糖尿病前期患者前庭功能损伤及其影响因素分析
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摘要
目的比较糖尿病前期患者与健康人群前庭温度试验的差异,了解糖尿病前期是否存在前庭功能受损,并探讨糖尿病前期前庭功能受损的影响因素。方法通过口服葡萄糖耐量试验连续入组糖尿病前期患者62例,男性30例,女性32例,平均年龄(52. 21±9. 78)岁,对照组选取同期年龄、性别构成接近的血糖结果正常的健康体检人群44例,男性19例,女性25例,平均年龄(49. 55±7. 20)岁。收集受试者身高、体质量等一般资料,进行内分泌相关检查及前庭温度试验,记录双眼慢相角速度。在糖尿病前期组中分析前庭功能损害的影响因素。结果糖尿病前期组44例(71. 0%)存在前庭功能损害,对照组为17例(38. 6%),差异有统计学意义(P=0. 001);与对照组比较,糖尿病前期组双眼慢相角速度下降,差异有统计学意义(右眼P=0. 026,左眼P=0. 016);在糖尿病前期组中,Logistic回归分析显示,随着年龄增大,糖化血红蛋白浓度升高,糖尿病前期患者出现前庭功能损害的危险性增大(年龄P=0. 013,糖化血红蛋白P=0. 040)。结论糖尿病前期患者前庭功能损害检出率高,表现为双侧受损。年龄、糖化血红蛋白是糖尿病前期前庭功能损害的可能危险因素。
Objective To compare the differences of vestibular function among the pre-diabetic patients and the controls and to analysis the characteristics and risk factors of vestibular dysfunction in pre-diabetic patients. Methods All participants underwent oral glucose tolerance test. Sixty-two pre-diabetic patients were enrolled with 44 age-and sex-matched controls. Weight,height,and other general information are collected in all subjects. Laboratory tests and vestibular caloric test were carried out. Slow phase velocity was collected. In pre-diabetic patients,the risk factors associated with vestibular dysfunction were analyzed. Results There were 44 cases with vestibular dysfunction in pre-diabetic patients,while 17 cases in the controls,with the statistically significant difference( P =0. 001). Compared with the controls,slow phase velocity decreased in both eyes in the pre-diabetic patients,with the statistically significant difference( P = 0. 026 for the right eyes and P = 0. 016 for the left eyes). Logistic regression analysis showed that as age and glycosylated hemoglobin A1c( HbA1c) increased,the pre-diabetic patients had an increased risk of vestibular dysfunction( age P =0. 013,HbA1c P = 0. 040). Conclusion The incidence of vestibular dysfunction is increased in the pre-diabetic patients. Age and HbA1c might be risk factors associated with vestibular dysfunction in the pre-diabetic patients.
Objective To compare the differences of vestibular function among the pre-diabetic patients and the controls and to analysis the characteristics and risk factors of vestibular dysfunction in pre-diabetic patients. Methods All participants underwent oral glucose tolerance test. Sixty-two pre-diabetic patients were enrolled with 44 age-and sex-matched controls. Weight,height,and other general information are collected in all subjects. Laboratory tests and vestibular caloric test were carried out. Slow phase velocity was collected. In pre-diabetic patients,the risk factors associated with vestibular dysfunction were analyzed. Results There were 44 cases with vestibular dysfunction in pre-diabetic patients,while 17 cases in the controls,with the statistically significant difference( P =0. 001). Compared with the controls,slow phase velocity decreased in both eyes in the pre-diabetic patients,with the statistically significant difference( P = 0. 026 for the right eyes and P = 0. 016 for the left eyes). Logistic regression analysis showed that as age and glycosylated hemoglobin A1c( HbA1c) increased,the pre-diabetic patients had an increased risk of vestibular dysfunction( age P =0. 013,HbA1c P = 0. 040). Conclusion The incidence of vestibular dysfunction is increased in the pre-diabetic patients. Age and HbA1c might be risk factors associated with vestibular dysfunction in the pre-diabetic patients.
引文
[1]纪立农.丰富中国2型糖尿病防治措施的临床证据链,建立基于中国人群证据的糖尿病防治指南——纪念第1版《中国2型糖尿病防治指南》发布10周年[J].中国糖尿病杂志,2014,22(1):1-4.
[2] XuY,Wang L,He J,et al. Prevalence and control of diabetes in Chinese adults[J]. JAMA, 2013,310(9):948-959.
[3] Group T D P P. The Diabetes Prevention Program:baseline characteristics of the randomized cohort. The Diabetes Prevention Program Research Group[J]. Diabetes Care,2000,23(11):1619-1629.
