中国实用口腔科杂志

中国实用口腔科杂志 ›› 2026, Vol. 19 ›› Issue (2): 190-196.DOI: 10.19538/j.kq.2026.02.010

• 论著 • 上一篇    下一篇

2型糖尿病老年患者肌少症影响因素及其与牙缺失相关性分析

曹国良，施惠华，朱    珠，杜    岑，汪海娅   

  1. 上海交通大学医学院附属第九人民医院老年病科，上海 201900
  • 出版日期:2026-03-30 发布日期:2026-03-30
  • 通讯作者: 汪海娅
  • 基金资助:
    上海市卫生健康委员会科研项目（202140030）

  • Online:2026-03-30 Published:2026-03-30

摘要： 目的    分析2型糖尿病（type 2 diabetes mellitus，T2DM）老年患者肌少症的影响因素及其与牙缺失相关性，初步探索牙缺失对T2DM老年患者肌少症的影响路径。方法    采用回顾性横断面研究设计，纳入2021—2024年于上海交通大学医学院附属第九人民医院就诊的T2DM老年患者326例。收集基线资料（人口学特征、临床特征、实验室检测及营养评估指标）、口腔检查数据［缺失牙数、社区牙周指数（community periodontal index，CPI）及咀嚼功能情况］及肌少症诊断指标［四肢骨骼肌质量指数（appendicular skeletal muscle mass index，ASMI）、握力及6 m内步速］。根据缺失牙数分为无牙缺失组（0颗，102例）、轻度牙缺失组（1 ~ 7颗，110例）和重度牙缺失组（> 7颗，114例）。分析T2DM老年患者肌少症患病情况及其影响因素，以及牙缺失与其他指标的相关性。结果    ①T2DM老年患者肌少症患病率为35.9%（117/326），其中无牙缺失组、轻度牙缺失组、重度牙缺失组患病率依次为18.6%（19/102）、34.5%（38/110）、52.6%（60/114），组间差异有统计学意义（χ2 = 40.923，P < 0.001）。②经单因素分析和多因素logistic回归分析显示，重度牙缺失（OR = 2.341，95%CI：1.363 ~ 4.023）、年龄≥ 70岁（OR = 1.987，95%CI：1.213 ~ 3.254）、T2DM病程≥ 15年（OR = 1.862，95%CI：1.105 ~ 3.138）、白蛋白质量浓度< 35 g/L（OR = 2.105，95%CI：1.252 ~ 3.536）、每周运动< 3次（OR = 1.724，95%CI：1.045 ~ 2.843）及咀嚼功能不良（OR = 1.689，95%CI：1.012 ~ 2.815）为肌少症的独立危险因素（均P < 0.05）。分层分析显示，在不同年龄段、性别患者中，重度牙缺失仍是肌少症的危险因素（均P < 0.05）。③重度牙缺失组患者年龄、T2DM病程、每周运动< 3次占比、白蛋白质量浓度< 35 g/L占比、咀嚼功能不良发生率均大于无牙缺失组及轻度牙缺失组（P < 0.05）。④Spearman相关性分析显示，缺失牙数与年龄、T2DM病程、吸烟史、糖化血红蛋白（glycated hemoglobin，HbA1c）含量、CPI、咀嚼功能不良发生率呈正相关，与每周运动频次、白蛋白质量浓度、前白蛋白质量浓度、25-羟维生素D浓度、蛋白质摄入达标率及肌少症诊断指标（ASMI、握力、6 m内步速）呈负相关（均P < 0.001）。结论    伴重度牙缺失的T2DM老年患者肌少症患病率较高，重度牙缺失是T2DM老年患者肌少症的独立危险因素，其可能通过“牙缺失-咀嚼功能下降-营养摄入不足-肌少症”路径影响T2DM老年患者的全身健康。临床应重视口腔健康与营养、运动相结合的跨学科管理策略。

关键词: 老年, 2型糖尿病, 牙缺失, 肌少症, 咀嚼功能, 危险因素

Abstract: Objective    To analyze the influencing factors of sarcopenia in elderly patients with type 2 diabetes mellitus（T2DM）and its correlation with tooth loss，and to preliminarily explore the pathway through which tooth loss affects sarcopenia in this population. Methods    A retrospective cross-sectional study design was adopted，enrolling 326 elderly patients with T2DM who visited the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from 2021 to 2024. Baseline data（demographic characteristics，clinical features，laboratory tests，and nutritional assessment indicators），oral examination data ［number of missing teeth，community periodontal index（CPI），and masticatory function］，and sarcopenia diagnostic indicators ［appendicular skeletal muscle mass index（ASMI），handgrip strength，and 6-meter gait speed］ were collected. Based on the number of missing teeth，patients were divided into a no tooth loss group（0 teeth，n = 102），a mild tooth loss group（1 - 7 teeth，n = 110），and a severe tooth loss group（> 7 teeth，n = 114）. The prevalence of sarcopenia and its influencing factors in elderly T2DM patients，as well as the correlation between tooth loss and other indicators，were analyzed. Results    ①The prevalence of sarcopenia among elderly T2DM patients was 35.9%（117/326），with the incidence being 18.6%（19/102）in the no tooth loss group，34.5%（38/110）in the mild tooth loss group，and 52.6%（60/114）in the severe tooth loss group；the difference among groups was statistically significant（χ2 = 40.923，P < 0.001）. ②Univariate analysis and multivariate logistic regression analysis showed that severe tooth loss（OR = 2.341，95%CI：1.363 - 4.023），age ≥ 70 years（OR = 1.987，95%CI：1.213 - 3.254），T2DM duration ≥ 15 years（OR = 1.862，95%CI：1.105 - 3.138），serum albumin concentration < 35 g/L（OR = 2.105，95%CI：1.252 - 3.536），exercise frequency < 3 times per week（OR = 1.724，95%CI：1.045 - 2.843），and poor masticatory function（OR = 1.689，95%CI：1.012 - 2.815）were independent risk factors for sarcopenia（all P < 0.05）. Stratified analysis revealed that severe tooth loss remained a risk factor for sarcopenia across different age groups and genders（all P < 0.05）. ③The severe tooth loss group had significantly higher values for age，T2DM duration，proportion of exercise < 3 times/week，proportion of albumin < 35 g/L，and incidence of poor masticatory function compared to the no tooth loss and mild tooth loss groups（P < 0.05）. ④Spearman correlation analysis showed that the number of missing teeth was positively correlated with age，T2DM duration，smoking history，HbA1c level，CPI，and rate of poor masticatory function（all P < 0.001），while negatively correlated with weekly exercise frequency，albumin concentration，prealbumin concentration，25-hydroxyvitamin D concentration，protein intake adequacy rate，and sarcopenia diagnostic indicators（ASMI，handgrip strength，6-meter gait speed）（all P < 0.001）. Conclusion    Elderly T2DM patients with severe tooth loss have a higher prevalence of sarcopenia. Severe tooth loss is an independent risk factor for sarcopenia in this population，potentially affecting the systemic health of elderly T2DM patients through a "tooth loss - decreased masticatory function - inadequate nutritional intake - sarcopenia" pathway. Clinically，emphasis should be placed on an interdisciplinary management strategy integrating oral health with nutrition and exercise.

Key words: elderly, type 2 diabetes mellitus, tooth loss, sarcopenia, masticatory function, risk factors