CAJ | 학술논문

目的分析绝经后女性糖尿病足溃疡(DFU)患者内源性性激素水平与病情严重程度的相关性,探讨性激素水平对绝经后女性DFU预后的影响.方法选取2012年1月至2013年1月在瑞金医院糖尿病足中心住院治疗的绝经后女性DFU患者158例和高危DFU患者162例,收集其基本临床资料,评估足溃疡严重程度,测定这些患者入院后48 h内静脉血中卵泡刺激素(FSH)、黄体生成素(LH)、催乳素(PRL)、雌二醇(E2)、孕酮(P)、睾酮(T)、游离睾酮(FT)、硫酸脱氢表雄酮(DHEAS)、雄烯二酮(AD)和性激素结合球蛋白(SHBG)水平,采用多元线性回归分析不同严重程度的DFU患者体内性激素指标的变化;随访观察DFU患者6个月溃疡愈合、复发及非致死性心脑血管事件的发生情况,采用logistic回归探讨性激素相关指标与DFU预后的关系.结果随着Wagner级别增加,绝经后女性糖尿病足病患者体内E2、T、FT水平上升(t值分别为4.47、2.03、2.16;趋势P值分别为＜0.0001、0.041、0.035);随着DFU感染程度加重,E2呈上升趋势(t值为2.41,趋势P值为0.02);E2水平与非致死性心脑血管事件的发生呈正相关(OR=1.019,95％CI:1.002～1.037,P＜0.05).结论绝经后女性DFU患者内源性E2、T/FT水平与病情、感染程度相关,E2水平对心脑血管事件的发生具有一定提示意义.
목적 분석절경후녀성당뇨병족궤양(DFU)환자내원성성격소수평여병정엄중정도적상관성,탐토성격소수평대절경후녀성DFU예후적영향.방법 선취2012년1월지2013년1월재서금의원당뇨병족중심주원치료적절경후녀성DFU환자158례화고위DFU환자162례,수집기기본림상자료,평고족궤양엄중정도,측정저사환자입원후48 h내정맥혈중란포자격소(FSH)、황체생성소(LH)、최유소(PRL)、자이순(E2)、잉동(P)、고동(T)、유리고동(FT)、류산탈경표웅동(DHEAS)、웅희이동(AD)화성격소결합구단백(SHBG)수평,채용다원선성회귀분석불동엄중정도적DFU환자체내성격소지표적변화;수방관찰DFU환자6개월궤양유합、복발급비치사성심뇌혈관사건적발생정황,채용logistic회귀탐토성격소상관지표여DFU예후적관계.결과 수착Wagner급별증가,절경후녀성당뇨병족병환자체내E2、T、FT수평상승(t치분별위4.47、2.03、2.16;추세P치분별위＜0.0001、0.041、0.035);수착DFU감염정도가중,E2정상승추세(t치위2.41,추세P치위0.02);E2수평여비치사성심뇌혈관사건적발생정정상관(OR=1.019,95％CI:1.002～1.037,P＜0.05).결론 절경후녀성DFU환자내원성E2、T/FT수평여병정、감염정도상관,E2수평대심뇌혈관사건적발생구유일정제시의의.
Objectives To investigate the association of sex hormone with the severity of diabetic foot ulcer (DFU) and its effect on prognosis of DFU in postmenopausal women.Methods From January 2012 to January 2013,clinical data from 158 postmenopausal women with DFU and 162 postmenopausal women with high risk of DFU admitted to Diabetic Foot Center of Ruijin Hospital were collected.The severity of DFU was evaluated on admission.Serum concentration of sex hormone,included follicle stimulating hormone (FSH),lutenizing hormone (LH),prolactin (PRL),estradiol (E2),progesterone (P),testosterone (T),free testosterone (FT),dehydroepiandrosterone (DHEAS),androstenedione (AD) and sex hormone-binding globulin (SHBG) were tested within 48 hours after admission.The association between sex hormone and the severity of DFU was analyzed by using multiple linear regression.All these patients with DFU were followed up for 6 months to observe their outcomes including ulcer healing,recurrence,and nonfatal cardiovascular and cerebrovascular events.Logistic regression was used to analyze the impact of sex hormones on the outcome of DFU.Results Serum concentrations of E2,T,FT increased (t=4.47,2.03,2.16 respectively; P=0.0001,0.0410,0.0350 respectively for trend) with the Wagner grades of DFU in postmenopausal women.Similarly,serum concentration of E2 increased (t=2.41; P=-0.02 for trend) with the severity of infection.The level of E2 was positively correlated with the occurrence of non-fatal cardiovascular and cerebrovascular events (OR=1.109,95％CI:1.002-1.037,P＜0.05).Conclusions Serum concentration of E2 and T/FT were associated with the severity of DFU in postmenopausal women.The change of E2 might imply the occurrence of non-fatal cardiovascular and cerebrovascular events.