二甲双胍对2型糖尿病患者脊柱内固定手术后远期功能的影响:一项回顾性研究

Effects of metformin on long-term function after spinal internal fixation surgery in patients with type 2 diabetes:a retrospective study

目的 探讨二甲双胍对2型糖尿病(T2DM)患者脊柱内固定手术后远期功能的影响。方法 选取2011年1月至2022年1月在空军军医大学西京医院骨科行脊柱内固定手术的T2DM患者,根据降糖药物的不同,将患者分为二甲双胍组和胰岛素组。收集患者的病历资料和生活质量、脊柱功能及疼痛的评估资料,采用t检验、单因素方差分析、Mann-Whitney U检验、Kruskal-Wallis H检验、χ^(2)检验和多元线性回归分析进行数据比较和分析。结果 共纳入患者204例,其中二甲双胍组108例(52.94%),胰岛素组96例(47.06%)。术后远期功能评估,相对于胰岛素,二甲双胍的使用可显著提高患者健康调查简表生理机能维度评分(75.14分vs 65.36分,P<0.05)和一般健康状况维度评分(58.02分vs 48.08分,P<0.05),同时显著降低颈椎功能障碍指数或Oswestry功能障碍指数(15.93 vs 23.16,P<0.05)。此外,空腹血糖或餐后血糖越高、手术节段越多和体质量指数越大是影响患者术后远期功能的危险因素(P<0.05);在手术方式方面,相对于颈前路椎间盘切除融合术,腰椎后路椎间融合术是影响患者术后远期功能的危险因素(P<0.05)。结论 相对于胰岛素,二甲双胍的使用可有效改善T2DM患者脊柱内固定手术后的远期功能。

Objective To investigate the effect of metformin on long-term function after spinal internal fixation surgery in patients with type 2 diabetes mellitus(T2DM).Methods Patients with T2DM who underwent spinal internal fixation surgery in Department of Orthopedics,Xijing Hospital,Air Force Medical University from January 2011 to January 2022 were selected and divided into metformin group and insulin group according to the use of hypoglycemic drugs.Patients medical records and evaluation data of quality of life,spinal function and pain were collected.T-test,one-way ANOVA,Mann-Whitney U test,Kruskal-Wallis H test,χ^(2) test and multiple linear regression analysis were used to compare and analyze the data.Results A total of 204 patients were included,including 108 patients(52.94%)in the metformin group and 96 patients(47.06%)in the insulin group.In the long-term functional evaluation after surgery,compared with insulin,the use of metformin significantly improved the scores in the dimension of physical functioning(75.14 vs 65.36,P<0.05)and the scores in the dimension of general health(58.02 vs 48.08,P<0.05)of patients in the Short Form 36 Health Survey,and Neck Disability Index or Oswestry Disability Index were significantly reduced(15.93 vs 23.16,P<0.05).In addition,higher fasting blood glucose or postprandial blood glucose,more surgical segments and larger body mass index were risk factors for the long-term postoperative function(P<0.05).In terms of surgical methods,compared with anterior cervical discectomy and fusion,posterior lumbar interbody fusion was a risk factor for long-term postoperative function(P<0.05).Conclusion Compared with insulin,the use of metformin can effectively improve the long-term function after spinal internal fixation surgery in patients with T2DM.