Abstract Objective To investigate (1) whether the association of thyroid hormone with frailty risk is linear or nonlinear and (2) which range of thyroid hormones or thyroid stimulating hormone (TSH) is more associated with a higher risk of frailty in older adults. Design Systematic review and dose–response meta-analysis. Methods Medical electronic databases were searched for cross-sectional or longitudinal studies, published from database inception to February 2022. We focused on the relationship between TSH and frailty. Data on TSH reference range, TSH exposure categories, sample size of each exposure category, and adjusted odds ratios (ORs) for frailty with 95% confidence interval (CI) were extracted. In the dose–response meta-analysis, we set the OR for frailty as 1 at 0.3 mIU/L TSH. Results The systematic review included 10 studies, whereas the meta-analysis included 3 studies (n = 6388). TSH levels ranged from 0.3 to 4.8 mIU/L, and the dose–response meta-analysis revealed a significant J-shaped association (p = 0.0071). Frailty OR (95% CI) increased from 1.30 (1.06–1.59) for 2.7 mIU/L TSH to 2.06 (1.18–3.57) for 4.8 mIU/L TSH. Conclusions A significant nonlinear, J-shaped association was noted between TSH level and frailty. TSH levels within the upper half (2.7–4.8mIU/L) of reference range was noted to significantly higher risk of frailty; by contrast, those in the lower half (0.6–1.5 mIU/L) had a lower risk of frailty, though not significantly so. Trail registration This systematic review was registered with PROSPERO (registration number: CRD42022299214).

The prevalence and impact on physical function of osteosarcopenia in the Chinese population remain unclear. The purpose of this study was to assess the prevalence of osteosarcopenia and its association with physical function in the elderly population of China. A total of 519 participants (327 males, 192 females; mean age: 67.2 years) elderly people were recruited. Physical performance was evaluated using the Timed Up and Go test and the Short Physical Performance Battery (SPPB). Osteoporosis was diagnosed based on the 1994 WHO criteria, while sarcopenia was defined according to the AWGS guidelines. Osteosarcopenia was diagnosed when both sarcopenia and osteoporosis were present. Among the participants, osteosarcopenia was identified in 27 (5.20

Type 2 diabetes mellitus (T2DM) is a major risk factor of a number of neurodegenerative diseases (NDDs). Ketogenic diet (KD) has significant beneficial effects on glycemic control and may act effectively against NDDs, but the mechanism remains unclear. In this study, we aimed to investigate the potential effects of KD on gene expressions in the brains of T2DM model mice. Male db/db mice at the age of 9 weeks were fed with KD or normal diet to the age of 6 months, and the whole brains were subjected to mRNA-seq analysis for differentially expressed genes. KD significantly lowered fasting glucose and body weights in db/db mice (P<0.05), and the expression of 189 genes in the brain were significantly changed (P<0.05, |log2|>1). Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses revealed that the differentially expressed genes upon KD are involved in inflammatory responses and the functions of biosynthesis. In inflammatory responses, NF-κB signaling pathway, viral protein interaction with cytokine and cytokine receptor, and cytokine-cytokine receptor interaction pathways were enriched, and in biosynthesis pathways, genes functioning in lipid and amino acid metabolism, protein synthesis, and energy metabolism were enriched. Moreover, consistent with the gene set enrichment analysis results, proteasomal activity measured biochemically were enhanced in KD-fed T2DM mice. These data may facilitate the understanding of how KD can be protective to the brain in T2DM background. KD could be a new strategy for the prevention of NDDs in T2DM patients.

