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绝经后女性糖尿病足患者性激素变化及与预后的相关性

The change of sex hormone level in postmenopausal women with diabetic foot ulcer and its association with prognosis

摘要:

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.

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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.

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