糖调节异常患者平衡功能相关研究

发布时间：2018-04-23 23:37

本文选题：糖调节异常 + 平衡功能　；参考：《首都医科大学》2017年硕士论文

【摘要】：研究背景糖尿病(diabetes mellitus,DM)是由遗传和环境因素共同引起的一组以糖代谢紊乱为主要表现的临床综合征。2013年宁光教授的流调数据中我国糖尿病的患病率为11.6%,糖调节异常的发生率高达50.1%[1]。国内外大量研究表明糖尿病患者发生跌倒风险明显增高[2,3],其治疗及护理需要更多时间及经济方面投入,严重影响患者及其家人生活质量,增加家庭及社会医疗负担,2012年美国糖尿病学会(American Diabetes Association,ADA)指南[4]和2013年美国老年学会(Gerontological Society of American,AGS)指南[5]中均建议医护人员关注糖尿病患者跌倒的预防和治疗。跌倒的发生与很多因素有关,而最重要的为平衡能力受损[6]。因此了解糖尿病前期患者平衡功能状况,从而对高危人群跌倒风险进行早期评估尤为重要。目前相关研究较少。本研究将应用平衡仪对糖调节异常(Impaired Glucose Regulation,IGR)患者进行平衡功能检查,分析IGR患者的平衡功能特点,为糖尿病前期阶段跌倒高风险人群的早发现、早预防提供依据。目的通过平衡功能测试,了解糖调节异常人群平衡功能状况。方法1、通过文献检索、专家论证、设定入排标准、技术路线和调查问卷,调查问卷见附件1。2、根据问卷调查、查体、化验检查纳入年龄≤65岁既往无糖尿病病史的受试者,排除耳源性眩晕、前庭神经炎、严重视觉障碍及视野缺损、颅脑疾患、下肢畸形、新发骨折等影响姿态平衡的疾病。3、通过OGTT试验选取IGR患者29例(男9例,女20例,平均年龄52.93±7.53岁),对照组选取年龄、性别匹配糖耐量正常的同期健康体检者共27例(男7例,女20例,平均年龄49.59±7.60岁)。4、收集受试者一般基线资料(包括年龄、性别、既往史、跌倒史等),及内分泌相关化验结果(如糖化血红蛋白、血脂、甲状腺功能等),并对受试者进行身高、体重测量。5、平衡能力测试。应用的设备为synapsys平衡仪,通过感觉结构测试(sensory organization test,SOT)对本体觉、前庭觉及视觉在维持姿势稳定中的贡献度进行定量分析。对比分析两组的感觉结构测试评分、压力中心移动面积(Surface of the Statokinesigram,SSKG)、前后及左右方向压力中心最大位移(Anteroposterior and Medio-Lateral Maximum amplitudes)来研究IGR患者平衡功能特点。6、数据处理:使用SPSS21.0进行统计学分析。计量资料符合正态分布的数据用均数±标准差表示,非正态分布的计量数据经对数转换后呈正态分布以几何均数±标准差表示。对于经对数转换后仍为非正态分布的数据则以中位数[第一四分位数,第三四分位数]表示。两组间均数比较符合正态分布的采用两独立样本t检验,不符合正态分布的采用Mann-Whitney u检验,率的比较采用卡方检验。所有统计检验均采用双侧检验,显著性水平选取P0.05。结果1、IGR组在睁眼站立于海绵垫时、闭眼站立于海绵垫时及站立于海绵垫同时受到视觉干扰情况下,SSKG均大于对照组,差异有统计学意义(P0.05);2、IGR组在睁眼站立于海绵垫时左右方向最大位移大于对照组,在闭眼站立于海绵垫时前后方向最大位移大于对照组,在站立于海绵垫同时受到视觉干扰时前后及左右方向最大位移均大于对照组,差异有统计学意义(P0.05);3、SOT结果:IGR组左右方向前庭觉评分、前后及左右方向综合评分小于对照组,差异有统计学意义(P0.05)。结论糖调节异常患者平衡能力较正常人下降,表现在:1、本体觉受到干扰情况下维持姿态稳定的能力较正常人下降;2、其依赖前庭觉维持姿态平衡的能力较正常人有所减弱。
[Abstract]:Research background diabetes (diabetes mellitus, DM) is a group of genetic and environmental factors co induced by a group of clinical syndromes with glucose metabolism disorder as the main manifestation of.2013 years Professor Ning Guang's flow data, the prevalence rate of diabetes in China is 11.6%, the incidence of abnormal glucose regulation is up to 50.1%[1]. at home and abroad a large number of studies show that diabetes mellitus The risk of falling falls significantly increased [2,3], and its treatment and nursing needs more time and economic input, seriously affecting the quality of life of the patients and their families, and increasing the burden on family and social health. In 2012, the American Diabetes Society (American Diabetes Association, ADA) refers to the South [4] and the 2013 American Society for aging (Gerontological Society o). The f American, AGS) guide [5] recommends that medical staff pay attention to the prevention and treatment of fall in diabetic patients. The occurrence of falls is related to many factors, and the most important is the balance of impaired [6].. Therefore, it is particularly important to understand the balance function of prediabetes patients so as to make early assessment of the risk of falling in high-risk groups. The study will be less. This study will use balance instrument to check the balance function of patients with Impaired Glucose Regulation (IGR), analyze the balance function of IGR patients and provide the basis for early detection and early prevention of high risk people who have fallen in the early stage of diabetes. Method 1. Through literature search, expert demonstration, set up standard, technical route and questionnaire, the questionnaire was found in Annex 1.2. According to the questionnaire survey, examination and test, the subjects who were less than 65 years old without the history of