不同血压状态老年2型糖尿病患者静态平衡功能特征分析

Characteristics of Static Balance Function in Elderly Patients with Type 2 Diabetes Mellitus in Different Blood Pressure States

目的:分析不同血压水平下老年2型糖尿病患者静态平衡功能的变化特征。方法:选择2013年11月—2020年8月于福建中医药大学附属第二人民医院进行体检的60~80周岁受试者体检信息共2179例,按血糖及血压状态分为健康人群(对照组)、血压正常2型糖尿病组(T2DM组)及血压异常升高2型糖尿病组(T2DM-HTN组),其中对照组使用倾向性评分匹配的方法挑选281例,T2DM组273例,T2DM-HTN组281例。比较3组空腹血糖(FBG)、糖化血红蛋白(GHbA1c)、血脂[三酰甘油(TG)、总胆固醇(TC)、高/低密度脂蛋白(HDL/LDL)]等血液生化指标;血压(BP)和每分钟脉搏数等健康相关指标;睁眼和闭眼状态下动摇总轨迹长(LNG)、轨迹图面积(SSKG)、单位面积轨迹长(LNG/area)、X方向轨迹长(LNG-X)、Y方向轨迹长(LNG-Y)、Romberg商(RQ)和重心偏移幅度(DA)等静态平衡功能参数的差异。结果:(1)血液生化指标:与对照组比较,T2DM组和T2DM-HTN组FBG、GHbA1c、TG、总胆固醇、LDL等血液生化代谢指标明显升高(P<0.05);与T2DM组比较,T2DM-HTN组FBG水平升高(P<0.05)。(2)健康相关指标:与对照组比较,T2DM组和T2DM-HTN组BMI、每分脉搏数和血压明显升高(P<0.05);与T2DM组比较,T2DM-HTN组的BMI、每分脉搏数和血压水平升高(P<0.05)。(3)静态平衡功能参数:在睁眼状态下,与对照组比较,T2DM组LNG/area升高(P<0.05),T2DM-HTN组LNG、SSKG、LNG/area、LNG-X、LNG-Y均升高(P<0.05);与T2DM组比较,T2DM-HTN组LNG、LNG/area、LNG-X、LNG-Y均升高(P<0.05)。在闭眼状态下,与对照组比较,T2DM组SSKG和LNG-X升高,T2DM-HTN组的LNG、SSKG、LNG/area、LNG-X、LNG-Y均升高(P<0.05);与T2DM组比较,T2DM-HTN组LNG、LNG/area、LNG-X、LNGY均升高(P<0.05)。与对照组和T2DM组比较,T2DM-HTN组RQ和DA均明显升高(P<0.05)。结论:老年2型糖尿病患者维持静态姿势稳定性的能力较同龄非糖尿病者下降,需要更多的视觉代偿以维持平衡,其中X轴方向的平衡控制能力受视觉影响更明显。血压异常升高将导致老年2型糖尿病患者的静态平衡能力进一步下降,且身体重心偏移幅度更大。

Objective:To analyze the changes characteristics of static balance function in elderly patients with type 2 diabetes mellitus(T2DM)in different blood pressure states.Methods:A total of 2179 medical records of eligible subjects who were selected for physical examination in the Second People's Hospital of Fujian University of Traditional Chinese Medicine from November 2013 to August 2020,which were divided into health people(the control group),the type 2 diabetes mellitus group under normal blood pressure state(T2DM group),the type 2 diabetes mellitus group under hypertension state(T2DM-HTN group)according to the state of blood pressure and blood sugar status,with 281 cases in the control group by the propensity score matching method,with 273 cases and 281 cases respectively in the T2DM group and the T2DM-HTN group.Compared the difference of blood biochemical indicators in three groups,such as fasting blood glucose(FBG),glycosylated hemoglobin(GHbA1c),triglycerides(TG),total cholesterol(TC),high/low density lipoprotein(HDL/LDL),etc.;compared the difference of health-related indicators in three groups,such as blood pressure(BP)and pulse rate per minute;compared the difference of static balance function parameters in three groups,such as track length(LNG),surface of the statokine-sigram(SSKG),LNG/area,track length-X(LNG-X),track length-Y(LNG-Y),romberg quotient(RQ)and deviation amplitude(DA).Results:①Blood biochemical indexes:compared with the control group,FBG,GHbA1c,TG,TC and LDL in the T2DM group and T2DM-HTN group were higher(P<0.05);compared with T2DM group,FBG in the T2DM-HTN group was higher(P<0.05).②Health-related indicators:compared with the control group,BMI,pulse rate per minute and systolic and diastolic blood pressure in the T2DM group and T2DM-HTN group were higher(P<0.05);compared with the T2DM group,BMI,pulse rate per minute and systolic and diastolic blood pressure in the T2DM-HTN group were higher(P<0.05).③Static balance function parameters:At open eyes state,compared with the control group,LNG/area in the T2DM group was higher(P<0.05),LNG,SSKG,LNG/area,LNG-X and LNG-Y in the T2DM group were higher(P<0.05);Compared with the T2DM group,LNG,LNG/area,LNG-X and LNG-Y in the T2DM-HTN group were higher(P<0.05).At closed eyes state,compared with the control group,SSKG,LNG-X in the T2DM group were higher,LNG,SSKG,LNG-X,LNG-Y in the T2DM-HTN group were higher(P<0.05);compared with the T2DM group,LNG,SSKG,LNG-X,LNG-Y in the T2DM-HTN group were higher(P<0.05).Compared with the control group and the T2DM group,RQ and DA in the T2DM-HTN group were higher(P<0.05).Conclusion:The ability of elderly patients with T2DM to maintain static postural was lower than that in non-diabetic patients of the same age,the patients with T2DM should provide more visual compensation to maintain stability,the balance control ability in the X-axis direction was more obviously affected by vision.Hypertension will lead to a further decline of the static balance ability of elderly patients with T2DM,and the offset amplitude of body center of gravity was greater.