血清肌酐/胱抑素C比值、小腿围与2型糖尿病合并肌少症的相关性研究

吕铭焱; 梁兰玉; 单清

doi:10.16766/j.cnki.issn.1674-4152.003717

血清肌酐/胱抑素C比值、小腿围与2型糖尿病合并肌少症的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.003717

扬州大学附属医院老年医学科，江苏扬州 225000

基金项目:

江苏省老年健康科研项目 LKM2022024

扬州大学医学创新转化专项基金项目 AHYZUCXTD202107

详细信息

通讯作者:
单清，E-mail: qingshan@yzu.edu.cn

中图分类号: R587.1
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- 被引次数: 0
出版历程
- 收稿日期: 2024-01-23
- 网络出版日期: 2024-12-28

Correlation between serum creatinine/cystatin C ratio, calf circumference and type 2 diabetes with sarcopenia

Department of Geriatrics, the Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, China

摘要

摘要: 目的探讨血清肌酐/胱抑素C比值(CCR)联合小腿围对2型糖尿病(T2DM)合并肌少症的筛查价值。方法纳入2022年12月—2023年6月在扬州大学附属医院内分泌科诊断为2型糖尿病的276例患者资料，根据JSH标准将其分为肌少症组和非肌少症组。采用Spearman相关分析研究CCR与影响肌少症的指标之间的关系。通过二元logistic回归的逐步回归法分析CCR值影响肌少症发病的风险。采用受试者工作特征(ROC)曲线分析CCR、小腿围单独及联合检测筛查2型糖尿病合并肌少症的价值。结果本研究2型糖尿病合并肌少症的患病率为14.13%(39/276)。CCR与BMI、尿肌酐(UCR)、第12胸椎水平竖脊肌面积(T₁₂ CSA)、第三腰椎水平的骨骼肌质量指数(L₃ SMI)、小腿围均呈正相关关系(P < 0.05)，与年龄、胱抑素C(CysC)、尿白蛋白与肌酐的比值(ACR)均呈负相关关系(P < 0.05)。研究采用双向逐步法的二分类logistic回归分析得出BMI、糖尿病周围血管病变病史、ACR、CCR、总胆固醇(TC)、小腿围均是2型糖尿病合并肌少症的危险因素(P < 0.05)。ROC曲线分析得出CCR联合小腿围预测糖尿病合并肌少症的AUC为0.817，灵敏度和特异度分别为91.1%和56.4%，约登指数为0.475。结论 CCR和小腿围与糖尿病合并肌少症的发生密切相关，CCR结合小腿围将成为2型糖尿病患者早期筛查肌少症的有效指标。
- 2型糖尿病 /
- 肌少症 /
- 血清肌酐与胱抑素C比值 /
- 骨骼肌指数 /
- 小腿围
Abstract: Objective To investigate the value of serum creatinine/cystatin C ratio (CCR) combined with calf circumference for screening type 2 diabetes mellitus combined with sarcopenia. Methods The data of 276 patients with type 2 diabetes diagnosed in the Department of Endocrinology of the Affiliated Hospital of Yangzhou University from December 2022 to June 2023 were included, and they were divided into a sarcopenia group and a non-sarcopenia group according to the JSH standard. Spearman correlation analysis was used to study the relationship between CCR and indicators affecting sarcopenia. The risk of CCR value affecting the incidence of sarcopenia was analyzed by stepwise regression of binary logistic regression. The receiver operating characteristic (ROC) curve was used to analyze the value of CCR, and calf circumference alone and jointly in screening type 2 diabetes with sarcopenia. Results The prevalence of type 2 diabetes mellitus with sarcopenia in this study was 14.13% (39/276). CCR was positively correlated with BMI, urinary creatinine (UCR), erector spinae muscle area (T₁₂ CSA) at the 12th thoracic vertebra level, skeletal muscle mass index (L₃ SMI) at the third lumbar vertebra level, and calf circumference (P < 0.05), and negatively correlated with age, CysC and urinary albumin to creatinine ratio (ACR, P < 0.05). The study used two-way stepwise binary logistic regression analysis to obtain BMI, history of diabetes peripheral vascular disease, ACR, CCR, total cholesterol (TC), and calf circumference were all risk factors for type 2 diabetes with sarcopenia (P < 0.05). ROC curve analysis showed that the AUC of CCR combined with calf circumference to predict diabetes with sarcopenia was 0.817, the sensitivity and specificity were 91.1% and 56.4%, respectively, and the Yoden index was 0.475. Conclusion CCR and calf circumference are closely related to the occurrence of sarcopenia in diabetes. CCR combined with calf circumference will become an effective indicator for early screening of sarcopenia in patients with type 2 diabetes.
- Type 2 diabetes mellitus /
- Sarcopenia /
- Serum creatinine to cystatin C ratio /
- Skeletal muscle index /
- Calf circumference

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图 1 胸部CT第12胸椎体中心层面T₁₂ CSA勾画示意图

Figure 1. Schematic diagram of T₁₂ CSA in the central plane of the 12th thoracic vertebra on chest CT