BACKGROUND Dyslipidemia and type 2 diabetes mellitus (T2DM) are chronic conditions with substantial public health implications. Effective management of lipid metabolism in patients with T2DM is critical. However, there has been insufficient attention given to the relationship between thyroid hormone sensitivity and dyslipidemia in the T2DM population, particularly concerning non-high-density lipoprotein cholesterol (non-HDL-C). AIM To clarify the association between thyroid hormone sensitivity and dyslipidemia in patients with T2DM. METHODS In this cross-sectional study, thyroid hormone sensitivity indices, the thyroid feedback quantile-based index (TFQI), the thyroid-stimulating hormone index (TSHI), the thyrotrophic T4 resistance index (TT4RI), and the free triiodothyronine (FT3)/free thyroxine (FT4) ratio were calculated. Logistic regression analysis was performed to determine the associations between those composite indices and non-HDL-C levels. Random forest variable importance and Shapley Additive Explanations (SHAP) summary plots were used to identify the strength and direction of the association between hyper-non-HDL-C and its major predictor. RESULTS Among the 994 participants, 389 (39.13%) had high non-HDL-C levels. Logistic regression analysis revealed that the risk of hyper-non-HDL-C was positively correlated with the TFQI (OR: 1.584; 95%CI: 1.088-2.304; P = 0.016), TSHI (OR: 1.238; 95%CI: 1.034-1.482; P = 0.02), and TT4RI (OR: 1.075; 95%CI: 1.006-1.149; P = 0.032) but was not significantly correlated with the FT3/FT4 ratio. The relationships between composite indices of the thyroid system and non-HDL-C levels differed according to sex. An increased risk of hyper-non-HDL-C was associated with elevated TSHI levels in men (OR: 1.331; 95%CI: 1.003-1.766; P = 0.048) but elevated TFQI levels in women (OR: 2.337; 95%CI: 1.4-3.901; P = 0.001). Among the analyzed variables, the average SHAP values were highest for TSHI, followed by TT4RI. CONCLUSION Impaired sensitivity to thyroid hormones was associated with high non-HDL-C levels in patients with T2DM.

The association between the geriatric nutritional risk index (GNRI) and osteosarcopenia in older adults with type 2 diabetes mellitus (T2DM) is not clear. A total of 573 individuals with T2DM were included in this cross-sectional study. Osteosarcopenia was defined as the presence of both osteoporosis and sarcopenia. Appendicular skeletal muscle mass and bone mineral density (BMD) was measured by dual energy X-ray absorptiometry to diagnose sarcopenia and osteoporosis. Multivariate analyses were used to assess the association between Geriatric Nutritional Risk Index (GNRI) and osteosarcopenia. The patients were divided into four groups: robust (n = 367), osteoporosis alone (n = 154), sarcopenia alone (n = 29), and osteosarcopenia (n = 23). The GNRI was the lowest in osteosarcopenia group and was positively correlated with skeletal muscle index (SMI) (r = 0.122, p = 0.004), grip strength (r = 0.154, p < 0.001), gait speed (r = 0.123, p = 0.004), and BMD of lumbar spine 2–4, femoral neck, and total hip (r = 0.137, p = 0.002; r = 0.096, p = 0.028; r = 0.086, p = 0.049, respectively). In the logistic regression model low GNRI was significantly associated with an increased risk of osteosarcopenia (adjusted OR, 4.164; 95

ObjectivesTo investigate the association between body fat (BF%) and sarcopenia in older adults with type 2 diabetes mellitus (T2DM) and potential link with increased levels of inflammatory indicators and insulin resistance.MethodsA total of 543 older adults with T2DM were included in this cross-sectional study. Appendicular skeletal muscle (ASM), handgrip strength and gait speed were measured to diagnose sarcopenia according to the updated Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Body composition data were tested using dual-energy X-ray absorptiometry (DEXA). Levels of serum high-sensitive C-reactive protein (hs-CRP), interleukin-6, fasting blood insulin (FINS), hemoglobin A1c (HbA1c), 25-hydroxyvitamin D3 [25(OH) D3] were also determined.ResultsThe prevalence of sarcopenia in all participants was 8.84%, of which 11.90% were male and 5.84% females. The Pearson’s correlation analysis revealed that BF% was negatively correlated with gait speed in men and women (R =-0.195, P=0.001; R = -0.136, P =0.025, respectively). After adjusting for all potential confounders, sarcopenia was positive associated with BF% (male, OR: 1.38, 95% CI: 1.15–1.65, P< 0.001; female, OR: 1.30, 95% CI: 1.07–1.56, P=0.007), and negatively associated with body mass index (BMI) (male, OR: 0.57, 95% CI: 0.44–0.73, P<0.001; female, OR: 0.48, 95% CI: 0.33–0.70, P<0.001). No significant differences were found in hs-CRP, interleukin-6, and insulin resistance between older T2DM adults with and without sarcopenia.ConclusionHigher BF% was linked to an increased risk of sarcopenia in older adults with T2DM, suggesting the importance of assessing BF% rather than BMI alone to manage sarcopenia.

