老年2型糖尿病合并肌少症患者炎症反应与心肌损伤及日常生活能力受限的相关性分析

Correlation analysis of inflammatory response with myocardial injury and activities of daily living limitations in elderly patients with type 2 diabetes mellitus complicated by sarcopenia

摘要:

目的 探讨老年2型糖尿病（T2DM）合并肌少症患者血清炎症反应与心肌损伤标志物及日常生活能力（ADL）的关联性，为临床早期干预提供理论依据。方法 选取2021年12月—2024年12月南通市第三人民医院202例老年T2DM患者，根据是否存在肌少症分为T2DM合并肌少症组（95例）与T2DM组（107例），另同期选取该院50例体检健康者纳入对照组。检测各组的炎症反应、心肌损伤及日常生活能力。采用Pearson法分析炎症因子与心肌损伤标志物、ADL的相关性。结果 T2DM合并肌少症组的糖尿病病程及空腹血糖（FPG）水平均高于T2DM组（P <0.05），ADL评分低于T2DM组（P <0.05）。T2DM合并肌少症组的白细胞计数（WBC）、中性粒细胞/淋巴细胞比值（NLR）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平均高于T2DM组和对照组（P <0.05））。T2DM组的WBC、NLR、IL-6、TNF-α水平均高于对照组（P <0.05）。T2DM合并肌少症组的血红蛋白（Hb）、人血白蛋白（Alb）水平均低于T2DM组和对照组（P <0.05）。T2DM组的Hb、Alb水平均低于对照组（P <0.05）。T2DM合并肌少症组的N末端B型利尿钠肽原（NT-proBNP）、高敏肌钙蛋白I（hs-cTnI）、肌钙蛋白（TcTnT）和肌酸激酶同工酶MB（CK-MB）水平均高于T2DM组和对照组（P <0.05）。T2DM组的NT-proBNP、hs-cTnI、cTnT和CK-MB水平均高于对照组（P <0.05）。Pearson相关性分析结果显示，WBC、NLR、IL-6、TNF-α与NT-proBNP、hs-cTnI、cTnT、CK-MB水平均呈正相关（P <0.05），与ADL评分均呈负相关（P <0.05）。Hb、Alb与NT-proBNP、hs-cTnI、cTnT、CK-MB水平均呈负相关（P <0.05），与ADL评分均呈正相关（P <0.05）。结论 老年T2DM合并肌少症患者存在炎症反应、心肌损伤及功能受限，且三者具有相关性，可作为评估病情的重要指标。

Abstract:

Objective To investigate the associations among serum inflammatory factors, myocardial injury markers, and activities of daily living (ADL) in elderly patients with type 2 diabetes mellitus (T2DM) complicated by sarcopenia, providing a theoretical basis for early clinical intervention.Methods A total of 202 elderly T2DM patients admitted between December 2021 and December 2024 were enrolled and categorized into T2DM with sarcopenia group (n = 95) and T2DM alone group (n = 107) based on the presence of sarcopenia, with 50 age- and sex-matched healthy individuals serving as controls. Inflammatory markers, myocardial injury indicators, and ADL were measured in all participants. Pearson correlation analysis was performed to examine relationships among these parameters.Results Compared with the T2DM alone group, patients with sarcopenia exhibited significantly longer diabetes duration, higher fasting plasma glucose (FPG) levels, and lower ADL scores (P < 0.05). The sarcopenia group demonstrated elevated serum levels of white blood cells (WBC), neutrophil-to-lymphocyte ratio (NLR), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), along with reduced hemoglobin (Hb) and albumin (Alb) concentrations compared to both the T2DM group and controls (P < 0.05). The T2DM alone group also showed higher levels of WBC, NLR, IL-6, and TNF-α, and lower levels of Hb and Alb compared to the control group (P < 0.05). Myocardial injury markers including NT-proBNP, high-sensitivity cardiac troponin I (hs-cTnI), cardiac troponin T (cTnT), and creatine kinase-MB (CK-MB) were significantly higher in the sarcopenia group than in the T2DM and control groups (P < 0.05). These myocardial injury markers were also higher in the T2DM alone group compared to the controls (P < 0.05). Positive correlations were observed between inflammatory markers (WBC, NLR, IL-6, TNF-α) and myocardial injury indicators, while negative correlations were found with ADL scores (P < 0.05). Conversely, Hb and Alb levels showed negative correlations with myocardial injury markers but positive correlations with ADL scores (P < 0.05).Conclusion Elderly T2DM patients with sarcopenia present with significant inflammatory responses, myocardial injury, and functional limitations that demonstrate strong intercorrelations, serving as valuable clinical indicators for disease assessment.