Abstract: Sarcopenia is a common complication in patients with type2 diabetes,characterized by progressive loss of skeletal muscle mass, reduced muscle strength, and functional decline,closely associated with insulin resistance,chronic inflammation,and metabolic disturbances.Tirzepatide, the first global dual glucose-dependent insulinotropic polypeptide (GIP)/ glucagon-like peptide-1 (GLP-1) receptor agonist, demonstrates significant advantages in glucose control,weight reduction,and metabolic regulation by simultaneously activating both GLP-1 and GIP receptor pathways.Recent studies have revealed that tirzepatide exerts a dual effect on skeletal muscle in patients with type 2 diabetes complicated by sarcopenia:on one hand,it protects muscle through mechanisms such as reducing visceral fat area and improving muscle lipid infiltration; on the other hand, rapid body weight loss may increase the risk of muscle loss. This review systematically integrates basic research and clinical evidence to clarify the dual impact of tirzepatide on muscle composition across different populations with type 2 diabetes, explore the balance between muscle preservation and weight reduction,and discuss the clinical potential of combined intervention strategies, providing evidence-based insights for clinical practice.

Key words: Diabetes mellitus, type 2, Tirzepatide, Glucose-dependent insulinotropic polypeptide, Glucagon-like peptide-1 receptor agonist, Sarcopenia

摘要： 肌少症是2型糖尿病患者常见的并发症，以骨骼肌量进行性减少、肌力减退及功能衰减为特征，与胰岛素抵抗、慢性炎症及代谢紊乱密切相关。替尔泊肽作为全球首个胰高糖素样肽-1（GLP-1）/葡萄糖依赖性促胰岛素多肽（GIP）双受体激动剂，通过激活GLP-1受体和GIP受体双重通路，在降糖、减重及调节代谢中展现出显著优势。近年来研究发现，替尔泊肽对2型糖尿病合并肌少症患者的肌肉存在双向影响：一方面通过减少内脏脂肪面积、改善肌肉脂肪浸润等多种机制保护肌肉；另一方面可能因体质量快速下降引发肌肉流失风险。本综述系统整合基础研究与临床证据，旨在阐明替尔泊肽对不同2型糖尿病人群肌肉成分的双向影响，探讨肌肉保护与减重的平衡，并讨论联合干预策略的临床潜力，为临床实践提供证据。

关键词: 糖尿病, 2 型；替尔泊肽；葡萄糖依赖性促胰岛素多肽；胰高糖素样肽 -1 受体激动剂；肌少症