老年糖尿病患者跌倒及其危险因素

Falls and its risk factors among elderly patients with diabetes

目的 探讨老年糖尿病患者跌倒及其危险因素。方法 2 0 0 3- 0 1～ 2 0 0 3- 0 6期间在中国人民解放军总医院就诊年龄≥ 6 0岁 10 1例糖尿病患者为研究对象 ,对照组为同期观察的 10 4例 (年龄均≥ 6 0岁 )的非糖尿病老年人。采用成组病例对照研究方法 ,调查测评内容包含 4个方面共 6 8项因素。结果 老年糖尿病组年跌倒发生率为 2 4 75 % ,高于对照组 13 4 0 % (P <0 0 5 )。老年糖尿病组合并高血压、高血脂、脑血管病变、视力、听力异常明显高于非糖尿病老年人 (P <0 0 0 1)。老年糖尿病患者下肢感觉神经功能异常 :痛觉、位置觉、冷热觉、压力觉异常、足背动脉搏动减弱或消失的发生较对照组明显增多 (P <0 0 0 1)。从跌倒相关的 6 8项因素中 ,先经单因素分析筛选出 10个与跌倒密切相关的因素 ,进一步应用非条件Logistic多元回归分析筛选出了 6个有显著统计学意义的变量 :脑血管病变、周围神经病变、压力觉异常、足部病变、直立性低血压、降压药等均与老年糖尿病患者跌倒的发生呈显著正相关 (P <0 0 5～ 0 0 1)。结论 糖尿病周围血管病变与神经病变相互作用是导致老年糖尿病患者高跌倒发生率的病理生理基础。

Objective To study falls and its risk factors among elderly patients with diabetes.Methods A case-control study was conducted among 101 diabetic patients aged over 60 years,and 104 elderly people without diabetes were taken as controls.Results Falls in elderly diabetic patients (24.75%) were higher than elderly people without diabetes (13.40%)(P<0.05).The number of cases with hypertension,dyslipidemia,macrovascular diseases,abnormal sight and hearing in study group was higher than that of control group(P<0.001).The number of cases with abnormal sensory tests results including pain sense,topognosis,touch sensation,temperature perception,pressure sense and the absence of foot pulses was higher in study group than in control group(P<0.001).Univariate analysis showed that ten variables were significant high risk factors.By logistic regression analysis,six variables were identified as independent of each other,namely,macrovascular diseases,neuropathy and pressure sense, diabetic foot, orthostatic hypotention and hypotensor,which were positively correlated with falls of elderly diabetic patients(P<0.05～0.01).Conclusion Diabetic neuropathy and peripheral vascular disease are the pathophysiologic basis for falls of elderly patients with diabetes.