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图 2 CCR、小腿围及联合预测肌少症的ROC曲线

Figure 2. CCR, calf circumference, and combined predictive ROC curve for sarcopenia

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表 1 肌少症组与非肌少症组研究对象一般资料比较

Table 1. Comparison of general data between the sarcopenia group and the non-sarcopenia group

项目		总体	肌少症组(39例)	非肌少症组(237例)	统计量	P值
性别[例(%)]	男性	169(61.23)	14(35.90)	155(65.40)	12.280^a	< 0.001
	女性	107(38.77)	25(64.10)	82(34.60)
年龄(x±s，岁)		60.20±10.99	66.03±8.97	59.24±11.02	3.653^b	< 0.001
身高[M(P₂₅, P₇₅)，m]		1.69(1.60, 1.72)	1.60(1.56, 1.69)	1.70(1.61, 1.72)	4.061^c	< 0.001
体重(x±s，kg)		68.87±10.42	59.33±8.83	70.43±9.82	6.630^b	< 0.001
BMI[M(P25，P75)]		24.67(22.84, 26.23)	22.31(20.73, 24.77)	24.77(23.26, 26.40)	4.232^c	< 0.001
脑梗死[例(%)]	是	77(27.90)	18(46.15)	59(24.89)	7.524^a	0.006
	否	199(72.10)	21(53.85)	178(75.11)
PAD[例(%)]	是	237(85.87)	38(97.44)	199(83.97)	5.008^a	0.025
	否	39(14.13)	1(2.56)	38(16.03)
小腿围[M(P₂₅, P₇₅)，cm]		34.75(33.00, 36.50)	31.50(30.00, 34.00)	35.00(33.00, 37.00)	5.914^c	< 0.001
注：^a为χ²值，^b为t值，c为Z值。

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表 2 肌少症组与非肌少症组实验室检查资料比较

Table 2. Comparison of laboratory examination data between the sarcopenia group and the non-sarcopenia group

组别	例数	RBC (x±s，×10¹²L)	Hb (x±s，g/L)	FC-P [M(P₂₅, P₇₅)，pmol/L]	ALT [M(P₂₅, P₇₅)，U/L]	CysC [M(P₂₅, P₇₅)，mg/L]
肌少症组	39	4.26±0.57	126.64±15.20	348.70(194.57, 527.21)	14.50(10.65, 24.00)	0.96(0.80, 1.06)
非肌少症组	237	4.56±0.51	137.28±15.56	446.55(246.18, 680.39)	20.20(14.20, 27.00)	0.84(0.70, 0.99)
统计量		3.325^a	3.968^a	2.080^b	2.967^b	2.796^b
P值		0.001	<0.001	0.037	0.003	0.005

组别	例数	CCR [M(P₂₅, P₇₅)]		UCR [M(P₂₅, P₇₅)，mg/L]	ACR [M(P₂₅, P₇₅)，mg/g]	TG [M(P₂₅, P₇₅)，mmol/L]
肌少症组	39	0.72(0.63, 0.81)		627.84(468.88, 1031.97)	27.61(15.47, 94.75)	1.32(0.80, 1.99)
非肌少症组	237	0.87(0.76, 1.03)		980.20(673.16, 1422.03)	16.25(10.94, 32.52)	1.63(1.11, 2.44)
统计量		4.937^b		4.106^b	2.880^b	2.441^b
P值		< 0.001		< 0.001	0.004	0.015
注：^a为t值，^b为Z值。

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表 3 T2DM肌少症与非肌少症组肌肉量及肌力的比较

Table 3. Comparison of muscle mass and muscle strength between the T2DM sarcopenia group and the non-sarcopenia group

组别	例数	T₁₂ CSA (x±s，cm²)	T₁₂肌肉密度[M(P₂₅, P₇₅)，HU]	L₃ SMI (x±s，cm²/m²)	握力(x±s，kg)	小腿围[M(P₂₅, P₇₅)，cm]
肌少症组	39	22.58±5.52	34.87(26.99，42.06)	33.44±4.54	16.56±5.63	31.50(30.00, 34.00)
非肌少症组	237	33.02±7.71	40.30(33.05，45.84)	42.48±6.87	31.22±8.89	35.00(33.00, 37.00)
统计量		10.276^a	2.589^b	10.588^a	13.702^a	5.914^b
P值		< 0.001	0.010	< 0.001	< 0.001	< 0.001
注：^a为t值，^b为Z值。

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表 4 肌少症危险因素的二元logistic回归分析

Table 4. Binary logistic regression analysis of risk factors for sarcopenia

变量	B	SE	Waldχ²	OR(95% CI)	P值
BMI(kg/m²)	-0.179	0.083	4.631	0.836(0.710，0.984)	0.031
PAD	2.531	1.176	4.633	12.562(1.254，125.849)	0.031
CCR	-3.386	1.545	4.807	0.034(0.002，0.698)	0.028
ACR(mg/g)	0.001	0.000	4.127	1.001(1.000，1.002)	0.042
TC	-0.506	0.236	0.236	0.603(0.379，0.958)	0.032
小腿围	-0.298	0.082	13.174	0.742(0.632，0.872)	< 0.001

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