中国骨质疏松杂志

中老年T2DM患者合并肌肉量减少的影响因素分析

Analysis of Influencing Factors for Sarcopenia in Middle-Aged and Elderly Patients with T2DM

投稿时间：2025-07-27 修订日期：2025-12-02

DOI：

英文关键词:Type 2 diabetes mellitus Sarcopenia Body mass index Dominant handgrip strength High-density lipoprotein cholesterol

基金项目:南京市医疗机构中药传统制剂备案研究项目(NJCC-ZJ-202406)，南京中医药大学自然科学基金项目（XZR2023011)

作者	单位	邮编
王宏宇	江苏省中西医结合医院	232001
胡咏新^*	江苏省中西医结合医院	210000
孙凡	江苏省中西医结合医院
胡晓帆	江苏省中西医结合医院
盛天旸	江苏省中西医结合医院

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中文摘要:

目的探究中老年T2DM人群合并肌肉量减少的独立影响因素。方法选取2024-2025年江苏省中西医结合医院收治的年龄≥50岁的T2DM患者，进行人体成分分析，收集结局数据（肌肉量减少组44例、非肌肉量减少组111例）及潜在影响因素，包括人口学、临床及实验室变量。比较两组资料，采用单、多因素回归分析，Lasso数据降维、变量筛选，评估合并肌肉量减少的影响因素。通过R软件rms程序包构建列线图模型，采用校准曲线、受试者工作特征（ROC）曲线验证模型的一致性、区分度。结果两组的性别、年龄、腰围（WC）、体重指数（BMI）、优势手握力（DHS）、小腿围、5次起坐时间、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、肿瘤坏死因子-α（TNF-α），差异有统计学意义（P均<0.05）；BMI高、DHS高是中老年T2DM肌少症发生的独立保护因素，调整后OR分别为（OR=0.78；95% CI：0.67-0.91；p=0.001；OR=0.89；95% CI：0.84-0.94；p<0.001）；HDL-C是其独立危险因素，调整后OR=3.70；95% CI：1.27-10.77；p=0.016。列线图预测模型H-L拟合优度检验显示２=8.136，p=0.403，校准曲线斜率趋近于1，ROC曲线下面积（AUC）为0. 860（95% CI：0.794-0.926），列线图预测模型的一致性、区分度良好。结论在中老年T2DM患者中，HDL-C是肌肉量减少的独立危险因素，BMI及DHS是肌肉量减少的独立保护因素，构建的列线图模型可预测肌少症发生。

英文摘要:

Objective To explore the independent influencing factors for sarcopenia in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM). Methods A total of 155 T2DM patients aged≥50 years admitted to Jiangsu Hospital of Integrated Traditional Chinese and Western Medicine between 2024 and 2025 were selected. They underwent body composition analysis, and outcome data were collected, including 44 cases in the sarcopenia group and 111 cases in the non-sarcopenia group. Potential influencing factors, including demographic, clinical, and laboratory variables, were also recorded. The data between the two groups were compared. Univariate and multivariate regression analyses were performed, and Lasso regression was used for data dimensionality reduction and variable screening to evaluate the influencing factors for sarcopenia. A nomogram model was constructed using the rms package in R software. Calibration curves and receiver operating characteristic (ROC) curves were used to validate the model's calibration and discriminative ability. Results Significant differences were observed between the two groups in terms of gender, age, waist circumference (WC), body mass index (BMI), dominant handgrip strength (DHS), calf circumference, five-times-sit-to-stand test time, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and tumor necrosis factor-α (TNF-α) (all P<0.05). Higher BMI (adjusted OR=0.78; 95% CI:0.67-0.91; P=0.001) and higher DHS (adjusted OR=0.89; 95% CI:0.84-0.94; P<0.001) were independent protective factors against sarcopenia in middle-aged and elderly T2DM patients. Higher HDL-C was an independent risk factor (adjusted OR=3.70; 95% CI:1.27-10.77; P=0.016). The nomogram prediction model showed good calibration (Hosmer-Lemeshow test:２=8.136, P=0.403; calibration curve slope approaching 1) and excellent discriminative ability (Area Under the ROC Curve is 0.860, 95% CI:0.794-0.926). Conclusion In middle-aged and elderly T2DM patients, HDL-C is an independent risk factor for sarcopenia, while BMI and DHS are independent protective factors. The constructed nomogram model effectively predicts the risk of sarcopenia.

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