性激素在糖尿病足患者的变化及其与预后的关系
发布时间：2018-12-13 07:05
【摘要】：目的:分析性激素指标在不同病情糖尿病足溃疡患者体内的变化,探讨这些变化对糖尿病足溃疡患者预后的影响。方法:收集我院住院治疗的糖尿病足溃疡患者362例(男204例,女158例),另选取年龄匹配的高危糖尿病足病患者225例(男63例,女162例)作为对照。入院48小时内测定入选者血浆黄体生成素、卵泡刺激素、催乳素、睾酮、游离睾酮、雄烯二酮(女性)、硫酸脱氢表雄酮(女性)、孕酮、雌二醇、性激素结合球蛋白水平,分析上述指标与糖尿病足病严重程度(Wagner级别)、感染程度的关系;随访足溃疡患者入选后6个月溃疡愈合、复发、患者心脑血管事件发生和死亡情况,分析性激素指标对糖尿病足溃疡患者预后的影响。结果:随Wagner级别上升,男性患者睾酮、游离睾酮呈下降趋势(趋势P值分别为0.005,0.0027),雌二醇呈升高趋势(趋势P值0.0012);绝经后女性睾酮、游离睾酮、雌二醇水平呈上升趋势(趋势P值分别为0.041、0.035、0.0001)。随足溃疡感染加重,男性游离睾酮下降(趋势P值为0.007);绝经后女性雌二醇升高(趋势P值为0.02)。雌二醇水平与男性和绝经后女性糖尿病足溃疡患者心脑血管事件的发生正相关(男性OR=1.11,P=0.03,绝经后女性OR=1.019,P=0.03),男性雌二醇水平与死亡呈正相关(OR=1.01,P=0.04)。结论:雌二醇、睾酮在不同Wagner级别和感染程度的糖尿病足病患者体内发生改变,雌二醇水平对患者预后有一定提示意义。
[Abstract]:Aim: to analyze the changes of sex hormone indexes in patients with diabetic foot ulcers and to explore the influence of these changes on the prognosis of diabetic foot ulcers. Methods: 362 diabetic foot ulcers (204 males and 158 females) and 225 age-matched high risk diabetic foot ulcers (63 males and 162 females) were selected as control group. Plasma luteinizing hormone, follicle stimulating hormone, prolactin, testosterone, free testosterone, androstenedione (female), dehydroepiandrosterone sulfate (female), progesterone, estradiol, androgen binding globulin were measured within 48 hours after admission. To analyze the relationship between the above indexes and the severity of diabetic foot disease (Wagner grade) and the degree of infection. Patients with foot ulcers were followed up 6 months after the ulcer healing, recurrence, cardiovascular and cerebrovascular events and death, analysis of sex hormone indicators on the prognosis of diabetic foot ulcers. Results: with the increase of Wagner grade, testosterone and free testosterone in male patients showed a downward trend (P = 0.005 卤0.0027) and estradiol increased (P value 0.0012). The levels of testosterone, free testosterone and estradiol in postmenopausal women showed an increasing trend (P = 0.041 0. 035 卤0. 0001). Free testosterone decreased (trend P = 0.007) and estradiol increased in postmenopausal women (trend P = 0. 02). Estradiol levels were positively correlated with cardiovascular and cerebrovascular events in male and postmenopausal women with diabetic foot ulcers (OR=1.019,P=0.03 in male OR=1.019,P=0.03 postmenopausal women). The level of estradiol was positively correlated with death (OR=1.01,P=0.04). Conclusion: the changes of estradiol and testosterone in patients with diabetic foot disease with different Wagner grade and degree of infection may indicate the prognostic significance of estradiol level.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2
[Abstract]:Aim: to analyze the changes of sex hormone indexes in patients with diabetic foot ulcers and to explore the influence of these changes on the prognosis of diabetic foot ulcers. Methods: 362 diabetic foot ulcers (204 males and 158 females) and 225 age-matched high risk diabetic foot ulcers (63 males and 162 females) were selected as control group. Plasma luteinizing hormone, follicle stimulating hormone, prolactin, testosterone, free testosterone, androstenedione (female), dehydroepiandrosterone sulfate (female), progesterone, estradiol, androgen binding globulin were measured within 48 hours after admission. To analyze the relationship between the above indexes and the severity of diabetic foot disease (Wagner grade) and the degree of infection. Patients with foot ulcers were followed up 6 months after the ulcer healing, recurrence, cardiovascular and cerebrovascular events and death, analysis of sex hormone indicators on the prognosis of diabetic foot ulcers. Results: with the increase of Wagner grade, testosterone and free testosterone in male patients showed a downward trend (P = 0.005 卤0.0027) and estradiol increased (P value 0.0012). The levels of testosterone, free testosterone and estradiol in postmenopausal women showed an increasing trend (P = 0.041 0. 035 卤0. 0001). Free testosterone decreased (trend P = 0.007) and estradiol increased in postmenopausal women (trend P = 0. 02). Estradiol levels were positively correlated with cardiovascular and cerebrovascular events in male and postmenopausal women with diabetic foot ulcers (OR=1.019,P=0.03 in male OR=1.019,P=0.03 postmenopausal women). The level of estradiol was positively correlated with death (OR=1.01,P=0.04). Conclusion: the changes of estradiol and testosterone in patients with diabetic foot disease with different Wagner grade and degree of infection may indicate the prognostic significance of estradiol level.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2
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