2型糖尿病患者下肢震动感觉阈值水平与动力性平衡功能的相关性分析

Study of the relationship between vibration perception threshold and dynamic balance in patients with type 2 diabetes mellitus

目的探讨T2DM患者下肢震动感觉阈值(VPT)水平与动力性平衡功能的相关性。方法选取2017年8月至2018年6月于我院内分泌科住院治疗的T2DM患者235例,收集身高、体重、WC、血压、FPG、HbA1c及股骨颈骨密度(BMD)、下肢VPT、踝臂指数(ABI),测定站起测试(CRT)、走直线步态测试(TGT)和2.4 m行走测试的动力性平衡指标。根据VPT水平将患者分为低风险组(LR,双足VPT均≤15 V,n=109)、中风险组(MR,任一足1525 V,n=61)。结果各组FPG、股骨颈BMD、HbA1c、SBP、DBP、WC、BMI比较,差异无统计学意义;LR、MR、HR组年龄依次升高[(61.66±7.76)vs(64.85±7.39)vs(66.66±7.41)岁,P<0.05];HR组DM病程大于MR、LR组[15.01(8.50~20.00)vs 10.37(5.00~14.00)vs 8.64(3.00~12.50)年,P<0.05];HR组ABI低于LR组[(0.94±0.16)vs(0.86±0.26),P<0.05];HR组站起测试较MR、LR组延长[(12.12±7.38)vs(10.68±7.37)vs(9.61±5.88)s,P<0.05];HR组2.4 m行走测试较LR组延长[(5.30±2.91)vs(3.84±1.66)s,P<0.05];LR、MR、HR组TGT正常患者比例依次降低(71.56%vs 50.77%vs 24.59%,P<0.05)。Pearson相关分析显示,CRT与年龄、DM病程、下肢VPT呈正相关(P<0.05),与股骨颈BMD、ABI呈负相关(P<0.05)。2.4 m行走测试与下肢VPT、WC呈正相关(P<0.05),与ABI呈负相关(P<0.05)。Logistic回归分析结果显示,下肢VPT升高是TGT能力下降的危险因素。结论 T2DM患者下肢VPT与CRT、2.4 m行走测试呈正相关,与TGT呈负相关。下肢VPT可作为评估DM患者跌倒风险的指标。

Objective To investigate the relationship between vibration perception threshold(VPT)and dynamic balance in patients with type 2 diabetes mellitus(T2DM).Methods 235 T2DM in patients from August 2017 to June 2018 were enrolled.Height,weight,WC,blood pressure,fasting blood glucose(FPG),HbA1c,Femur bone mineral density(BMD),ankle brachial index(ABI)and lower limb VPT of lower limbs were measured.The dynamic balance were assessed with chair-rising test(CRT),tandem gait test(TGT),2.4 m walk test.The patients were divided into three groups by the level of VPT:low risk group(both foot VPT≤15 V,n=109),moderate risk group(any one foot 1525 V,n=61).Results There were no significant differences of FPG,BMD,HbA1c,systolic pressure,diastolic pressure,waistline and BMI among the three groups.The higher VPT was showed in older patients[(66.66±7.41)vs(64.85±7.39)vs(61.66±7.76)years,P<0.05].The duration of T2DM in high risk group was significantly longer than that of moderate or low risk group[15.01(8.50~20.00)vs 10.37(5.00~14.00)vs 8.64(3.00~12.50)years,P<0.05].High risk group had lower ABI than that of low risk group[(0.94±0.16)vs(0.86±0.26),P<0.05].CRT in high-risk group was significantly longer than that of moderate risk group and low risk group[(12.12±7.38)vs(10.68±7.37)vs(9.61±5.88)s,P<0.05].Compared with low risk group,2.4 m walk test in high risk group was significantly longer[(5.30±2.91)vs(3.84±1.66)s,P<0.05].TGT decreased gradually from low risk group,moderate risk group to high risk group(71.56% vs 50.77% vs 24.59%,P<0.05).Correlation analysis showed that VPT,age,and ABI were closely related to CRT.Moreover,VPT,waistline and ABI were closely related to 2.4 m walk test.According to logistic regression analysis,higher VPT was a risk factor for poor TGT.Conclusion The lower limb VPT of T2DM patients was positively correlated with CRT and 2.4 m walk test,and negatively correlated with TGT.In clinical practice,we can use VPT as an indicator to assess the risk of falls in diabetic patients.