老年2型糖尿病合并营养不良患者与肌少症高风险的影响因素分析

谢明慧; 梁冰; 金国玺; 魏娜娜; 刘雨润

doi:10.16766/j.cnki.issn.1674-4152.003836

老年2型糖尿病合并营养不良患者与肌少症高风险的影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003836

1.
蚌埠医科大学第一附属医院全科医学科，安徽蚌埠 233004
2.
蚌埠医科大学第一附属医院内分泌科

基金项目:

安徽省临床医学研究转化专项项目 202204295107020049

蚌埠医学院科研计划项目 2020byzd168

详细信息

通讯作者:
梁冰，E-mail：407281726@qq.com

中图分类号: R587.1 R685
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出版历程
- 收稿日期: 2024-05-27
- 网络出版日期: 2025-02-13

Analysis of factors influencing high risk of type 2 diabetes mellitus combined with malnutrition and sarcopenia in elderly patients

1.
Department of General Practice, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的调查老年2型糖尿病(T2DM)合并营养不良患者出现肌少症高风险的现状，多方面分析发生肌少症的原因。方法选取2023年9月—2024年4月于蚌埠医科大学第一附属医院住院的212例老年T2DM合并营养不良患者(≥60岁)为研究对象，采用微型营养筛查量表(MNA-SF)筛查出营养不良者，测量小腿围和握力计算Ishii评分，根据得分分为肌少症高风险组(142例)和肌少症低风险组(70例)并进行组间比较，采用多因素logistic回归分析出现肌少症高风险的影响因素。结果老年T2DM合并营养不良患者的肌少症高、低风险组间比较显示，年龄、BMI、血红蛋白(Hb)、前白蛋白(PA)、24小时尿微量白蛋白(24hUMA)、胰岛素抵抗指数(HOMA-IR)、胰岛素(INS)、钠-葡萄糖共转运蛋白2抑制剂(SGLT-2i)、日常生活能力评分(ADL)等11项自变量差异均有统计学意义(P < 0.05)；多因素logistic回归分析显示，年龄60~69岁、BMI＜21、PA＜280 mg/L、24hUMA≥30 mg/24 h、HOMR-IR≥2.69、SGLT-2i、ADL＜70分为肌少症高风险的危险因素, 注射胰岛素为保护因素。结论老年T2DM合并营养不良患者肌少症发生率较高，全科医生应及时干预并逆转危险因素，控制血糖，改善营养状况，延缓肌少症发生，减少骨折跌倒等糖尿病并发症发生。
- 老年2型糖尿病 /
- 营养不良 /
- 肌少症 /
- 影响因素
Abstract: Objective This study aims to investigate the high risk of sarcopenia in elderly patients with type 2 diabetes mellitus complicated with malnutrition, and analyze underlying causes of sarcopenia. Methods A total of 212 elderly patients with type 2 diabetes mellitus and malnutrition (aged≥60 years old) hospitalized at the First Affiliated Hospital of Bengbu Medical University from September 2023 to April 2024 were selected as the research objects. Malnutrition patients were screened using the mini-nutritional assessment short-form (MNA-SF), and calf circumference was measured to calculate the Ishii score. According to the Ishii scores, the patients were divided into the high-risk group (142 cases) and the low-risk group (70 cases), and comparisons were made between the two groups. Multivariate logistic regression was used to analyze the factors influencing the high risk of sarcopenia. Results A comparison between the low-risk group and the high-risk group for sarcopenia in elderly patients with type 2 diabetes mellitus complicated with malnutrition revealed 11 statistically significant independent variables. These variables included age (year), BMI, hemoglobin (Hb), prealbumin (PA), 24-hour urinary microalbumin (24hUMA), insulin resistance index (HOMA-IR), insulin injection, sodium-dependent glucose transporters 2 inhibitor (SGLT-2i), and ADL score (P < 0.05). Multivariate logistic regression analysis showed that age 60-69 years, BMI < 21, PA < 280 mg/L, 24hUMA≥30 mg/24 h, HOMR-IR≥2.69, SGLT-2i, ADL < 70, and insulin were risk factors for high risk of sarcopenia, while insulin injection was a protective factor. Conclusion Elderly patients with type 2 diabetes mellitus complicated with malnutrition have a high incidence of sarcopenia. General practitioners should intervene promptly to reverse risk factors, control blood glucose, improve nutritional status, delay the occurrence of sarcopenia, and reduce the risk of diabetic complications such as falls and osteoporosis.
- Elderly type 2 diabetes /
- Malnutrition /
- Sarcopenia /
- Influencing factors

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表 1 2组老年T2DM合并营养不良患者一般资料、实验室检查等指标比较[例(%)]

Table 1. Comparison of general information and laboratory indicators between two groups of elderly T2DM patients with malnutrition[cases(%)]