Objective:To investigate the correlation between fasting blood glucose (FPG) and neurological function in patients with acute ischemic stroke.Methods:A retrospective analysis was performed on 3 338 stroke patients admitted to Xuanwu Hospital of Capital Medical University within 24 hours of onset from November 2013 to October 2016. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. FPG, 2 hours postprandial-based blood glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), glycated hemoglobin A 1c (HbA 1c), serum creatinine (Scr), urea, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), homocysteine (Hcy), plasma fibrinogen (Fg) were detected. National institutes of health stroke scale (NIHSS), Glasgow coma index (GCS) and modified Rankin scale (MRS) were used to evaluate neurological function. Patients were divided into three groups according to different FPG levels on admission: normal blood glucose group (FPG<6.1 mmol/L, no history of diabetes, 1 507 cases), FPG impaired group (6.1 mmol/L≤FPG<7.0 mmol/L, 1 002 cases), diabetes group (FPG≥7.0 mmol/L or previous history of diabetes, 829 cases). According to NIHSS score, all patients were divided into neurological impairment group (NIHSS score>1 point, 1 906 cases) and normal neurological function group (NIHSS score≤1 point, 1 432 cases). The analysis of variance, t test, and χ2 test were used for comparison between groups. Pearson correlation analysis was used to analyze the correlation between FPG and neural function score. Multivariate logistic regression analysis was used to analyze the influencing factors of neurological function in acute ischemic stroke patients. Results:Compared with the normal blood glucose group and the impaired FPG group, SBP, DBP, FPG, ALT and AST were increased and the indexes of Scr, urea and TG were decreased in the diabetic group, the differences were statistically significant (all P<0.05). Compared with the normal blood glucose group, the SBP, DBP, FPG and ALT in the FPG impaired group were increased, while the AST, Scr, urea and TG were decreased, and the differences were statistically significant (all P<0.05). There were statistically significant differences in NIHSS, MRS and GCS scores among the three groups (all P<0.001). NIHSS and MRS scores in the diabetic group were significantly higher than those in the FPG impaired group, and GCS scores were significantly lower than those in the FPG impaired group (all P<0.001). NIHSS and MRS scores in the FPG impaired group were significantly higher than those in the normal blood glucose group, and GCS scores were significantly lower than those in the FPG impaired group (all P<0.05). FPG was positively correlated with NIHSS and MRS scores ( r=0.80, P<0.05; r=0.84, P<0.05), was negatively correlated with GCS scores ( r=-0.83, P<0.05). Multivariate logistic regression analysis showed that age, 2 hours postprandial-based blood glucose, hypoglycemic agents and FPG were all related to neurological function in stroke patients ( P<0.05). Conclusions:There is a significant correlation between FPG and neurological function score in patients with acute ischemic stroke. Patients with high FPG have more severe neurological function injury, poorer neurological function recovery state and worse consciousness state.

Although multiple mechanisms have been studied, there is still a lack of effective treatment on non-motor symptoms in Parkinson's disease (PD) patients. Therapeutic effects of 5-(4-hydroxy-3-dimethoxybenzylidene)-thiazolidinone (RD-1), one of rhodamine derivatives, on motor recovery have been previously demonstrated, but its effects on non-motor symptoms remain unclear. Herein, we explored the beneficial effects of RD-1 on PD-related non-motor symptoms and changes in synaptic plasticity in the mesencephalon. To investigate its therapeutic effects in the non-motor symptoms of Parkinsonian model, we employed male C57BL/6N mice and double injection with noradrenergic specific neurotoxin N-2-Chloroethyl-N-ethyl-2-bromobenzylamine hydrochloride, followed 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. Next, we performed behavioral tests, histological analyses and immunoblotting. Our findings showed that RD-1 significantly alleviated locomotor abnormality, motor disturbance, anxiety/depression-like behavior and memory deficit. It rescued the levels of tyrosine hydroxylase in substantia nigra, and striatum. Moreover, RD-1 upregulated expression levels of α-synuclein, synapsin II, postsynaptic density 95 and vesicle-associated membrane protein 2. The restoration of synaptic function may underlie the neuroprotective effects of RD-1 in double lesioned mice, confirming its protective effect for dopaminergic neurodegeneration.

