2型糖尿病合并肌少症的椎体能谱CT参数与骨骼肌参数关系

Relationship between vertebral energy spectrum CT parameters and skeletal muscle parameters in type 2 diabetes mellitus combined with sarcopenia

目的:探讨2型糖尿病(T2DM)合并肌少症的椎体能谱CT参数与骨骼肌参数关系。方法:回顾性分析2021年11月-2022年11月在本院内分泌科住院的69例T2DM患者及在本院就诊的35例非T2DM患者(健康对照组)的临床资料。依据2019肌少症诊断及治疗专家共识中的诊断标准,T2DM患者分为T2DM合并肌少症患者38例和T2DM未合并肌少症患者31例。统计分析三组基线资料和第三腰椎CT参数水平。采用Spearman检验对第三腰椎CT参数进行相关性分析。结果:T2DM患者空腹血糖(FPG)、餐后2小时血糖(2hPG)、糖化血红蛋白(HbA1c)较健康对照组升高,握力、步速、空腹胰岛素(FINS)、空腹C肽(FCP)、餐后2小时C肽(2hCP)较健康对照组下降,差异具有统计学意义(P<0.05)。T2DM合并肌少症组、T2DM未合并肌少症组、健康对照组四肢骨骼肌指数(ASMI)逐渐升高,差异具有统计学意义(P<0.05)。T2DM合并肌少症组第三腰椎椎体40~140 keV单能量CT值、碘(水)、HAP(水)、HAP(脂肪)、钙(水)密度值、λ、骨骼肌面积(SMA)及骨骼肌指数(SMI)较T2DM未合并肌少症组比健康对照组均明显下降,差异有统计学意义(P<0.05)。Spearman相关分析显示40~140 keV单能量CT值、碘(水)、HAP(水)、HAP(脂肪)、钙(水)密度值及λ与SMA、SMI及ASMI均成正相关(P<0.05)。结论:椎体能谱CT参数与骨骼肌参数之间存在明显相关性,椎体能谱CT参数可作为参考指标更简便地评估肌肉质量,进而诊断肌少症。

Objective:To investigate the relationship between vertebral energy spectrum CT parameters and skeletal muscle parameters in type 2 diabetes mellitus(T2DM)combined with sarcopenia.Methods:The clinical data of 69 patients with T2DM hospitalized in our endocrinology department from November 2021 to November 2022 and 35 non-T2DM patients admitted to to the Department of Endocrinology of our hospital from November 2021 to November 2022 and 35 non-T2DM patients(healthy control group)attending our hospital were retrospectively analysed.Based on the diagnostic criteria in the 2019 Expert Consensus on Diagnosis and Treatment of Myasthenia Gravis,38 patients with T2DM combined with myasthenia gravis and 31 patients with T2DM not combined with myasthenia gravis were categorized.The baseline data and third lumbar spine CT parameter levels of the three groups were statistically analysed.Spearman test was used to correlate the third lumbar spine CT parameters.Results:Fasting glucose(FPG),2-hour postprandial glucose(2hPG),and glycosylated hemoglobin(HbA1c)were elevated,and grip strength,step speed,fasting insulin(FINS),fasting C-peptide(FCP),and 2-hour postprandial C-peptide(2hCP)were decreased in patients with T2DM compared with those with healthy controls,and the difference was statistically significant(P<0.05).The appendicular skeletal muscle index(ASMI)gradually increased in the T2DM combined sarcopenia group,T2DM uncomplicated sarcopenia group,and healthy control group,and the difference was statistically significant(P<0.05).The third lumbar vertebrae single energy CT values from 40keV to 140keV,Iodine(Water),HAP(Water),HAP(Fat),Calcium(Water)density values,the slope of spectral Hu curve(λ),skeletal muscle area(SMA),skeletal muscle index(SMI)of the T2DM combined with sarcopenia gravis group were significantly lower than those in the T2DM uncomplicated sarcopenia gravis group and the healthy control group,and the difference was statistically significant(P<0.05).Spearman's correlation analysis showed that the 40~140keV single-energy CT values,Iodine(water),HAP(water),HAP(fat),Calcium(water)density values andλwere significantly positively correlated with SMA,SMI and ASMI(P<0.05).Conclusion:There was a significant correlation between vertebral energy spectrum CT parameters and skeletal muscle parameters,and vertebral energy spectrum CT parameters can be used as a reference index to assess muscle mass more easily and then diagnose sarcopenia.