老年2型糖尿病患者体脂率对肌力和躯体功能的影响

Effect of body fat percentage on muscle strength and physical performance in the elders with type 2 diabetes mellitus

目的探讨老年2型糖尿病(type 2 diabetes mellitus,T2DM)体脂率与肌力及躯体功能的相关性。方法纳入127例于首都医科大学宣武医院内分泌科住院的≥60岁的T2DM患者,测定糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)、25羟维生素D3[25-hydroxyvitamin D3,25(OH)D3],空腹胰岛素(fasting insulin,FINS),C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)浓度。双能X线吸收仪测定受试者体脂率及四肢骨骼肌肌肉质量(appendicular skeletal muscle mass,ASM)。用握力和椅子起坐试验来评价肌肉力量。步速和简易体能状况量表(Short Physical Performance Battery,SPPB)来评价躯体功能。多元线性回归分析体脂率对肌力和躯体功能的影响。结果女性患者体脂率显著高于男性(35.18%±6.32%vs 28.75%±4.48%,P<0.001)。体脂率与ASM、骨骼肌肌肉质量指数(appendicular skeletal muscle massindex,ASMI)、握力、步速、SPPB评分显著负相关,与CRP、胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)、椅子起坐时间正相关(P<0.01)。调整年龄、性别、ASM、HbA1c和高腰围后,体脂率与握力、步速降低相关(分别为β=-33.68,P=0.003;β=-1.316,P=0.002),亦与5次起坐时间增加相关(β=31.60,P=0.011)。结论体脂率与老年2型糖尿病患者的肌力下降及不良的躯体功能显著相关。

Objective To explore the association between body fat percentage and muscle strength and physical performance in old people with type 2 diabetes mellitus(T2DM).Methods A total of 127 old people aged more than 60 years who were admitted in the Department of Endocrinology,Xuanwu Hospital,Capital Medical University were included in the study.Levels of glycosylated hemoglobin A1c(HbA1c),25-hydroxyvitamin D3,[25(OH)D3],fasting insulin(FINS),serum C-reactive protein(CRP)and interleukin-6(IL-6)were measured.Body fat percentage and appendicular skeletal muscle mass(ASM)were assessed by dual energy X-ray absorptiometry(DEXA).Muscle strength was assessed using hand-grip strength(HS)and chair stands test.Gait speed(GS)and the Short Physical Performance Battery(SPPB)were used to evaluate physical performance.Multiple linear regression analysis was used to evaluate the association between fat percentage and muscle strength,physical performance.Results Female participants had higher body fat percentage than male subjects(35.18%±6.32%vs 28.75%±4.48%,P<0.001).Body fat percentage were negatively correlated with ASM,appendicular skeletal muscle mass index(ASMI),hand-grip strength,gait speed,SPPB score,while it was positively correlated with serum levels of CRP,HOMA-IR and chair stands time(P<0.01).After adjusting age,sex,ASM,HbA1c and high waist circumference,body fat percentage was inversely associated with hand-grip strength and gait speed(β=-33.68,P=0.003;β=-1.316,P=0.002,respectively),while it was positively associated with increased chair stands time(β=31.60,P=0.011).Conclusion Body fat percentage were associated with lower muscle strength and poor physical performance in old people with T2DM.