目的 探讨老年2型糖尿病患者跌倒的相关因素,找出跌倒风险的相关因素.方法 纳入2016年5月10日-2019年11月20日北京某三甲医院内分泌科住院的60岁以上的2型糖尿病患者共530例,根据过去1年是否有跌倒情况分为跌倒组和无跌倒组.测定空腹血糖、糖化血红蛋白、血脂、骨骼肌肌肉质量、握力、步速等.计算体质量指数与四肢骨骼肌肌肉质量指数.分析跌倒的影响因素.结果 跌倒组的ASMI、握力、步速、前白蛋白、血色素水平显著低于非跌倒组(P＜0.05).跌倒组女性比例、糖尿病视网膜病变患病率显著高于非跌倒组(分别为P＜0.001).多元Logistic回归分析显示糖尿病视网膜病变OR(95％CI):2.517(1.553-4.078)、低步速 OR(95％CI):2.894(1.692-4.948)、前白蛋白OR(95％CI):0.996(0.992-0.999)为跌倒的独立影响因素.结论 糖尿病视网膜病变、低步速为老年T2DM患者跌倒的危险因素,前白蛋白为跌倒的保护因素.

Purpose: Muscle dysfunction is considered as a sign of poor prognosis in patients with type 2 diabetes (T2D). Thus, early detection of muscle disorders is particularly important in T2D population. For free fatty acid (FFA) is known as a clinical indicator of metabolic diseases and muscle function, hence, we aimed to investigate whether FFA could serve as a biomarker for muscle function. Methods: There are totally 160 adult subjects with T2D were characterized and analyzed in this study. Muscle mass and function were measured by walking speed, grip strength and height-adjusted appendicular skeletal muscle mass (SMI). Logistic regression was applied to explore the correlation of FFA with muscle indicators. Receiver operating characteristic (ROC) curves were utilized to conduct the diagnostic value of FFA. Results: FFA was negatively correlated with SMI (r = -0.347, P = 1.0E-05), grip strength (r = -0.313, P = 7.1E-05) and walking speed (r = -0.167, P = 0.039). Notably, the relationships between FFA and SMI and walking speed remained significant even after adjusting for age, sex, body mass index (BMI) and hemoglobin A1C (HbA1c). The combination of conventional indicators including age, BMI and HbA1c provided discrimination effect of low grip strength with an AUC of 0.648, low walking speed with an AUC of 0.714. Importantly, when FFA was added to the model, the value of ROC curve was further improved, with an AUC of 0.785 for low grip strength, 0.755 for low walking speed. Conclusions: The current study demonstrated a negative correlation of FFA with muscle indicators in adult T2D patients after adjusting for HbA1c. FFA may play an important role in the pathological process of muscle dysfunction in adults with T2D.

Abstract Objectives Several studies demonstrated a positive relationship between hemoglobin level and bone mineral density (BMD). Thus, the association between hemoglobin concentration and osteoporosis in elders with type 2 diabetes mellitus (T2DM) was explored in this study. Methods Totally, 573 elders with T2DM were included in the study. BMD was measured by dual-energy X-ray absorptiometry. Hemoglobin levels were tested. The association between the hemoglobin level and osteoporosis was subjected to logistic regression analysis. Results For men, the hemoglobin levels were significantly lower in osteoporosis group than that in non-osteoporosis group (135.98 ± 16.20 vs. 142.84 ± 13.78 g/L, P = 0.002). Hemoglobin levels were positively related with BMD of total hip and femoral neck in men (r = 0.170, P = 0.004; r = 0.148, P = 0.012, respectively). After adjusting for age, body mass index (BMI), hemoglobin A1c (HbA1c), estimated glomerular filtration rate (eGFR) and 25-hydroxyvitamin D3 [25(OH) D3], the hemoglobin level was related with a 0.97-fold lower risk of osteoporosis (odds ratio (OR): 0.97; 95% confidence interval (CI): 0.95–0.99; P = 0.004) in men, but no such association was found in women. Conclusion Higher levels of hemoglobin play a protective role against osteoporosis in older men with T2DM.

