2型糖尿病患者动力性平衡能力的相关因素分析

Analysis of related factors for dynamic balance ability in patients with type 2 diabetes mellitus

目的探讨影响T2DM患者动力性平衡能力的相关因素。方法选取2016年11月至2017年3月于我院内分泌科住院的T2DM患者172例(T2DM组)及同期在我院体检的健康人群151名(NC组),收集人口学资料,检测糖尿病相关指标、25羟维生素D[25(OH)D],测定握力、踝肱指数(ABI)、定量震动感觉阈值、骨密度、动力性平衡指标[站起测试(CRT)、2.4 m行走测试、走直线步态测试(TGT)],比较两组差异,分析影响动力性平衡指标的相关因素。结果与NC组比较,T2DM组25(OH)D、握力、ABI、TGT正常的患者比例下降,CRT、2.4m行走测试时间延长,下肢震动感觉阈值增高(P<0.05)。ABI<0.9的T2DM患者2.4m行走测试时间长于ABI≥0.9的患者[(3.70±2.02)vs(3.10±1.12)s,P=0.045]。多因素相关分析显示,25(OH)D、握力、ABI、下肢震动感觉阈值与CRT、2.4m行走测试均密切相关。Logistic回归分析结果显示,年龄、25(OH)D(OR=0.916、1.150,P=0.003、0.002)是TGT的影响因素。结论下肢动脉病变、25(OH)D是除周围神经病变、肌力外影响T2DM患者动力性平衡能力的重要因素。

Objective To explore factors related to dynamic balance ability in patients with type 2 diabetes（T2DM）. Methods A total of 172 patients with T2DM（T2DM group）and 151 age,sex matched controls without diabetes（NC group）were enrolled in this study from November 2016 to March 2017 in our hospital.Demographic characteristics,indicators associated with diabetes,25-hydroxy vitamin D concentration were recorded.Power of grip,ankle-brachial index（ABI）,quantitative vibration sensory threshold,bone density,chair-rising test data,2.4 m walk test＇s results and tandem gait test＇s results were obtained from professional staff.Differences of all above-mentioned terms between these two groups,as well as factors related to dynamic balance ability were analyzed. Results The level of 25-hydroxy vitamin D concentration,power of grip,and ABI was lower,time spent in chair-rising test and 2.4 mwalk test was longer,proportion of subjects who accomplished tandem gait test was lower,quantitative vibration sensory threshold was higher in T2DM group than in NC group（all P0.05）.Type 2 diabetic patients with ABI0.9 needed longer time to accomplish 2.4 m walk test than patients with ABI≥0.9[（3.70±2.02）vs（3.10±1.12）s,P=0.045].Multivariate correlation analysis indicated that quantitative vibration sensory threshold,the power of grip and 25-hydroxy vitamin D concentration were closely associated with both time in chair-rising test and time in 2.4 m walk test.Besides,ABI was also closely related to time in 8-foot walk test.Logistic regression analysiss showed that age and 25-hydroxy vitamin D（OR=0.916,1.150,P=0.003,0.002）were associated with tandem gait test. Conclusion Except for peripheral neuropathy and muscle strength,lower extremity arterial disease and 25-hydroxy vitamin D were important influencing factors for dynamic balance in patients T2DM.