目前,我国已逐渐步入高龄社会,2型糖尿病因其在中老年人群中的普遍性以及日渐攀升的患病比例,在医疗实践中,治疗此病须充分考虑到特定年龄段的生理和病理特点。根据中医学说,2型糖尿病与脾机能失调有紧密的联系,过往医籍在疗法上主张益气健脾和祛除体内湿邪。结合古今对2型糖尿病的成因剖析、中老年人体质研究,以及脾功能对胰岛的影响等多方面的考量,我们得出结论:“脾虚夹湿”是该年纪层次2型糖尿病形成的主要病因。因此,基于上述理论的“益气健脾化湿”治疗方案,应当成为针对此类病患的治疗常规。At present, China has gradually stepped into an ageing society, type 2 diabetes mellitus, because of its prevalence in the middle-aged and elderly population and the increasing proportion of the disease, in medical practice, the treatment of this disease must fully take into account the physiological and pathological characteristics of the specific age group. According to Chinese medicine, type 2 diabetes mellitus is closely related to spleen dysfunction, and past medical texts have advocated the use of qi to strengthen the spleen and remove dampness from the body. Taking into account the causes of type 2 diabetes mellitus in the past and the present, the study of the physique of the middle-aged and the elderly, as well as the influence of the spleen function on the pancreatic islets, we conclude that “spleen deficiency and dampness” is the main cause of type 2 diabetes mellitus at this age level. Therefore, based on the above theory, the treatment plan of “benefiting qi, strengthening the spleen, and eliminating dampness” should become the treatment routine for this type of patients.
目的依据亚洲肌少症工作组(Asian Working Group for Sarcopenia,AWGS)2014年(AWGS2014)和2019年(AWGS2019)的诊断标准,对比分析中国老年2型糖尿病(T2DM){2}中肌少症的患病率及相关因素的差异。方法选取2016年2月—2017年1月在上海市第十人民医院住院治疗的116例老年T2DM{2}作为研究对象。通过采集血液样本、测量握力、步速和四肢骨骼肌质量,并根据AWGS2014和AWGS2019的标准诊断肌少症;采用SPSS 28.0统计软件分析2种标准下肌少症患病率的差异,并通过二元逻辑回归分析评估肌少症的相关因素。结果依据AWGS2014和AWGS2019的标准,中国老年T2DM{2}肌少症的患病率分别为36.2%和56.0%;且年龄和BMI均与肌少症相关。在AWGS2014的诊断标准中,血清白蛋白(Alb)水平是肌少症的保护性因素,但其在AWGS2019的标准中未得到验证。相较于AWGS2014的诊断标准,采用AWGS2019的诊断标准评估的中国老年2型糖尿病{2}中肌少症的患病率更高,且年龄增长和BMI降低均为一致的风险因素;但血清白蛋白水平仅在AWGS2014的标准中与肌少症相关。结论肌少症的诊断标准会影响患病率及相关因素的识别,需要进一步的研究来确认哪些临床指标对肌少症更为敏感,以推动肌少症的早期临床诊断和干预。