目的 探索不同方法校正的肌肉质量与老年2型糖尿病(type 2 diabetes mellitus,T2DM)躯体功能的相关性.方法 纳入首都医科大学宣武医院内分泌科≥60岁的T2DM患者248例,测定血红蛋白(hemoglobin,Hb),糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)、空腹血糖(fasting plasma glucose,FPG),维生素D、握力、步速、起立行走计时(timed go and up,TUG)测试时间,计算体质量指数(body mass index,BMI).并用双能X线吸收检测仪测定四肢骨骼肌肌肉质量(appendicular skeletal muscle mass,ASM),分别用身高(height,ht)的平方(ASM/ht2)和BMI(ASM/BMI)两种方法对肌肉质量校正,分析躯体功能的影响因素.结果 偏相关分析结果显示,ASM/BMI均与握力、步速、TUG时间显著相关(分别为r=0.636,P<0.001;r=0.191,P=0.003;r=-0.143,P=0.026),而ASM/ht2仅与握力相关(r=0.513,P<0.001).多元Logistic回归分析结果显示,低ASM/BMI显著影响患者的步速和TUG时间(分别为OR=4.73,95％CI:1.54～14.60,P=0.007;OR=2.92,95％CI:1.12～7.63,P=0.029),而ASM/ht2对患者躯体功能无显著影响.结论 低ASM/BMI而不是低ASM/ht2与老年T2DM患者差的躯体功能相关,ASM/BMI可能是更适合于T2DM患者的肌肉质量校正方法.

Osteocalcin may benefit nonalcoholic fatty liver disease (NAFLD). The present study aimed to explore the levels of serum osteocalcin in NAFLD in patients with type 2 diabetes mellitus (T2DM). In total, 1026 inpatients diagnosed with T2DM were enrolled in the study. NAFLD was defined according to the working definition of the revised guidelines for the management of NAFLD published by the Chinese Liver Disease Association, and confirmed by abdominal ultrasonography. The current study found a NAFLD prevalence of 54

目的 探讨老年2型糖尿病(type 2 diabetes mellitus,T2DM)体脂率与肌力及躯体功能的相关性.方法 纳入127例于首都医科大学宣武医院内分泌科住院的≥60岁的T2DM患者,测定糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)、25羟维生素D3[25-hydroxyvitamin D3,25(OH)D3],空腹胰岛素(fasting insulin,FINS),C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)浓度.双能X线吸收仪测定受试者体脂率及四肢骨骼肌肌肉质量(appendicular skeletal muscle mass,ASM).用握力和椅子起坐试验来评价肌肉力量.步速和简易体能状况量表(Short Physical Performance Battery,SPPB)来评价躯体功能.多元线性回归分析体脂率对肌力和躯体功能的影响.结果 女性患者体脂率显著高于男性(35.18％ ±6.32％vs 28.75％ ±4.48％,P<0.001).体脂率与ASM、骨骼肌肌肉质量指数(appendicular skeletal muscle massindex,ASMI)、握力、步速、SPPB评分显著负相关,与CRP、胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)、椅子起坐时间正相关(P<0.01).调整年龄、性别、ASM、HbA1c和高腰围后,体脂率与握力、步速降低相关(分别为β=-33.68,P=0.003;β=-1.316,P=0.002),亦与5次起坐时间增加相关(β=31.60,P=0.011).结论 体脂率与老年2型糖尿病患者的肌力下降及不良的躯体功能显著相关.

Objective:The objective of this study was to examine the correlation between blood glucose and serum insulin with acute cerebrovascular disease. Methods:A total of 1548 patients with acute cerebrovascular illness and 364 patients with a normal physical examination who were admitted to our hospital (endocrinology department) between January 2017 and July 2020 were recruited. Patients with acute cerebrovascular illness were included in the experimental group, while healthy individuals after physical examinations were included in the control group. All patients' blood glucose and serum insulin levels were measured, and the association of blood glucose and serum insulin with acute cerebrovascular illness was investigated. Results:Acute cerebrovascular disease is associated with significantly higher blood glucose and serum insulin levels versus healthy status (P < 0.05). Blood glucose and serum insulin levels were observed to be significantly higher in the hemorrhagic stroke group than in the ischemic stroke or mild hemorrhagic group (P < 0.05). Severe ischemic strokes were associated with significantly higher blood glucose levels versus mild ischemic strokes (P < 0.05). There were no significant differences in serum insulin levels between the severe ischemic stroke group and the mild ischemic stroke group (P > 0.05). Conclusion:A rise in blood glucose and serum insulin levels is associated with the incidence and prognosis of acute cerebrovascular disease, and it is positively correlated with the severity of the acute cerebrovascular disease.

