老年住院2型糖尿病患者合并肌少症的情况及其影响因素

Prevalence of sarcopenia in hospitalized elderly patients with type 2 diabetes mellitus and its influencing factors

摘要:

目的 分析老年住院2型糖尿病患者合并肌少症的患病情况及其影响因素。方法 按照纳入与排除标准,连续入选2018年1月至2019年12月于北京协和医院老年医学科住院治疗且年龄≥65岁的2型糖尿病患者为研究对象。运用老年综合评估,评价患者的共存疾病及老年综合征情况。采用SPSS 24.0统计软件进行数据分析。根据数据类型,分别采用t检验、Wilcoxon秩和检验、χ²检验或 Fisher精确概率法进行组间比较。采用多因素logistic回归模型分析老年2型糖尿病患者合并肌少症的影响因素。结果 最终入选225例患者,其中59例合并肌少症(肌少症组),166例未合并肌少症(非肌少症组)。与无肌少症组比较,肌少症组患者的年龄更大,住院时间更长,有跌倒史、需要辅助行走、合并糖尿病靶器官病变及尿失禁的比例更高,5次起坐时间明显延长,不能完成全足距测试的比例更高,血肌酐水平更高,差异均有统计学意义(均P＜0.05)；男性比例较低,体质量指数(BMI)水平较低,微营养评估简表、 基本日常生活活动、工具性日常生活活动分值较低,差异均有统计学意义(均P＜0.05)；空腹血糖、糖化血红蛋白、血清白蛋白及前白蛋白等其他血液学指标差异无统计学意义(均P＞0.05)。多因素logistic回归分析显示,低BMI(OR=0.716,95%CI 0.609~0.842,P＜0.001)和需要辅助行走(OR=4.391,95%CI 1.167~16.512,P=0.029)是老年2型糖尿病患者合并肌少症的影响因素。结论 老年住院2型糖尿病患者合并肌少症的患病率高,且患病率随增龄而进一步升高。对于低BMI、躯体功能下降的老年糖尿病患者,应注意肌少症的筛查并进行相应干预。

Abstract:

Objective To determine the prevalence of sarcopenia among the elderly inpatients with type 2 diabetes mellitus (T2DM) and investigate its influencing factors. Methods According to our inclusion and exclusion criteria, consecutive elderly T2DM inpatients (≥65 years old) in Geriatrics Department of Peking Union Medical College Hospital between January 2018 and December 2019 were enrolled in this study. Geriatric assessment was performed to evaluate their existing comorbidities and geriatric syndromes. SPSS statistics 24.0 was used to perform the statistical analysis. For different data types, student′s t test, Wilcoxon rank sum test, Chi-square test, or Fisher exact test was employed for intergroup comparison. Multivariate logistic regression model was applied to analyze the influencing factors of sarcopenia in the elderly type 2 diabetes mellitus (T2DM) patients. Results A total of 225 patients were finally enrolled in the study, including 59 cases complicated with sarcopenia (sarcopenia group) and 166 without (non-sarcopenia group). Compared with the patients from the non-sarcopenia group, those of the sarcopenia group were older, and had longer hospital stay, higher ratios of fall history, assisted walking, diabetic target-organ lesions and urinary incontinence, longer time of 5-times sit-to-stand, and proportion of being unable to achieve a tandem stance, and higher level of serum creatinine (all P<0.05). Lower ratio of males, lower body mass index (BMI), lower scores of mini nutritional assessment short form, activities of daily living and instrumental activities of daily living were seen in the sarcopenia group than the non-sarcopenia group (all P<0.05). There were no significant differences in the levels of fasting blood glucose, glycosylated hemoglobin, serum albumin, prealbumin and other hematological indicators (all P>0.05). Multivariate logistic regression analysis showed that low BMI (OR=0.716,95%CI 0.609-0.842, P<0.001) and assisted walking (OR=4.391,95%CI 1.167-16.512) were influencing factors of sarcopenia in elderly T2DM patients. Conclusion The prevalence of sarcopenia is quite high in hospitalized elderly T2DM patients, and it was further increased with age. For the elderly diabetic patients with low BMI and reduced physical function, attention should be paid to the screen and corresponding intervention for sarcopenia.