竖脊肌横截面积和肝脾比值与老年糖尿病患者衰弱的关系：一项横断面研究。
The cross-sectional area of erector spinae muscle and the liver-to-spleen ratio are associated with frailty in older patients with diabetes: a cross-sectional study.
机构信息
Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan.
The Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan.
出版信息
BMC Geriatr. 2023 Nov 22;23(1):765. doi: 10.1186/s12877-023-04347-6.
BACKGROUND
Older patients with diabetes mellitus are more susceptible to frailty. Although some imaging markers of appendicular skeletal muscle mass obtained using dual-energy X-ray absorptiometry or computed tomography (CT) imaging can reflect frailty status, the association between imaging indices obtained by abdominal CT scans and frailty in older inpatients has not been reported.
METHODS
A total of 151 older inpatients with diabetes mellitus (median age, 79 years; men, 42%) who underwent abdominal CT scans close to the admission date were studied to examine the associations between abdominal CT indices and frailty. Two frailty definitions were used: the modified Cardiovascular Health Study (mCHS) criteria and Kihon Checklist (KCL) criteria. Using the imaging analysis software SYNAPSE VINCENT®, we compared the cross-sectional areas (CSA) of four truncal muscles (erector spinae, iliopsoas, rectus abdominis, and abdominal oblique muscles) and the liver-to-spleen ratio (L/S), the ratio of the CT values of the liver and spleen between frail and non-frail patients. The muscle areas that showed the strongest associations with frailty were also investigated in relation to grip strength and walking speed. Finally, multivariate binominal logistic regression analyses were performed to assess the independent associations of CSA of muscle and L/S with the prevalence of frailty.
RESULTS
The prevalence of frailty defined by the mCHS and KCL criteria was 55% and 52%, respectively. The CSA of the erector spinae muscle was most significantly associated with frailty, and was significantly smaller in both sexes of mCHS-defined frail patients and in men with KCL-defined frailty. The CSA of erector spinae muscle was also positively correlated with grip strength and walking speed. In contrast, the L/S was higher in men with KCL-defined frailty. Multivariate logistic regression analyses revealed that the CSA of the erector spinae muscle was independently associated with mCHS-defined frailty in women, and the L/S was associated with KCL-defined frailty in men.
CONCLUSIONS
The CSA of erector spinae muscle and low liver fat content could be indices of frailty in older patients with diabetes.
背景
患有糖尿病的老年患者更容易出现虚弱。虽然双能 X 射线吸收法或计算机断层扫描 (CT) 成像等获得的四肢骨骼肌质量的一些影像学标志物可以反映虚弱状态，但腹部 CT 扫描获得的影像学指标与老年住院患者的虚弱之间的关系尚未得到报道。
方法
本研究纳入了 151 名年龄在 79 岁（男性占 42%）且接近入院日期接受腹部 CT 扫描的老年糖尿病患者，以研究腹部 CT 指数与虚弱之间的关系。使用两种虚弱定义：改良心血管健康研究 (mCHS) 标准和 Kihon 清单 (KCL) 标准。使用影像学分析软件 SYNAPSE VINCENT®，我们比较了 4 个躯干肌肉（竖脊肌、腰大肌、腹直肌和腹斜肌）的横截面积 (CSA) 和肝脏-脾脏比值 (L/S)，即肝脏和脾脏之间的 CT 值比，以及虚弱和非虚弱患者之间。还研究了与握力和步行速度相关性最强的肌肉面积与虚弱的关系。最后，进行了多变量二项逻辑回归分析，以评估 CSA 肌肉和 L/S 与虚弱患病率的独立关联。
结果
mCHS 和 KCL 标准定义的虚弱患病率分别为 55%和 52%。竖脊肌 CSA 与虚弱最显著相关，mCHS 定义的虚弱男性和 KCL 定义的虚弱男性的 CSA 均显著较小。竖脊肌 CSA 也与握力和步行速度呈正相关。相比之下，KCL 定义的虚弱男性的 L/S 更高。多变量逻辑回归分析显示，女性的竖脊肌 CSA 与 mCHS 定义的虚弱独立相关，而男性的 L/S 与 KCL 定义的虚弱相关。
结论
竖脊肌 CSA 和低肝脂肪含量可能是老年糖尿病患者虚弱的指标。
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