营养干预与运动康复治疗改善老年2型糖尿病患者肌少症的研究

Efficacy of nutritional intervention and exercise rehabilitation therapy on sarcopenia in elderly patients with type 2 diabetes mellitus

目的观察营养干预、运动康复治疗对老年2型糖尿病合并肌少症患者的影响。方法本研究是横断面研究。选取2019年3月至2020年9月天津市第三中心医院内分泌科住院治疗的101例老年2型糖尿病合并肌少症患者,利用倾向性评分匹配分为健康宣教无营养及运动干预组(A组,22例)、单纯营养干预组(B组,28例)、营养干预联合抗阻训练组(C组,27例)、营养干预联合抗阻及有氧训练组(D组,24例)。4组均持续干预24周,试验中因患者自身原因C、D两组分别有2名脱落,分别于干预前后测定4组患者的25羟维生素D3[25(OH)D3]水平、握力、四肢骨骼肌质量指数、简易体能状况量表(SPPB)评分。结果B、C、D等3组患者干预后25(OH)D3水平分别为(33.45±4.05)、(33.68±4.69)、(34.28±5.58)μg/L,均较治疗前升高(均P<0.01),组间差异无统计学意义(P>0.05);B、C、D等3组患者干预后肌量分别为5.650(5.102,6.658)、6.601(6.007,7.156)和6.520(6.017,7.302)kg/m2,均较干预前有所提高(均P<0.01),其中C、D组较B组肌量增加更明显(均P<0.01),但C、D两组间比较差异无统计学意义(P>0.05);C、D两组患者干预后肌力分别为20.60(19.20,24.55)和21.15(19.43,26.63)kg,干预后的SPPB功能评分分别为8.00(7.00,9.00)和8.00(8.00,9.00)分,较干预前均有所增长(均P<0.01),但两组间比较差异均无统计学意义(均P>0.05);D组SPPB评分优于C组,差异有统计学意义(P<0.05)。结论营养干预可以改善老年2型糖尿病合并肌少症患者的肌量;若联合康复训练,对这类患者的肌力、肌肉功能也有改善,且对肌量的改善优于单纯营养干预;增加肌力方面,两种运动模式相当;联合有氧运动同时还可以改善这类患者的肌肉功能。

Objective To observe the effect of nutrition intervention and exercise rehabilitation treatment on the sarcopenia in elderly patients with type 2 diabetes.Methods It was a cross-sectional study.From March 2019 to September 2020,101 elderly patients with type 2 diabetes complicated with sarcopenia treated in the Department of Endocrinology of Tianjin Third Central Hospital were enrolled in this study.The patients were divided into four groups with propensity score matching method:sarcopenia education group without nutrition and resistance training group(group A,n=22),simple nutrition intervention group(group B,n=28),nutritional intervention combined with resistance training group(group C,n=27)and nutritional intervention combined with aerobic and resistance training group(group D,n=24).All the patients were intervened for 24 weeks,two patients in groups C and D dropped due to their own reasons.The 25-dihydroxy vitamin D3(25(OH)D3),grip strength,muscle mass of the limbs and short physical performance battery(SPPB)scores were measured before and 24 weeks after the intervention in all the participants.Results After the intervention,the 25(OH)D3 levels in the B,C,D groups was(33.45±4.05),(33.68±4.69),(34.28±5.58)μg/L,respectively,all were higher than those before the treatment(all P<0.01),and there was no significant differences among the three groups(P>0.05).The muscle mass in the B,C,D groups after intervention was 5.650(5.102,6.658),6.601(6.007,7.156)and 6.520(6.017,7.302)kg/m2,respectively,all were significantly higher than those before the treatment(all P<0.01);the muscle mass in group C and D increased more significantly than that in group B(P<0.01),but there was no significant differences between group C and D(P>0.05).After the intervention,the muscle strength in the C and D groups was 20.60(19.20,24.55)kg and 21.15(19.43,26.63)kg,and the SPPB scores was 8.00(7.00,9.00)points and 8.00(8.00,9.00)points,respectively,all were higher than those before the intervention(all P<0.01),but there was no significant differences between the two groups(both P>0.05).The SPPB function score in group D was better than that in group C,the difference was statistically significant(P<0.05).Conclusions Nutritional intervention can improve the muscle mass in elderly type 2 diabetes patients with sarcopenia.Combined with rehabilitation training,the muscle strength and muscle function of these patients could also be improved,and the improvement of muscle mass is better than that in patients receiving nutritional intervention only.In terms of increasing muscle strength,the two kinds of rehabilitation training are equivalent.If combined with aerobic exercise,it can also improve the muscle function of these patients.