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研究生: 呂曉琪
Lu, Hsiao-Chi
論文名稱: 2型糖尿病患下肢肌肉功能與肌少症指標之相關研究
The Study on the Correlation between Lower Extremity Muscle Function and the Sarcopenia Index in Patients with Type 2 Diabetes Mellitus
指導教授: 吳柏翰
Wu, Bo-Han
學位類別: 碩士
Master
系所名稱: 人文暨社會科學院 - 休閒運動健康系所
Department of Recreational Sport and Health Promotion
畢業學年度: 107
語文別: 中文
論文頁數: 93
中文關鍵詞: 爆發力醣化血色素身體組成
外文關鍵詞: Muscular Power, Hemoglobin A1C, Body Composition
DOI URL: http://doi.org/10.6346/NPUST201900351
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  • 目的:了解二型糖尿病人下肢肌肉功能與肌少症的相關指標之相關性,並且探討坐站檢測做為早期糖尿病肌少症檢測指標之可能性。方法:本研究採橫斷性研究,對象為南部糖尿病專科診所,經醫師診斷為二型糖尿病患者為研究對象。資料採用2019年2月1日至2019年5月31日,以亞洲肌少症工作組織(AWGS)建議的檢測及切點來判斷有無肌少症及肌少症前期,同時收集小腿圍、下肢肌肉功能及相關病史、個人基本資料及生化指標。統計方法為皮爾森相關係數、單因子變異數分析、二元邏輯斯回歸以分析下肢肌肉功能、小腿圍、SARC-F量表及生化指標與肌少症檢測之相關與差異。結果:共收集298名二型糖尿病患者,其中男性153人(51.4%),平均年齡為63.9±9.8歲,罹病期為12.5±7.8年,依據握力、生物電阻抗分析及身體活動功能檢測,共有23位患者診斷肌少症(7.7%)。年齡、小腿圍及檢測下肢肌肉功能中的F2值為肌少症的預測因子。結論:臨床實務上,以測力板測量下肢肌肉功能中F2值為指標,可作為二型糖尿病肌少症之參考。

    Objective: Thy objective of the study was to examine the correlation between lower extremity muscle function and the sarcopenia index in patients with type 2 diabetes mellitus and investigate the possibility to use the Sitting Rising Test as the index to detect the early stage of sarcopenia for patients.
    Method: A cross-sectional study was conducted to examine patients with type 2 diabetes mellitus diagnosed by doctors from three specialized diabetes clinics in the south of Taiwan. The data was collected from February 1st to May 31st, 2019, with the screening criteria and cutoff point recommended by the Asian Working Group for Sarcopenia (AWGS) to identify sarcopenia for patients. The study also gathered information of patients in calf circumference, lower extremity muscle function, related medical history, basic personal information, and biochemical index.
    Statistical methods were utilized for data analysis: Pearson's correlation coefficient, anova, and multinomial logistic regression analysis to analyze the correlation between lower extremity muscle function, calf circumference, SARC-F Scale, biochemical index and sarcopenia diagnosis. Results: The study enrolled 298 patients with type 2 diabetes mellitus, with 153 males (51.4%) involved, mean age 63.9±9.8, average disease duration 12.5±7.8 years. Twenty-three patients (7.7%) were diagnosed sarcopenia based on the tests conducted on their hand grip strength, bioelectrical impedance analysis and physical performance test.
    Age, calf circumference, and F2 (the force for lower limb muscle mass) on the lower extremity muscle function test were independent risk factors for sarcopenia. Conclusion: In clinical practice, the measurement of lower extremity muscle function can be utilized as the reference for sarcopenia in patients with type 2 diabetes mellitus to reach the goal for early diagnosis and treatment.

    目錄

    目錄 ii
    圖目錄 iv
    表目錄 v
    摘要 vi
    Abstract vii
    謝誌 ix
    第一章 緒論 1
    第一節 研究背景與動機 1
    第二節 研究目的 4
    第三節 研究問題 5
    第四節 名詞操作型定義 6
    第二章 文獻查證 8
    第一節 糖尿病概況 8
    第二節 肌少症的定義 13
    第三節 肌少症發生機制 14
    第四節 糖尿病與肌少症 18
    第五節 肌少症的盛行率 22
    第六節 肌少症判定標準 25
    第七節 肌少症的測量方式 31
    第三章 研究方法 40
    第一節 研究架構 41
    第二節 研究假設 42
    第三節 研究流程 43
    第四節 研究地點與對象 44
    第五節 研究工具 45
    第六節 資料統計與分析 52
    第七節 倫理考量 54
    第四章 研究結果 55
    第一節 研究對象現況分析 56
    第二節 研究對象社會人口學、生化指標及下肢肌肉功能與肌少症檢測工具之相關 59
    第三節 不同肌少症分期對社會人口學、生化指標、下肢肌力與各檢測工具之差異 61
    第四節 影響肌少症相關因素之二元邏輯斯迴歸分析 67
    第五章 討論 68
    第六章 結論與研究建議 71
    第一節 結論 71
    第二節 侷限 72
    第三節 對未來相關研究之建議 73
    參考文獻 74
    附件一 李氏聯合診所肌少評估表 93
    附件二 人體試驗同意書 94

    圖目錄

    圖一、肌肉老化在肌纖維與細胞的變化 15
    圖二、肌少症發生機制 16
    圖三、第二型糖尿病加速肌肉損失的途徑 20
    圖四、糖尿病肌少症的病理機轉 21
    圖五、生涯中正常與異常的肌肉量、肌力減少模型 22
    圖六、歐洲肌少症工作組織之肌少症階段評估流程 27
    圖七、亞洲肌少症小組肌少症評估流程 29
    圖八、研究架構 41
    圖九、研究流程 43
    圖十、握力器 47
    圖十一、電子式握力器檢測 47
    圖十二、地面反作用力參數 47
    圖十三、測力板上五次坐站 47
    圖十四、Kistler測力板 48
    圖十五、IN body 檢測方法 50
    圖十六、InBody 770人體成分分析儀 50
    圖十七、小腿圍量測 51
    圖十八、計時起立行走測試 51

    表目錄

    表一、歐盟肌少症工作組織2018年肌少症的診斷標準 25
    表二、歐洲肌少症工作組織針對各檢測的切點與文獻做一整理如下 28
    表三、歐洲與亞洲的肌少症診斷標準整理 30
    表四、中文版SARC-F量表 46
    表五、分析之參數 49
    表六、研究對象社會人口學現況分析(N=298) 56
    表七、研究對象生化指標現況分析(N=298) 57
    表八、研究對象肌少症現況分析(N=298) 58
    表九、各肌少症檢測指標與肌少症之相關 60
    表十、不同肌少症分期與社會人口學及生化指標之差異 62
    表十一、不同肌少症分期與身體組成之差異 64
    表十二、不同肌少症分期與各檢測指標之差異 66
    表十三、影響肌少症相關因素之二元邏輯斯迴歸分析 67

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