目的 探讨不同体质指数（BMI）分组成年1型糖尿病（T1DM）患者的临床特征以及超重/肥胖与心血管代谢危险因素之间的关系。方法 纳入2015年6月至2022年6月在广州市第一人民医院内分泌代谢科住院的268例成人T1DM患者。分为超重肥胖组（BMI≥24.0 kg/m²，41例）、体质量正常组（18.5≤BMI＜24.0 kg/m²，155例）和体质量过低组（BMI＜18.5 kg/m²，72例）。比较三组人口学、人体测量及代谢指标的差异，采用多元线性回归分析BMI与估算肾小球滤过率（eGFR）的关联。结果 超重肥胖组患者的特征表现为年龄更大、病程更长、体脂肪量更高、腹部皮下脂肪面积更大、腰围、臀围更大、合并高血压比例更高、收缩压更高、高密度脂蛋白胆固醇更低、eGFR更低、糖化血红蛋白（HbA1c）更低。多元线性回归分析显示，校正年龄、性别、病程后，BMI与eGFR呈负相关（β=-2.050，P=0.012）；进一步校正HbA1c、血压、血脂后，该关联不再显著。结论 超重/肥胖成人T1DM患者存在多重代谢异常聚集，BMI与eGFR的负向关联可能主要与血糖、血压、血脂等代谢因素有关。

Objective To investigate the clinical characteristics of adult patients with type 1 diabetes mellitus（T1DM）in different body mass index（BMI）categories and the associations of overweight and obesity with cardiometabolic risk factors．Methods A total of 268 adult T1DM inpatients from Guangzhou First People’s Hospital were enrolled．Patients were divided into three groups：overweight/obese（BMI≥24.0 kg/m²，n=41），normal-weight（18.5≤BMI＜24.0 kg/m²，n=155），and underweight（BMI＜18.5 kg/m²，n=72）．Demographic characteristics，anthropometric measurements，and metabolic parameters were compared among the three groups．Multivariable linear regression analyses were performed to evaluate the association between BMI and estimated glomerular filtration rate（eGFR）．Results Patients in the overweight/obesity group were characterized by older age，longer diabetes duration，higher body fat mass，larger abdominal subcutaneous fat area，greater waist and hip circumferences，a higher prevalence of hypertension，higher systolic blood pressure，lower high-density lipoprotein cholesterol levels，lower eGFR，and lower glycated hemoglobin（HbA1c）levels．Multivariable linear regression analysis demonstrated that BMI was inversely associated with eGFR after adjustment for age，sex，and diabetes duration（β=-2.050，P=0.012）．However，this association was no longer significant after further adjustment for HbA1c，blood pressure，and lipid parameters．Conclusions Overweight/obese adult T1DM patients exhibit clustering of metabolic abnormalities．The negative association between BMI and eGFR may be primarily mediated by metabolic factors such as hyperglycemia，hypertension，and dyslipidemia．

       目的 探讨肌少症性肥胖（SO）诊断标准的演进及其在中国老年人群中的本土化综合干预路径。方法 评述ESPEN/EASO最新共识，结合我国老年人代谢特征，系统分析“筛查-诊断-分期”流程及运动营养协同干预的临床效能。结果 SO诊断核心在于识别“隐性肥胖”，建议在AWGS2019标准基础上，叠加中国特异性腰围切点（男≥90 cm，女≥85 cm）或体脂率指标，并应用ALM/BMI校正肌肉质量。研究证实，以渐进式抗阻训练联合高蛋白营养（1.2~1.5 g·kg-1·d-1）为核心的协同模式，通过激活mTOR通路可显著逆转肌肉流失并改善胰岛素抵抗。融入八段锦等传统功法及乳清蛋白补充，能有效重塑中国患者“高碳水、低蛋白”的膳食习惯，提升依从性。结论 构建护士主导、社区依托的多学科管理模式，并借助远程健康工具实现闭环监测，是提升我国SO精准诊疗水平的关键路径。

      Objective To explore the evolution of diagnostic criteria for sarcopenic obesity（SO）and its localized comprehensive intervention pathways tailored to the metabolic characteristics of the Chinese elderly population．Methods The latest ESPEN/EASO consensus was reviewed．Combined with the metabolic profile of Chinese older adults，the “screening-diagnosis-staging” workflow and the clinical efficacy of synergistic exercise and nutrition interventions were systematically analyzed．Results The core of SO diagnosis lies in identifying “hidden obesity．”It is recommended to incorporate Chinese-specific waist circumference cut-offs（male≥90 cm，female≥85 cm）or body fat percentage into the AWGS2019 framework，utilizing ALM/BMI for muscle mass calibration．Evidence suggests that a synergistic model，centered on progressive resistance training（PRT）and high-protein nutrition（1.2~1.5 g·kg-1·d-1），can significantly reverse muscle loss and improve insulin resistance by activating the mTOR pathway．Integrating traditional Chinese exercises（e. g. ，Baduanjin）and whey protein supplementation effectively reshapes the “high-carbohydrate，low-protein” dietary habits of Chinese patients，thereby enhancing intervention adherence．Conclusions Establishing a nurse-led，community-based multidisciplinary management model，integrated with digital health tools for closed-loop monitoring，is a pivotal strategy for enhancing the precision of SO diagnosis and treatment in China．

       1型糖尿病（T1DM）是一种免疫介导的胰岛β细胞特异性破坏的自身免疫性疾病，全球发病率逐年上升。胰岛自身抗体（IAbs）是T1DM最可靠的生物标志物，用于早期预测和诊断。然而，传统的放射配体法（RBA）虽然具有高实验特异度，但在疾病特异度方面存在局限性，尤其是单抗体阳性的预测价值较低。近年来，电化学发光法（ECL）作为一种无放射性污染的新方法，能够区分高亲和力和低亲和力的IAbs，显著提高了疾病特异度。多项研究表明，ECL法在预测T1DM风险方面优于RBA法，特别是在单抗体阳性的情况下。本文综述了IAbs检测方法的进展及其在T1DM预测和诊断中的应用，强调了ECL法在提高疾病特异度方面的优势。

       Type 1 diabetes mellitus（T1DM）is  an  autoimmune  disease  characterized  by the immune-mediated destruction of pancreatic β-cells，with a rising global incidence．Islet autoantibodies（IAbs）are the most  reliable biomarkers for early prediction and diagnosis of T1DM．However，the traditional radio-binding assay（RBA），despite its high experimental specificity，has limitations in disease specificity，particularly in the predictive value of single autoantibody positivity．Recently，the electrochemiluminescence（ECL）method，a non-radioactive approach，has been developed to distinguish high-affinity from low-affinity IAbs，significantly improving disease specificity．Multiple studies have shown that the ECL method outperforms RBA in predicting T1DM risk，especially in cases of single autoantibody positivity．This review discusses the advancements in IAbs detection methods and their applications in T1DM prediction and diagnosis，highlighting the advantages of the ECL method in enhancing disease specificity．