2023 年第 2 期 第 18 卷

2型糖尿病肾病患者并发肌少症的危险因素分析及风险评估模型构建

Risk factors analysis and risk assessment model construction of sarcopenia in patients with type 2 diabetic nephropathy

作者：王静田惠玉张宇穆立芹胡秀红赵红敏

英文作者：Wang Jing Tian Huiyu Zhang Yu Mu Liqin Hu Xiuhong Zhao Hongmin

单位：河北医科大学第一医院全科医学科，石家庄050031

英文单位：Department of General Medicine the First Hospital of Hebei Medical University Shijiazhuang 050031 China

关键词：2型糖尿病；糖尿病肾病；肌少症；风险评估模型

英文关键词：Type2diabetesmellitus;Diabeticnephropathy;Sarcopenia;Riskassessmentmodel

• 摘要：

• 目的 分析2型糖尿病肾病患者并发肌少症的危险因素，构建并发肌少症的风险评估模型。方法 回顾性分析2020年3月至2021年4月河北医科大学第一医院收治的125例2型糖尿病肾病患者的临床资料。根据是否并发肌少症分为非肌少症组（86例）和肌少症组（39例）。收集比较2组的临床资料，以多因素Logistic回归模型分析影响2型糖尿病肾病并发肌少症的危险因素。根据Logistic多因素回归分析各独立危险因素的回归系数构建风险评估模型，并采用受试者工作特征（ROC）曲线与Hosmer-Lemeshow（H-L）检验对风险评估模型进行评价。结果 肌少症组年龄、糖尿病病程、空腹血糖及糖化血红蛋白水平均大于/长于/高于非肌少症组，体重指数、维生素D水平及骨密度均低于非肌少症组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示，年龄、体重指数、维生素D水平、骨密度为2型糖尿病肾病患者并发肌少症的危险因素（比值比=3.511、4.688、5.323、3.155，均P＜0.05）。风险评估模型的ROC曲线下面积及95%置信区间为0.809（0.732～0.895），H-L检验结果为0.098，风险评估效能较好。取6分为临界值，模型的特异度与敏感度较高。结论 年龄大，体重指数、骨密度、维生素D水平低的2型糖尿病肾病患者发生肌少症的风险较高。构建风险评估模型有助于评估风险，针对分值≥6分的患者应及早采取措施进行干预。

• Objective To analyze the risk factors of sarcopenia in patients with type 2 diabetic nephropathy, and to construct a risk assessment model of sarcopenia. Methods  The clinical data of 125 patients with type 2 diabetic nephropathy admitted to the First Hospital of Hebei Medical University from March 2020 to April 2021 were analyzed retrospectively. According to whether there was sarcopenia, they were divided into non sarcopenia group(86 cases) and sarcopenia group(39 cases). The clinical data of the two groups were compared, and the risk factors of type 2 diabetic nephropathy complicated with sarcopenia were analyzed by multivariate Logistic regression analysis. The risk assessment model was constructed according to the regression coefficient of each independent risk factor in the multivariate Logistic regression analysis, and the risk assessment model was evaluated by the receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow(H-L) test. Results  The age, duration of diabetes mellitus, fasting plasma glucose and glycosylated hemoglobin levels in the sarcopenia group were greater/longer/higher than those in the non sarcopenia group, and body mass index, vitamin D level and bone mineral density were lower than those in the non sarcopenia group(all P<0.05). Multivariate Logistic regression analysis showed that age, body mass index, vitamin D and bone mineral density were the risk factors for type 2 diabetic nephropathy patients with sarcopenia(odds ratio=3.511, 4.688, 5.323, 3.155, all P<0.05). The area under the ROC curve and 95% confidence interval of the risk assessment model were 0.809(0.732-0.895), and the H-L test result was 0.098; the risk assessment efficiency was good. Taking 6 points as the critical value, the specificity and sensitivity of the model were high. Conclusions  Patients with type 2 diabetic nephropathy who are older, and have lower body mass index, bone mineral density and vitamin D levels have a higher risk of sarcopenia. Building a risk assessment model is helpful to assess risk, and early intervention measures should be taken for patients with the score ≥6 points.