关键词: 老年人群, 肌少症, 肥胖, 糖尿病, 肌肉质量, 白细胞介素6, C-反应蛋白, 肿瘤坏死因子α

Abstract:

Objective To discuss the relationship between three proinflammatory factors and muscle mass （MM） in the elderly patients with sarcopenic obesity and diabetes， and to provide theoretical basis for the development of clinical treatment protocols in the elderly patients with sarcopenic obesity and diabetes. Methods The elderly patients with diabetes who visited our hospital from January 2021 to May 2023 were selected， including 41 patients with obesity and diabetes （OD group） and 46 patients with sarcopenic obesity and diabetes （SOD group）； 80 healthy subjects（control group） and 62 subjects with simple obesity （SO group） who underwent physical examination in our hospital during the same period were included. The clinical data of the subjects in four groups were compared， and the correlations between proinflammatory factors and MM and fat mass （FM） were analyzed. All the subjects were divided into sarcopenia group and normal group based on the presence of sarcopenia. Logistic regression model was used to analyze the independent influencing factors of sarcopenia； receiver operating characteristic （ROC） curve was drawn to determine the predictive value of the above factors for sarcopenia. Results Compared with control group， the body mass index （BMI）， FM and body fat percentage （BFP） of the subjects in SOD， OD and SO groups were significantly increased （P<0.05）； compared with control group， OD group and SO group， the appendicular skeletal muscle mass （ASM）， appendicular skeletal muscle mass index （ASMI） and grip strength （GS） of the subjects in SOD group were significantly decreased （P<0.05）， and the levels of serum interleukin-6（IL-6）， C-reactive protein（CRP） and tumor necrosis factor-α（TNF-α） were significantly increased （P<0.05）. In all the subjects， the IL-6， CRP and TNF-α were negatively correlated with ASMI （r=-0.589，r=-0.621，r=-0.620； P<0.05）， and positively correlated with BFP （r=0.252，r=0.221，r=0.147； P<0.05）. Compared with normal group， the ASM， ASMI and GS of the subjects in sarcopenia group were significantly decreased （P<0.05）， and the levels of serum proinflammatory factors IL-6， CRP and TNF-α were significantly increased （P<0.05）. The univariate Logistic regression analysis results showed that IL-6， CRP and TNF-α were the influencing factors of sarcopenia （P<0.05）. The multivariate Logistic regression analysis results showed that the increased levels of IL-6 and TNF-α were the independent risk factors for sarcopenia （OR>1， P<0.05）. The ROC curve results showed that the area under the curve （AUC） values of IL-6， CRP and TNF-α were all >0.700， indicating that the above indicators had good predictive value for sarcopenia. Conclusion The increased levels of proinflammatory factors IL-6， CRP and TNF-α are associated with the decrease of MM in the elderly patients with sarcopenic obesity and diabetes， and IL-6 and TNF-α are the independent risk factors for the sarcopenia.

Key words: Elderly population, Sarcopenia, Obesity, Diabetes, Muscle mass, Interleukin-6, C-reactive protein, Tumor necrosis factor-α