diabetes were excluded from ear origin vertigo, vestibule neuritis, severe visual impairment and visual field defect. .3, 29 cases of IGR patients (9 males, 20 females, average age 52.93 + 7.53 years old) were selected by OGTT test for craniocerebral disease, lower limb deformity and new fracture. The control group was selected for age, 27 cases (7 men, 20 women, 49.59 + 7.60 years old, average age 49.59 + 7.60 years) were selected for the control group, and the subjects were collected in the same period of healthy physical examination. General baseline data (including age, sex, past history, fall history, etc.), and endocrine related testing results (such as glycosylated hemoglobin, blood lipid, thyroid function, etc.), and the subjects were stature, weight measurement.5, balance test. The applied equipment was synapsys balance, sensory organization test, SOT) Quantitative analysis of the contribution of the sense of proprioception, vestibule and vision in maintaining the stability of the posture. Comparative analysis of two groups of sensory structure test scores, pressure center mobile area (Surface of the Statokinesigram, SSKG), the maximum displacement of the front and left pressure center (Anteroposterior and Medio-Lateral Maximum amplitudes) to study The balance function of IGR patients.6, data processing: statistical analysis using SPSS21.0. The data of measurement data conforming to normal distribution are represented by mean number of mean deviation, and the Cheng Zhengtai distribution of non normal distribution is expressed as a geometric mean difference after logarithmic conversion. For the data that is still a non normal distribution after the logarithmic transformation, The median number [first four quantiles, three or four digits] was expressed. The average number of two groups was compared with the normal distribution with two independent samples t test. The Mann-Whitney U test was not consistent with the normal distribution. The ratio of the rate was compared to the chi square test. All the statistical tests were both tested by bilateral test, the significant level was 1 of the P0.05. results, and the IGR group was open. When the eye station was standing on the sponge pad, when the closed eye station was standing on the sponge pad and standing on the sponge pad at the same time, the SSKG was larger than the control group, and the difference was statistically significant (P0.05). 2, the maximum displacement in the left and right direction in the group IGR was larger than the control group when the eye opening station was standing on the sponge pad, and the maximum displacement in the front and back of the closed eye station was larger than the sponge pad. In the control group, the maximum displacement in front and back and left and right direction were greater than that of the control group at the time of visual interference. The difference was statistically significant (P0.05); 3, SOT results: the score of the vestibular sense in the left and right direction of group IGR was less than that of the control group, the difference was statistically significant (P0.05). Conclusion the patients with abnormal glucose regulation were statistically significant. The ability of balance was lower than that of the normal person. 1, the ability to maintain attitude stability was lower than that of the normal person, and 2, the ability to maintain the balance of the vestibule was weaker than that of the normal person.

【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

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