南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (03): 407-412.doi: 10.12122/j.issn.1673-4254.2020.03.21

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2型糖尿病患者肌肉减少症与并发白蛋白尿的相关性

颜俊锋，郑开元，林 川，刘 春   

  • 出版日期:2020-04-08 发布日期:2020-03-20
  • 基金资助:

Correlation between sarcopenia and albuminuria in patients with type 2 diabetes

  

  • Online:2020-04-08 Published:2020-03-20

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摘要： 目的 探讨2型糖尿病（T2DM）患者肌肉减少症与2型糖尿病并发白蛋白尿的关系。方法 共纳入2015年1月~2018年12月期间于我住院治疗的T2DM患者360例（男性206例，女性154例），根据病史及相应辅助检查分为白蛋白尿组（n=122）、非白蛋白尿组（n=238）。收集临床资料，进行人体学测量，并以双能X线吸收法测定骨骼肌指数（SMI）、附肢肌质量，肌肉指数，总体脂，骨矿含量、骨密度。采用t检验、u检验、卡方检验进行统计学分析。采用logistic回归法分析身体成分与T2DM并发白蛋白尿或T2DM并发慢性肾脏病(CKD)的关系。结果 与非白蛋白尿组相比，白蛋白尿组患者T2DM病程、高血压病史、年龄、收缩压、低密度脂蛋白、甘油三酯、尿酸、腰围、尿白蛋白肌酐比、血肌酐及估算肾小球滤过率差异均有统计学意义（P<0.05），且肌少症患病率更高（31.4% vs 13.1%，χ2值=16.207，P<0.01）。身体成分方面，与非白蛋白尿患者相比，白蛋白尿组患者骨骼肌指数（t=-2.304，P=0.021）和体重指数（Z=-5.534，P<0.01）显著降低，总体脂显著升高（Z=-2.838，P=0.005）。利用多元Logistics回归分析校正年龄、性别、总体脂、吸烟史、饮酒史、糖尿病病程、糖化血红蛋白、高血压病史、收缩压、低密度脂蛋白、体重指数与甘油三酯等混杂因素后，随着SMI降低，T2DM并发白蛋白尿风险显著升高（P=0.011和P=0.010），SMI与T2DM患CKD的风险无显著相关性（P>0.05）。结论 肌少症降低，可能是T2DM并发白蛋白尿的独立危险因素。

Abstract: Objective To investigate the correlation between sarcopenia and albuminuria in patients with type 2 diabetes mellitus (T2DM). Methods A total of 360 T2DM patients (including 206 male and 154 female patients) hospitalized in our hospital between January, 2015 and December, 2018 were enrolled. According to their medical history and laboratory test results, the patients were divided into albuminuria group (n=122) and non-albuminuria group (n=238). The clinical and anthropological data were collected and skeletal muscle index (SMI), appendage lean mass, muscle index, total body fat, bone mineral capacity and bone mineral density were measured using dual-energy X-ray absorptiometry. Logistic regression was used to analyze the correlation of these body composition parameters with albuminuria or chronic kidney disease (CKD) in the diabetic patients. Results The disease course of T2DM, history of hypertension, age, systolic blood pressure, low density lipoprotein cholesterol, triglyceride, uric acid, waistline, Urinary albumin creatinine ratio, serum creatinine, and glomerular filtration rate differed significantly between the diabetic patients with albuminuria and those without albuminuria (P<0.05). The prevalence rate of sarcopenia was significantly higher in patients with albuminuria (31.4% vs 13.1%, P<0.01). Compared with those without albuminuria, the patients with albuminuria had significantly decreased SMI (t=-2.304, P=0.021) and body mass index (Z=- 5.534, P<0.01) and significantly increased total body fat (Z=- 2.838, P=0.005). Multivariate logistic regression analysis showed that after adjustment for age, gender, total body fat, smoking history, drinking history, duration of diabetes, HbA1c, history of hypertension, systolic blood pressure, low density lipoprotein cholesterol, body mass index, and triglyceride, the patients with a decreased SMI had a significantly increased risk of albuminuria (P=0.011 and 0.010), but SMI was not correlated with the risk of CKD in patients with T2DM (P>0.05). Conclusion Sarcopenia is probably an independent risk factor for albuminuria in patients with T2DM.