中老年2型糖尿病患者骨质疏松性肌少症与血管硬化度的关系研究

Relationship between Osteosarcopenia and the Degree of Vascular Sclerosis in Middle-Aged and Elderly Patients with Type 2 Diabetes Mellitus

摘要: 目的：探讨2型糖尿病(Type 2 Diabetes Mellitus, T2DM)患者骨质疏松性肌少症与血管硬化度的关系。方法：横断面连续选取215例T2DM住院患者(62.5 ± 7.59岁)，依据臂踝脉搏波传播速度(brachial-ankle Pulse Wave Velocity, baPWV)分为正常A组(<1800 cm/s, n = 112)与高值B组(≥1800 cm/s, n = 103)比较两组一般临床资料及实验室生化指标，分析骨质疏松性肌少症与血管硬化度的关系。结果：1) B组的年龄、糖尿病病程、收缩压(SBP)、收缩压/舒张压(DSP)、高血压史、低肌肉质量指数(skeletal lean mass index, SMI)检出率显著高于A组，肾小球滤过率、六米步速、股骨颈骨量显著低于A组，(P < 0.05)。2) 在T2DM患者、收缩压 < 140 mmHg T2DM患者、年龄 < 75岁患者中，单纯肌少症组、骨质疏松性肌少症组的baPWV异常检出率均高于正常组，差异有统计学意义，P < 0.05；单纯骨质疏松组与正常组、单纯肌少症组、骨质疏松性肌少症组的baPWV检出率均无统计学差异，肌少症组与骨质疏松性肌少症组的baPWV检出率均无统计学差异。3) Logistic回归分析显示，T2DM病程大于10年、年龄大于等于75岁，SBP大于等于140 mmHg和骨质疏松合并肌少症增加了baPWV异常的发生危险，差异有统计学意义，(0R = 2.080, 95% CI: 1.122~3.853, P = 0.020, 0R = 15.704, 95% CI: 1.664~148.183, P = 0.016, 0R = 2.976, 95% CI: 1.534~5.772, p = 0.001, 0R = 10.359, 95% CI: 1.941~55.270, P = 0.006)。结论：在中老年T2DM患者中，长病程、高龄、不达标的SBP和骨质疏松性肌少症是baPWV异常的危险因素，且在血压正常人群中骨质疏松性肌少症仍与baPWV异常关系密切。

Abstract: Objective: To investigate the relationship between osteosarcopenia and vascular sclerosis in Type 2 Diabetes Mellitus (T2DM) patients. Methods: 215 hospitalized T2DM patients (62.5 ± 7.59 years old) were continuously selected and divided into normal group A (<1800 cm/s, n = 112) and high value group B (≥1800 cm/s, n = 103) were compared with the general clinical data and laboratory bio-chemical indexes of the two groups, and the relationship between osteosarcopenia and vascular sclerosis was analyzed. Results: 1) Age, diabetes course, systolic blood pressure (SBP), systol-ic/diastolic blood pressure (DSP), history of hypertension, and low muscle mass index (SMI) of group B were significantly higher than those of group A, while glomerular filtration rate, 6-meter stride speed and femoral neck bone mass were significantly lower than those of group A (P < 0.05). 2) Among T2DM patients, systolic blood pressure < 140 mmHg T2DM patients and patients aged < 75 years, the abnormal detection rate of baPWV in simple sarcosis group and osteoporotic sarcosis group was higher than that in normal group, with statistical significance (P < 0.05); there was no statistical difference in baPWV detection rate between pure osteoporosis group and normal group, simple sarcopenia group and osteoporotic sarcopenia group. There was no statistical difference in baPWV detection rate between sarcopenia group and osteoporotic sarcopenia group. 3) Logistic re-gression analysis showed that the disease course of T2DM was greater than 10 years, the age was greater than or equal to 75 years, SBP was greater than or equal to 140 mmHg, osteoporosis com-bined with sarcosis increased the risk of baPWV abnormality, and the difference was statistically significant (0R = 2.080, 95% CI: 1.122~3.853, P = 0.020, 0R = 15.704, 95% CI: 1.664~148.183, P = 0.016, 0R = 2.976, 95% CI: 1.534~5.772, P = 0.001, 0R = 10.359, 95% CI: 1.941~55.270, P = 0.006). Conclusion: In middle-aged and elderly T2DM patients, long disease course, old age, sub-standard SBP and osteoporotic sarcopenia are risk factors for baPWV abnormality, and osteoporotic sarcope-nia is still closely related to baPWV abnormality in normal blood pressure population.