30.92±2.31与31.81±2.17,P<0.001)和女性SMI(25.48±2.14与26.34±2.28,P<0.001)均显著低于非NAFLD患者。多因素logistic回归模型分析提示男性2型糖尿病患者中肌少症是NAFLD的独立危险因素(OR=2.006,95%CI:1.012~3.976,P=0.046),女性患者在调整临床危险因素后肌少症与NAFLD不存在相关性。结论男性2型糖尿病患者中肌少症与NAFLD存在独立相关性,肌少症可能是男性NAFLD患者的独立危险因素。

Objective To explore the relationship between non-alcoholic fatty liver disease and sarcopenia in patients with type 2 diabetes mellitus.Methods 792 cases with type 2 diabetes mellitus who were hospitalized in the Endocrinology Department of the First Affiliated Hospital of Chongqing Medical University from June 2013 to December 2015 were enrolled in this cross-sectional study.Liver ultrasound examination and dual-energy X-ray absorptiometry(DXA)were used to examine the body composition.Patients were grouped according to gender and whether or not they had combined NAFLD,and indicators such as age,duration of diabetes,body mass index(BMI),waist circumference,biochemical indicators,skeletal muscle mass index(SMI),prevalence of sarcopenia,and medication status were collected.An independent-sample t-test,two-sample Kolmogorov-Smirnov test or χ^(2) test were performed on the data.Logistic regression model was used to analyze the correlation between NAFLD,sarcopenia and SMI in diabetic patients of different genders.Results The average age of 792 cases were(64.54±9.61)years,and there were 301(38%)patients with NAFLD.The prevalence of sarcopenia in male and female NAFLD patients was significantly higher than non-NAFLD patients(male 20.2%and 9.9%,χ^(2)=9-67,P=0.002;female 12.2%and 5.1%,χ^(2)=5.64,P=0.018).Male SMI(30.92±2.31 and 31.81±2.17,P<0.001)and female SMI(25.48±2.14 and 26.34±2.28,P<0.001)in NAFLD patients were significantly lower than non-NAFLD patients.Multivariate logistic regression analysis showed that sarcopenia was an independent risk factor for NAFLD in male patients with type 2 diabetes mellitus(OR=2.006,95%CI:1.012~3.976,P=0.046).There was no correlation between sarcopenia and NAFLD in female patients after adjusting for clinical risk factors.Conclusion There is an independent correlation between sarcopenia and NAFLD in male patients with type 2 diabetes,and sarcopenia may be an independent risk factor for male patients with NAFLD.