中老年2型糖尿病患者肌少症风险预测模型的构建与验证-现代医学

中老年2型糖尿病患者肌少症风险预测模型的构建与验证

作者：仲蕾¹ 2 3 张会¹ 2 3 许静¹ 陆雅维¹ 项晓婷¹ 王若梅² 3 王珩⁴

单位：1. 安徽医科大学护理学院, 安徽合肥 230601;
2. 安徽医科大学第一附属医院护理部, 安徽合肥 230022;
3. 安徽省公共卫生临床中心护理部安徽合肥 230000;
4. 安徽医科大学第一附属医院院长室, 安徽合肥 230022

关键词：老年人中年人 2型糖尿病肌少症预测模型

分类号：R473;R587.1

出版年·卷·期（页码）：2024·52·第六期（845-851）

摘要：

目的： 调查中老年2型糖尿病患者肌少症危险因素，并构建列线图模型。方法： 采用便利抽样的方法，选取安徽省某三级甲等医院内分泌科2023年5月—2023年12月收治的2型糖尿病患者349例，对其进行问卷调查。采用单因素和多因素Logistic回归分析对2型糖尿病患者肌少症危险因素进行探讨，并构建可视化的风险预测模型。通过受试者工作特征(ROC)曲线下面积对模型预测效能进行了验证。结果： 2型糖尿病患者肌少症的发生率为16.9%(59/349)。多因素分析结果显示，病程、每周锻炼次数、BMI、小腿围、匹兹堡睡眠质量指数(PSQI)得分、营养状态评估(MNA-SF)得分是2型糖尿病患者发生肌少症的影响因素。基于以上因素构建肌少症的风险预测模型，ROC曲线下面积为0.982[95%CI(0.968,0.995)];最佳临界值为0.366，灵敏度为0.966，特异度为0.934。H-L拟合优度检验显示, χ²=2.446，P=0.964；Brier评分为0.036。结论： 肌少症风险预测模型预测效能较好，可为医护人员进行临床决策提供参考。

Objective: To investigate the risk factors of sarcopenia in middle-aged and elderly patients with type 2 diabetes and construct a nomogram model. Methods: In this cross-sectional study, a total of 349 patients with type 2 diabetes admitted from May 2023 to December 2023 in the Department of Endocrinology of a tertiary A-level hospital in Anhui Province were selected and investigated using questionnaires and convenient sampling. Univariate analysis and Logistic regression analysis were performed to explore the risk factors of sarcopenia in type 2 diabetes patients, and a visual risk prediction model was constructed. The prediction efficiency of the model was verified by the region under receiver operating characteristic(ROC) curve. Results: The incidence of sarcopenia in patients with type 2 diabetes was 16.9%(59/349). Multivariate logistic regression analysis showed that diabetes course, the number of exercises per week, BMI, calf girth, Pittsburgh Sleep Quality Index(PSQI) score, and Nutritional Status Assessment(MNA-SF) score were the influencing factors for the development of sarcopenia in patients with type 2 diabetes. According to these variables, a prediction model was constructed, and the area under the ROC curve was 0.982 [95%CI(0.968, 0.995)]. The optimal critical value was 0.366, the sensitivity was 0.966, and the specificity was 0.934. The H-L test showed that χ²=2.446, P=0.964, and Brier score was 0.036. Conclusion: The risk prediction model of sarcopenia is effective and can provide reference for clinical treatment.

