老年2型糖尿病患者平衡能力的相关危险因素分析

Risk factors of poor balance in elderly patients with type 2 diabetes mellitus

目的 探讨65岁及以上病程＞10年的2型糖尿病（T2DM）患者平衡能力及其相关危险因素.方法 2011年5月至9月选取97例65岁及以上病程＞10年的T2DM患者以及59名65岁及以上非糖尿病健康人群进行Berg平衡量表、足部振动觉、压力觉、温度觉、踝肱比、人体成分分析等测试,测定血清25羟维生素D3 [25 （OH） D3]、1,25二羟维生素D3[1.25（OH）2D3]水平,询问近12个月内跌倒次数并采集相关生化及临床指标.应用Spearman相关分析以及多元线性回归方法筛选平衡能力相关因素.结果 糖尿病组未受外力作用且与低血糖无关的跌倒发生率[27.8％（18/97）比10.17％（6/59）,χ^2=6.230]、人年均跌倒次数[（0.41±0.08）比（0.12±0.05）次,t=2.570]均明显高于对照组,Berg量表评分[（48.0±1.8）比（50.4±1.4）分,t=-8.900]、振动觉[（17±5）比（13±3）V,f =4.970]、踝肱比（0.79 ±0.11比0.97 ±0.16,t=-8.430）、压力觉（正常比例68.0％比89.8％,χ^2=9.627）、温度觉（正常比例52.6％比69.5％,χ^2=4.338）均低于对照组,差异均有统计学意义（均P＜0.05）.Spearman相关分析提示糖尿病组患者Berg量表评分与振动觉呈负相关（r=-0.760,P＜0.05）,与压力觉、踝肱比呈正相关（r=0.556、0.472,均P＜0.05）,多元线性回归提示振动觉和压力觉为Berg量表评分的独立影响因素（β=-0.702、0.251,均P＜0.05）.结论 65岁及以上病程＞10年的T2DM患者平衡能力明显减退,振动觉、压力觉是影响其平衡能力的独立危险因素.

Objective To evaluate the degree of balance in type 2 diabetic patients with long duration（〉 10 years） aged 65 years or above and to analyze its related risk factors.Methods A total of 97 diabetic outpatients with a duration over 10 years aged 65 years or above（DM group） and 59 healthy people aged over 65 years （control group） were enrolled in this study.Perception of vibration,pressure,temperature,ankle brachial index,waist-hip ratio,body fat percentage,serum 25 （OH） vitamin D3 （25 （OH） D3）,1.25（OH）2 vitamin D3 （1.25 （OH） 2D3）,blood glucose,glycated hemoglobin A1c （HbA1c）,blood lipid,blood pressure were tested.The balance degree of all subjects were evaluated by Berg balance scale,the cases and number of falls of all subjects in last 12 months were recorded.Statistical analysis was performed by using Spearman correlation analysis and multiple linear regression analysis.Results In DM group,the incidence of falling （27.8% （18/97） vs 10.17% （6/59）,χ^2 =6.230） and number of falls （（0.41 ± 0.08） vs （0.12 ± 0.05）,t =2.570） were significant higher,while the Berg balance scale scores （48.0±1.8 vs50.4±1.4,t=-8.900）,perception of vibration（（17±5） vs （13±3）V,t=4.970）,ankle brachial index （0.79 ± 0.11 vs 0.97 ± 0.16,t =-8.430）,pressure sense （normal ratio 68.0% vs 89.8%,χ^2 =9.627）,temperature sense （normal ratio 52.6% vs 69.5%,χ^2 =4.338） decreased significantly when compared to those in control group（all P 〈 0.05）.Spearman correlation analysis showed that Berg balance scale scores was negatively correlated with vibration perception（r =-0.760,P 〈 0.05）,positively correlated with pressure sense （r =0.556,P 〈 0.05） and ankle brachial index （r =0.472,P 〈 0.05）.Multiple linear regression analysis showed that vibration perception and pressure sense were independent risk factors for Berg balance scale scores （β =-0.702,0.251,both P 〈 0.05）.Conclusion The balance degree in patients with long-duration T2DM aged 65 years and above declines obviously,vibration perception and pressure sense are independent risk factors for balance degree in those patients.