2021 年第 7 期 第 16 卷

血浆鸢尾素水平对2型糖尿病患者合并肌少症的影响

The effect of plasma Irisin level on type 2 diabetes mellitus patients complicated with sarcopenia

作者：任碧琦1苗登顺1雷敏聪2

英文作者：Ren Biqi1 Miao Dengshun1 Lei Mincong2

单位：1南京医科大学骨与干细胞研究中心211166；2南京医科大学第一附属医院老年康复科211166

英文单位：1Bone and Stem Cell Research Center Nanjing Medical University Nanjing 211166 China; 2Department of Geriatric Rehabilitation the First Affiliated Hospital with Nanjing Medical University Nanjing 211166 China

关键词：2型糖尿病；肌少症；鸢尾素；四肢骨骼肌质量指数；体重指数

英文关键词：Type2diabetesmellitus;Sarcopenia;Irisin;Limbsskeletalmuscleindex;Bodymassindex

• 摘要：

• 目的 探讨血浆鸢尾素水平对2型糖尿病患者合并肌少症的影响。方法 选取南京医科大学第一附属医院2018年1月至2020年1月收治的2型糖尿病患者193例（2型糖尿病组），合并肌少症67例（肌少症组）、未合并肌少症126例（非肌少症组）,根据肌少症严重程度分为前期组(26例)、中期组(23例)和严重期组(18例)。另选取同时期来院体检健康者57例为对照组。比较2型糖尿病组和对照组血浆鸢尾素水平，肌少症组和非肌少症组一般资料和实验室指标以及人体成分指标水平，不同严重程度肌少症患者血浆鸢尾素水平，分析2型糖尿病患者合并肌少症的影响因素，以及血浆鸢尾素水平对2型糖尿病患者合并肌少症的诊断价值。结果 2型糖尿病组血浆鸢尾素水平低于对照组［(207±39)μg/L比(265±26)μg/L］(P＜0.05)。肌少症组患者年龄明显大于非肌少症组［(60±7)岁比（57±6）岁］，体重指数、骨矿物质含量、内脏脂肪面积、体脂百分比、四肢骨骼肌质量指数和血浆鸢尾素水平均低于非肌少症组［(22.4±1.8)kg/m2比（26.0±2.9）kg/m2，(2.44±0.23)g/cm比（3.02±0.34）g/cm，(82±23)cm2比（104±30）cm2，(29±5)%比（35±6）%，(6.2±1.6)kg/m2比（8.0±1.7）kg/m2，(166±21)μg/L比（229±27）μg/L］(均P＜0.05)。严重期组肌少症患者血浆鸢尾素水平低于中期组和前期组［（145±10）μg/L比（170±7）、（191±13）μg/L］,且中期组低于前期组(均P＜0.05)。多因素Logistic回归分析结果显示，体重指数(比值比=0.358，95%置信区间：0.341～0.849)、骨矿物质含量(比值比=0.038，95%置信区间：0.005～0.285)、鸢尾素(比值比=0.936，95%置信区间：0.901～0.974)为2型糖尿病患者合并肌少症的保护因素(均P＜0.05)。血浆鸢尾素水平预测2型糖尿病患者合并肌少症的曲线下面积为0.837，最佳界值为191.51 μg/L，敏感度和特异度分别82.57%和69.84%。结论 2型糖尿病合并肌少症患者血浆鸢尾素水平明显降低，血浆鸢尾素水平随着肌少症严重程度加重进一步降低，血浆鸢尾素为2型糖尿病患者合并肌少症的保护因素，可作为预测2型糖尿病合并肌少症的指标。

• Objective To investigate the effect of plasma Irisin level on type 2 diabetes mellitus (T2DM) patients complicated with sarcopenia. Methods From January 2018 to January 2020, 193 patients with T2DM admitted to the First Affiliated Hospital with Nanjing Medical University were selected (T2DM group). Among them, there were 67 cases complicated with sarcopenia (sarcopenia group) and 126 cases without sarcopenia (without sarcopenia group). According to the severity of sarcopenia, the patients in sarcopenia group were divided into the prophase group (26 cases), the middle stage group (23 cases) and the severe stage group (18 cases). In addition, 57 healthy people undergoing physical examination in the hospital during the same period were selected as the control group. Plasma Irisin level between T2DM group and control group, the general data, laboratory indexes and body composition indexes between sarcopenia group and without sarcopenia group, and plasma Irisin level among patients with different severities of sarcopenia were compared. The influencing factors of T2DM patients complicated with sarcopenia, and the diagnostic value of plasma Irisin level in T2DM patients complicated with sarcopenia were analyzed. Results The plasma Irisin level in T2DM group was lower than that in control group ［(207±39)μg/L vs (265±26)μg/L］(P<0.05). The age in sarcopenia group was significantly higher than that in without sarcopenia group ［(60±7)years vs (57±6)years］, and body mass index, bone mineral content, visceral fat area, percentage of body fat, limbs skeletal muscle mass index and plasma Irisin level in sarcopenia group were lower than those in without sarcopenia group ［(22.4±1.8)kg/m2 vs (26.0±2.9)kg/m2, (2.44±0.23)g/cm vs (3.02±0.34)g/cm, (82±23)cm2 vs (104±30)cm2, (29±5)% vs (35±6)%, (6.2±1.6)kg/m2 vs (8.0±1.7)kg/m2, (166±21)μg/L vs (229±27)μg/L］(all P＜0.05). The plasma Irisin level in severe stage group was lower than that in middle stage group and prophase group ［(145±10)μg/L vs (170±7), (191±13)μg/L］, and that in middle stage group was lower than that in prophase group (all P＜0.05). Multivariate Logistic regression analysis showed that body mass index (odds ratio=0.358, 95% confidence interval: 0.341-0.849), bone mineral content (odds ratio=0.038, 95% confidence interval: 0.005-0.285), and Irisin (odds ratio=0.936, 95% confidence interval: 0.901-0.974) were protective factors for T2DM patients complicated with sarcopenia (all P＜0.05). The area under the curve of plasma Irsin level in predicting T2DM patients complicated with sarcopenia was 0.837, the optimal cut-off value was 191.51 μg/L, and the sensitivity and specificity were 82.57% and 69.84%, respectively. Conclusions Plasma Irisin level in T2DM patients complicated with sarcopenia is significantly reduced, and it reduces further with the aggravation of sarcopenia severity. Irisin is a protective factor for T2DM patients complicated with sarcopenia. It can be used as an indicator for predicting T2DM complicated with sarcopenia.