参考文献：

[1] SAEEDI P,PETERSOHN I,SALPEA P,et al.Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045:results from the International Diabetes Federation Diabetes Atlas,9th edition[J].Diabetes Res Clin Pract,2019,157:107843.
[2] YAN Y,WU T,ZHANG M,et al.Prevalence,awareness and control of type 2 diabetes mellitus and risk factors in Chinese elderly population[J].BMC Public Health,2022,22(1):1382.
[3] CRUZ-JENTOFT A J,BEAYENS J P,BAUER J M,et al.Sarcopenia:European consensus on definition and diagnosis:report of the European Working Group on sarcopeniain older people[J].Age Ageing,2010,39(4):412-423.
[4] WANG T.Searching for the link between inflammaging and sarcopenia[J].Ageing Res Rev,2022,77:101611.
[5] 健康中国行动(2019-2030年):总体要求、重大行动及主要指标[J].中国循环杂志,2019,34(9):846-858.
[6] 钱荣立.关于糖尿病的新诊断标准与分型[J].中国糖尿病杂志,2000(1):4-5.
[7] American Dlabetes Association Professional Practice Committee.Classification and diagnosis of diabetes:standards of medical care in diabetes—2022[J].Diabetes Care,2022,45(Supplement_1):S17-S38.
[8] WYNANTS L,BOUWMEESTER W,MOONS K G M,et al.A simulation study of sample size demonstrated the importance of the number of events per variable to develop prediction models in clustered data[J].J Clin Epidemiol,2015,68(12):1406-1414.
[9] BOUCHI R,FUKUDA T,TAKEUCHI T,et al.Insulin treatment attenuates decline of muscle mass in Japanese patients with type 2 diabetes[J].Calcif Tissue Int,2017,101(1):1-8.
[10] 姜珊,康琳,刘晓红.2019亚洲肌少症诊断及治疗共识解读[J].中华老年医学杂志,2020,39(4):373-376.
[11] PACIFICO J,GEERLINGS M A J,REIJNIERSE E M,et al.Prevalence of sarcopenia as a comorbid disease:a systematic review and meta-analysis[J].Exp Gerontol,2020,131:110801.
[12] NISHIKAWA H,FUKUNISHI S,ASAI A,et al.Sarcopenia,frailty and type 2 diabetes mellitus(review)[J].Mol Med Rep,2021,24(6):854.
[13] 刘贤臣,唐茂芹,胡蕾,等.匹兹堡睡眠质量指数的信度和效度研究[J].中华精神科杂志,1996(2):103-107.
[14] MNA-International Group,KAISER M J,BAUER J M,et al.Validation of the mini nutritional assessment short-form(MNA-SF):a practical tool for identification of nutritional status[J].J Nutr Health Aging,2009,13(9):782-788.
[15] WANG T,FENG X,ZHOU J,et al.Type 2 diabetes mellitus is associated with increased risks of sarcopenia and pre-sarcopenia in Chinese elderly[J].Sci Rep,2016,6(1):38937.
[16] TRIERWEILER H,KISIELEWICZ G,JONASSON H T,et al.Sarcopenia:a chronic complication of type 2 diabetes mellitus[J].Diabetol Metab Syndr,2018,10(1):25.
[17] MESINOVIC J,ZENGIN A,DE COURTN B,et al.Sarcopenia and type 2 diabetes mellitus:a bidirectional relationship[J].Diabetes Metab Syndr Obes,2019(12):1057-1072.
[18] CHEN F,XU S,WANG Y,et al.Risk factors for sarcopenia in the elderly with type 2 diabetes mellitus and the effect of metformin[J].J Diabetes Res,2020,2020:1-10.
[19] DAI S,SHU D,MENG F,et al.Higher risk of sarcopenia in older adults with type 2 diabetes:NHANES 1999-2018[J/OL].Obes Facts,2023,16(3):237-248.
[20] MERCHANT R A,SEETHARAMAN S,AU L,et al.Relationship of fat mass index and fat free mass index with body mass index and association with function,cognition and sarcopenia in pre-frail older adults[J].Frontiers Endocrinol(Lausanne),2021,12:765415.
[21] WALSH J S,VILACA T.Obesity,type 2 diabetes and bone in adults[J].Calcif Tissue Int,2017,100(5):528-535.
[22] 姚雪梅,李美艳,吴栋,等.睡眠质量与老年肌肉减少症关系的研究[J].中国全科医学,2020,23(22):2804-2808,2814.
[23] HAYASHI T,WADA N,KUBOTA T,et al.Associations of sleep quality with the skeletal muscle strength in patients with type 2 diabetes with poor glycemic control[J].J Diabetes Investig,2023,14(6):801-810.
[24] PIOVEZAN R D,ABUCHAM J,DOS SANTOS R V T,et al.The impact of sleep on age-related sarcopenia:possible connections and clinical implications[J].Ageing Res Rev,2015,23:210-220.
[25] NOMURA T,ISHIGURO T,OHIRA M,IKED Y.Diabetic polyneuropathy is a risk factor for decline of lower extremity strength in patients with type 2 diabetes[J].J Diabetes Investing,2018,9:186-192.
[26] PURNAMASARI D,TETRASIWI E N,KARTIKO G J,et al.Sarcopenia and chronic complications of type 2 diabetes mellitus[J].Rev of Diabet Stud,2022,18(3):157-165.

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