Objective:To investigate the influencing factors and bilirubin levels of diabetic retinopathy (DR) in hospitalized patients with type 2 diabetes mellitus (T2DM).Methods:T2DM patients who were hospitalized in the Department of Endocrinology from January to December 2021 in Xuanwu Hospital of Capital Medical University were retrospectively enrolled. All included patients underwent non-mydriatic fundus photography. The data of duration of diabetes, body mass index (BMI), creatinine, total bilirubin, direct bilirubin, indirect bilirubin, glycated hemoglobin A 1c (HbA 1c), high-sensitivity C-reactive protein (hs-CRP) and urinary albumin to creatinine ratio (UACR) were collected. The patients were divided into non-diabetic retinopathy (NDR) group and DR group according to the diagnostic and staging criteria of DR. The t-test, Mann-Whitney U test and χ 2 test were used to compare the general clinical data between the two groups; multivariate logistic regression analysis was used to analyze the risk factors of DR. Results:A total of 1 027 patients were enrolled, including 245 patients with DR and 782 patients with NDR. The prevalence of DR in hospitalized T2DM patients was approximately 23.9% (245/1 027). Compared with the NDR group, the DR group had a longer duration of diabetes, higher HbA 1c, creatinine, UACR, hs-CRP levels, and lower total bilirubin, direct bilirubin and indirect bilirubin concentrations. The differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for gender, age and BMI, HbA 1c (OR =1.199, 95 %CI 1.112-1.293), duration of diabetes (OR=1.063, 95%CI 1.034-1.093), creatinine (OR=1.007, 95%CI 1.002-1.013), UACR (OR=1.389, 95%CI 1.280-1.507) and hs-CRP (OR=1.260, 95%CI 1.108-1.432) were the main risk factors for DR, total bilirubin (OR=0.927, 95%CI 0.873-0.983), direct bilirubin (OR=0.831, 95%CI 0.701-0.985) and indirect bilirubin (OR=0.898, 95%CI 0.825-0.976) were protective factors for DR; after further adjustment for HbA 1c, diabetes duration (OR=1.063, 95%CI 1.033-1.093), creatinine (OR=1.008, 95%CI 1.002-1.013), UACR (OR=1.382, 95%CI 1.272-1.502) and hs-CRP (OR=1.214, 95%CI 1.065-1.384) were still independent risk factors for DR, total bilirubin (OR=0.922, 95%CI 0.867-0.980), direct bilirubin (OR=0.827, 95%CI 0.694-0.984) and indirect bilirubin (OR=0.889, 95%CI 0.815-0.969) were still protective factors for DR. Conclusion:HbA 1c, duration of diabetes, creatinine, UACR and hs-CRP are risk factors for DR, and bilirubin may be a protective factor for DR.

目的 探讨老年2型糖尿病(T2DM)患者骨质疏松与肌少症的相关性.方法 选择2017年5月至2019年7月于首都医科大学宣武医院内分泌科住院的579例年龄≥60岁的T2DM患者为研究对象,测量患者腰椎、左股骨颈及左全髋骨密度(BMD);测量糖化血红蛋白(HbA1c)、握力与步速、四肢骨骼肌质量( ASM),计算四肢骨骼肌质量指数( ASMI).按照患者是否发生骨质疏松和肌少症分别将患者分为骨质疏松组(180例)和非骨质疏松组(399例),肌少症组(52例)和非肌少症组(527例),分析骨质疏松与肌少症的相关性.采用SPSS 24. 0统计软件进行数据分析.根据数据类型,分别采用t检验、Mann-Whitney U检验或χ2 检验进行组间比较.采用多元logistic回归分析肌少症与骨质疏松的相互影响.结果 肌少症组体质量指数(BMI)、左股骨颈与左全髋的BMD和T值均显著低于非肌少症组(P<0. 05);骨质疏松组BMI、ASMI、握力、步速均显著低于非骨质疏松组(P<0. 05).多元logistic回归分析显示,老年T2DM患者肌少症为骨质疏松的危险因素( OR=2. 16,95% CI 1. 131～4. 125,P=0. 02),骨质疏松为肌少症的危险因素(OR=2. 27,95%CI 1. 121～4. 596,P=0. 023).结论 老年T2DM患者骨质疏松与肌少症有相互促进作用.