项目	肌少症高风险组 (n=142)	肌少症低分风险组 (n=70)	统计量	P值	项目	肌少症高风险组 (n=142)	肌少症低分风险组 (n=70)	统计量	P值
年龄(岁)			-5.017^a	＜0.001	25(OH)D(ng/mL)			0.458^b	0.499
60~69	111(78.2)	32(45.7)			＜20	64(45.1)	35(50.0)
70~79	23(16.2)	25(35.7)			≥20	78(54.9)	35(50.0)
≥80	8(5.6)	13(18.6)			24hUMA(mg/24 h)			41.684^b	＜0.001
病程(年)			-0.546^a	0.585	＜30	41(28.9)	53(75.7)
＜5	26(18.3)	13(18.6)			≥30	101(71.1)	17(24.3)
5~10	50(35.2)	28(40.0)			UACR(mg/g)			0.076^b	0.782
＞10	66(46.5)	29(41.4)			＜30	52(36.6)	27(38.6)
性别			1.607^b	0.205	≥30	90(63.4)	43(61.4)
男性	74(52.1)	30(42.9)			握力(kg)			105.474^b	＜0.001
女性	68(47.9)	40(57.1)			男＜26女＜18	135(95.1)	19(27.1)
BMI			9.206^b	0.002	男≥26女≥18	7(4.9)	51(72.9)
＜21	98(69.0)	36(51.4)			小腿围(cm)			30.835^b	＜0.001
≥21	44(31.0)	34(48.6)			男≤34女≤33	94(66.2)	18(25.7)
HAb1c(%)			0.033^b	0.857	男＞34女＞33	48(33.8)	52(74.3)
＜7	19(13.4)	10(14.3)			HOMA-IR			9.423^b	0.002
≥7	123(86.6)	60(85.7)			＜2.69	54(38.0)	49(70.0)
FPG(mmol/L)			0.501^b	0.479	≥2.69	88(62.0)	21(30.0)
≤10	114(80.3)	59(84.3)			双胍类			0.027^b	0.693
＞10	28(19.7)	11(15.7)			有	73(51.4)	38(54.3)
Hb(g/L)			4.590^b	0.032	无	69(48.6)	32(45.7)
≤120	51(35.9)	15(21.4)			磺脲类			0.051^b	0.462
＞120	91(64.1)	55(78.6)			有	54(38.0)	23(32.9)
FINS(mIU/L)			-0.386^a	0.699	无	88(62.0)	47(67.1)
＜5	71(50.0)	38(54.3)			噻唑烷二酮			0.001^b	0.987
5~20	44(31.0)	18(25.7)			有	4(2.8)	2(2.9)
＞20	27(19.0)	14(20.0)			无	138(97.2)	68(97.1)
PA(mg/L)			13.854^b	＜0.001	α-葡萄糖苷酶抑制剂			0.021^b	0.763
＜280	8(5.6)	16(22.9)			有	24(16.9)	13(18.6)
≥280	134(94.4)	54(77.1)			无	118(83.1)	57(81.4)
ALB(mg/L)			0.367^b	0.545	钠-葡萄糖共转运蛋白2抑制剂			4.767^b	0.029
＜35	18(12.7)	11(15.7)			有	56(39.4)	17(24.3)
≥35	124(87.3)	59(84.3)			无	86(60.6)	53(75.7)
Scr(mmol/L)			0.753^b	0.386	胰岛素			12.331^b	＜0.001
＜133	129(90.8)	66(94.3)			有	61(43.0)	48(68.6)
≥133	13(9.2)	4(5.7)			无	81(57.0)	22(31.4)
UA(mmol/L)			1.351^b	0.245	ADL评分(分)			10.558^b	0.001
≤420	127(89.4)	66(94.3)			＜70	37(26.1)	5(7.1)
＞420	15(10.6)	4(5.7)			≥70	105(73.9)	65(92.9)
注：^a为Z值，^b为χ²值。

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表 2 自变量赋值情况

Table 2. Variable assignment

变量	赋值方法
年龄	60~69岁=1，70~79岁=2，≥80岁=3
BMI	＜21=1，≥21=2
Hb	＜120 g/L=1，≥120 g/L=2
PA	＜280 mg/L=1，≥280 g/L=2
24hUMA	＜30 mg/24 h=1，≥30 mg/24 h=2
HOMA-IR	＜2.69=1，≥2.69=2
SGLT-2i	无=1，有=2
胰岛素	无=1，有=2
ADL评分	＜70分=1，≥70分=2

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表 3 老年T2DM合并营养不良患者与肌少症高风险多因素logistic回归分析

Table 3. Logistic regression analysis of high sarcopenia risk in elderly T2DM patients with dystrophy

变量	B	SE	Waldχ²	P值	OR(95% CI)
年龄	1.716	0.587	8.558	0.003	5.563(1.762~17.563)
BMI	0.744	0.300	6.136	0.013	2.104(1.168~3.789)
PA	1.879	0.548	11.023	0.001	6.164(2.107~18.036)
24hUMA	1.601	0.381	17.619	＜0.001	4.957(2.347~10.467)
HOMR-IR	1.305	0.375	12.113	0.001	3.689(1.769~7.695)
SGLT-2i	0.708	0.327	4.678	0.031	2.030(1.069~3.856)
胰岛素	-1.064	0.308	11.907	0.001	0.345(0.189~0.632)
ADL评分	1.522	0.502	9.194	0.002	4.581(1.713~12.252)

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