【作者】 张静；

【导师】 李维辛；

【作者基本信息】 兰州大学 ， 临床医学·老年医学（专业学位）， 2023， 硕士

【摘要】 目的:本研究旨在通过比较老年2型糖尿病(T2DM)患者合并或者不合并肌少症时的各指标如体重指数(BMI))、跌倒史(1年内)、锻炼习惯、步速、握力、25-羟维生素D[25(OH)D]及糖化血红蛋白等有无显著差异,探讨老年T2DM患者合并肌少症的相关影响因素及其与25-羟维生素D的关系。方法:收集2021年4月至2022年12月期间兰州大学第一医院内科住院的老年2型糖尿病患者共265例,年龄在60-88岁之间,根据SARC-Cal F量表将研究对象分为两组:糖尿病合并肌少症组(共79例,男性30例、女性49例)和单纯糖尿病组(共186例,男性118例、女性68例)。比较两组人群的一般资料、肌肉测量相关指标,以及25(OH)D等血液学指标的差异。应用SPSS 25.0软件进行统计学分析,探讨老年T2DM患者发生肌少症的相关影响因素以及与25-羟维生素D的关系。结果:1.两组间的一般资料分析:糖尿病合并肌少症组和单纯糖尿病组中独居患者分别占25.3%与14%,差异有统计学意义(p<0.05)。两组中有锻炼习惯的患者分别占48.1%、62.9%,差异有统计学意义(p<0.05)。根据患者是否有1年内跌倒史分类,糖尿病合并肌少症组中有跌倒史(1年内)患者占35.4%,单纯糖尿病组中占14.5%,两组间跌倒史差异也有统计学意义(p<0.05)。糖尿病合并肌少症组与单纯糖尿病组的性别、年龄、居住方式、锻炼习惯、跌倒史(1年内)及BMI差异有统计学意义(p<0.05),而糖尿病病程、ADL评分差异无统计学意义(p>0.05)。2.两组间肌肉测量指标分析:糖尿病合并肌少症组的小腿围、步速及握力明显小于单纯糖尿病组,差异均有统计学意义(p<0.05)。3.两组间血液学指标分析:糖尿病合并肌少症组的25(OH)D水平明显低于单纯糖尿病组,差异有统计学意义(p<0.05);而糖化血红蛋白、空腹血糖、TG、TC、HDL-C和LDL-C的差异无统计学意义(p>0.05)。4.老年T2DM合并肌少症患者的25-羟维生素D水平与步速、握力、糖尿病病程呈正相关,差异有统计学意义(p<0.05);与TC、HDL-C、LDL-C、糖化血红蛋白呈负相关,差异也均有统计学意义(p<0.05)。5.多因素逻辑回归分析:年龄(OR=1.113,p<0.05)、有1年内跌倒史(OR=4.136,p<0.05)是老年T2DM患者合并肌少症的危险因素,25(OH)D(OR=0.876,p<0.05)、小腿围(OR=0.839,p<0.05)、握力(OR=0.935,p<0.05)、有锻炼习惯(OR=0.365,p<0.05)和BMI(OR=0.863,p<0.05)是老年T2DM患者合并肌少症的保护因素。结论:1.老年T2DM患者合并肌少症发生的风险较高,且与25-羟维生素D、年龄、跌倒史(1年内)、锻炼习惯、BMI、握力及小腿围等因素密切相关。2.25-羟维生素D是老年T2DM合并肌少症的重要保护因素,且与肌肉评估指标步速、握力呈正相关。探讨25-羟维生素D与T2DM合并肌少症的关系,对于临床上老年T2DM患者肌少症的防治有重要意义。更多还原

【Abstract】 Objective: The purpose of this study was to investigate the related factors of sarcopenia in elderly patients with T2 DM and its relationship with 25-hydroxyvitamin D by comparing the indexes such as body mass index(BMI),fall history(within 1year),exercise habits,walking speed,grip strength,25-hydroxyvitamin D[25(OH)D]and glycosylated hemoglobin in elderly patients with type 2 diabetes mellitus(T2DM)with or without sarcopenia.Methods: A total of 265 elderly patients with type 2 diabetes,aged 60-88 years,admitted to the Department of Internal Medicine of Lanzhou University First Hospital from April 2021 to December 2022 were collected and divided into two groups according to the SARC-Cal F scale:Diabetes mellitus combined with sarcopenia group(79 cases,30 males and 49 females)and simple diabetes group(186 cases,118 males and 68 females).The differences of general data,muscle-related indicators,and hematological indicators such as 25(OH)D were compared between the two groups.SPSS 25.0 software was used for statistical analysis to explore the related influencing factors of sarcopenia in elderly patients with T2 DM and the relationship with 25-hydroxyvitamin D.Results:1.General data analysis between the two groups: Patients living alone accounted for 25.3% and 14% of patients in the diabetic group combined with sarcopenia and the simple diabetic group,respectively,and the difference was statistically significant(p <0.05).Patients with exercise habits in the two groups accounted for 48.1% and 62.9%,respectively,and the difference was statistically significant(p < 0.05).According to whether the patients had a fall history within 1 year,the patients with a fall history(within 1 year)accounted for 35.4% in the diabetic group combined with sarcopenia,and 14.5% in the simple diabetic group,and the difference in the fall history between the two groups was also statistically significant(p < 0.05).There were statistically significant differences in gender,age,residence style,exercise habits,fall history(within 1 year)and BMI between the diabetic group combined with sarcopenia and the diabetic group alone(p < 0.05),while there were no statistically significant differences in diabetes course and ADL score(p > 0.05).2.Analysis of muscle measurements between the two groups: the calf circumference,walking speed and grip strength of the diabetic group were significantly lower than those of the simple diabetic group,with statistical significance(p < 0.05).3.Analysis of hematological indexes between the two groups: the level of 25(OH)D in the diabetic group combined with sarcopenia was significantly lower than that in the simple diabetic group,and the difference was statistically significant(p <0.05).There were no significant differences in glycosylated hemoglobin,fasting blood glucose,TG,TC,HDL-C and LDL-C(p> 0.05).4.The level of 25-hydroxyvitamin D in elderly patients with T2 DM and sarcopenia was positively correlated with walking speed、grip strength and duration of diabetes,and the differences were statistically significant(p < 0.05).It was negatively correlated with TC 、 HDL-C 、 LDL-C and Hb A1 c,and the differences were also statistically significant(p < 0.05).5.Multivariate logistic regression analysis: Age(OR = 1.113,p < 0.05)and fall history within 1 year(OR = 4.136,p < 0.05)were risk factors for sarcopenia in elderly patients with T2 DM.And 25(OH)D(OR = 0.876,p < 0.05),calf circumference(OR = 0.839,p < 0.05),grip strength(OR = 0.935,p < 0.05),exercise habit(OR = 0.365,p < 0.05)and BMI(OR = 0.863,p < 0.05)were protective factors for sarcopenia in elderly patients with T2 DM.Conclusion:1.Elderly patients with T2 DM have a higher risk of developing sarcopenia,which is closely related to 25-hydroxyvitamin D,age,fall history(within 1 year),exercise habits,BMI,grip strength,calf circumference and other factors.2.25-hydroxyvitamin D is an important protective factor in elderly patients with T2 DM complicated with sarcopenia,and is positively correlated with muscle evaluation indicators as walking speed and grip strength.To investigate the relationship between 25-hydroxyvitamin D and sarcopenia associated with T2 DM may be of great significance for the prevention and treatment of sarcopenia in elderly patients with T2 DM.更多还原