Objective:To investigate the relationship between thyroid function and sarcopenia in Chinese geriatric patients with type 2 diabetes mellitus (T2DM).Methods:Patients with T2DM aged over 60 years old were recruited from department of endocrinology, Xuanwu Hospital, Capital Medical University, from April 2017 to April 2019. Appendicular skeletal muscle mass, grip strength, and walking speed were measured, appendicular skeletal muscle mass index (ASMI) was calculated. Concentrations of free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were determined, FT3/FT4 ratio was calculated. Sarcopenia was defined based on the standard of the Asian Working Group of Sarcopenia. The included patients were divided into sarcopenia group and non-sarcopenia group. The t test or χ2 test was used to compare general characteristics between the two groups; correlation analysis and multivariate logistic regression analysis were used to explore the relationship between thyroid function and sarcopenia. Results:A total of 535 patients with T2DM aged over 60 years old were enrolled. There were 490 patients in sarcopenia group and 45 patients in non-sarcopenia group, respectively. Compared with non-sarcopenia patients, patients with sarcopenia demonstrated lower levels of FT3 and FT3/FT4 ratio (all P<0.05). In geriatric patients with T2DM, FT3/FT4 ratio was significant positively correlated with ASMI, grip strength and walking speed ( r=0.240, 0.242 and 0.227, respectively, all P<0.01), the same with FT3 levels ( r=0.300, 0.366 and 0.296, respectively, all P<0.01). Multivariate logistic regression analysis showed that FT3/FT4 ratio (OR=0.396,95%CI 0.158-0.992, P=0.048) was independent risk factor for sarcopenia. Conclusions:In geriatric patients with T2DM, the concentrations of FT3 and FT3/FT4 ratio are significant positively correlated with the components of sarcopenia, and FT3/FT4 ratio is an independent predictor of sarcopenia.

目的 探讨中老年男性2型糖尿病(type 2 diabetes mellitus,T2DM)患者尿酸与肌少症的相关性.方法 纳入首都医科大学宣武医院内分泌科275例≥55岁男性2型糖尿病患者,检测血尿酸(uric acid,UA)、25羟维生素D3(25 hydroxyvitamin D3,25 OHD3)、糖化血红蛋白(hemoglobin A1c,HbA1c)等浓度.测定四肢骨骼肌肌肉质量(appendicular skeletal muscle mass,ASM)、握力、步速等,并计算出四肢骨骼肌质量指数(appendicular skeletal muscle mass index,ASMI),分析UA与肌少症的相关性.结果 55岁以上男性T2DM患者肌少症患病率为32.73％,肌少症组患者UA明显低于非肌少症组[(307.5±76.57)mmol/L vs(342.02±89.02)mmol/L,P=0.002].Pearson相关分析显示,UA与ASMI呈正相关(r=0.201,P=0.006),UA与握力,步速无相关性(P>0.05);多元Logistic回归分析显示,UA是中老年男性T2DM患者肌少症的独立保护因素(OR=0.89,95％CI:0.79～0.97,P=0.043).结论 尿酸对中老年男性T2DM患者的肌少症发挥一定的保护作用.

目的 分析60岁以上老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者肌少症与非乙醇性脂肪肝(nonalcoholic fatty liver disease,NAFLD)的相关性.方法 选取2015年10月至2019年10月在首都医科大学宣武医院内分泌科住院的老年T2DM患者共计533例,采用双能X线吸收测量仪(dual-energy X-ray absorptiometry,DXA)测量四肢骨骼肌肌肉质量(appendicular skeletal muscle mass,ASM).四肢骨骼肌质量指数(appendicular skeletal muscle index,ASMI)以ASM(kg)/身高2(m2)作为计算公式,以男性<7.26 kg/m2,女性<5.45 kg/m2作为肌少症的诊断标准,将入组患者分为肌少症组(116例)及非肌少症组(417例),进行相应的体格检查及实验室检查.结果 老年2型糖尿病肌少症组年龄(P<0.01)、性别(P<0.001)、体质量指数(body mass index,BMI)(P<0.001)、糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)(P<0.01)与非肌少症组相比差异有统计学意义;肌少症组NAFLD患病率显著低于非肌少症组(39.13％vs.57.83％,P<0.001).多因素Logistic回归分析显示肌少症与性别,年龄,HbA1c及BMI≥25 kg/m2独立相关(分别为OR=0.128,95％CI:0.073～0.224,P<0.01;OR=1.060,95％CI:1.024～1.097,P<0.01;OR=1.137,95％CI:1.004～1.286,P<0.05;OR=0.131,95％CI:0.078～0.222,P<0.01).多因素回归未显示肌少症与脂肪肝相关.结论 女性及BMI≥25 kg/m2为老年T2DM患者肌少症的保护因素;HbA1c升高,增龄为肌少症的危险因素.脂肪肝既不是肌少症的保护因素,也不是危险因素.