[4] Agrawal Y,Carey J P,Della S C,et al. Disorders of balance and vestibular function in US adults:data from the National Health and Nutrition Examination Survey,2001-2004[J]. Arch Intern Med,2009,169(10):938-944.
[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.
[6]周芸,刘博.糖尿病患者平衡功能障碍的发生机制[J].中华耳科学杂志,2011,9(4):365-368.
[7] D'Silva L J,Lin J,Staecker H,et al. Impact of diabetic complications on balance and falls:contribution of the vestibular system[J]. Phys Ther,2016,96(3):400-409.
[8]李鹃,张天宇,沈建中,等.糖尿病患者前庭功能的改变及其临床意义[J].临床耳鼻咽喉头颈外科杂志,2008,22(1):10-13.
[9]周芸,冯文静,刘博,等.糖尿病患者的位听功能状况分析[J].首都医科大学学报,2012,33(6):745-749.
[10] Ward B K,Wenzel A,Kalyani R R,et al. Characterization of vestibulopathy in Individuals with type 2 diabetes mellitus[J].Otolaryngolo Head Neck Surg,2015,153(1):112-118.
[11]刘雪冰,刘博,翟秀云,等.糖尿病患者前庭功能的变化特点[J].中国耳鼻咽喉头颈外科,2015,22(5):236-238.
[12] Gawron W,Pospiech L,Orendorz-Fraczkowska K,et al.Are there any disturbances in vestibular organ of children and young adults with type I diabetes?[J]. Diabetologia,2002,45(5):728-734.
[13] Agrawal Y,Carey J P,Della S C,et al. Diabetes,vestibular dysfunction, and falls:analyses from the National Health and Nutrition Examination Survey[J]. Otol Neurotol,2010,31(9):1445-1450.
[14]袁艺昕.糖尿病大鼠颈性前庭诱发肌源性电位的观察及其前庭外周传入神经系统与坐骨神经的比较[D].广州:南方医科大学,2016.
[15] Group D P P R. The prevalence of retinopathy in impaired glucose tolerance and recent-onset diabetes in the diabetes prevention program[J]. Diabet Med,2007,24(2):137-144.
[16]李谨,刘博,段金萍,等.糖尿病患者的前庭功能变化特点与分析[J].中华耳科学杂志,2016,14(4):460-463.
[17]卢彬,段金萍,孟岩,等.糖调节异常与听力损害[J].首都医科大学学报,2015,36(1):98-102.
[18]龚敬,段金萍,刘博,等.糖尿病患者听力损失的临床特点分析[J].首都医科大学学报,2015,36(1):84-89.
[2] XuY,Wang L,He J,et al. Prevalence and control of diabetes in Chinese adults[J]. JAMA, 2013,310(9):948-959.
[3] Group T D P P. The Diabetes Prevention Program:baseline characteristics of the randomized cohort. The Diabetes Prevention Program Research Group[J]. Diabetes Care,2000,23(11):1619-1629.
[4] Agrawal Y,Carey J P,Della S C,et al. Disorders of balance and vestibular function in US adults:data from the National Health and Nutrition Examination Survey,2001-2004[J]. Arch Intern Med,2009,169(10):938-944.
[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.
[6]周芸,刘博.糖尿病患者平衡功能障碍的发生机制[J].中华耳科学杂志,2011,9(4):365-368.
[7] D'Silva L J,Lin J,Staecker H,et al. Impact of diabetic complications on balance and falls:contribution of the vestibular system[J]. Phys Ther,2016,96(3):400-409.
[8]李鹃,张天宇,沈建中,等.糖尿病患者前庭功能的改变及其临床意义[J].临床耳鼻咽喉头颈外科杂志,2008,22(1):10-13.
[9]周芸,冯文静,刘博,等.糖尿病患者的位听功能状况分析[J].首都医科大学学报,2012,33(6):745-749.
[10] Ward B K,Wenzel A,Kalyani R R,et al. Characterization of vestibulopathy in Individuals with type 2 diabetes mellitus[J].Otolaryngolo Head Neck Surg,2015,153(1):112-118.
[11]刘雪冰,刘博,翟秀云,等.糖尿病患者前庭功能的变化特点[J].中国耳鼻咽喉头颈外科,2015,22(5):236-238.
[12] Gawron W,Pospiech L,Orendorz-Fraczkowska K,et al.Are there any disturbances in vestibular organ of children and young adults with type I diabetes?[J]. Diabetologia,2002,45(5):728-734.
[13] Agrawal Y,Carey J P,Della S C,et al. Diabetes,vestibular dysfunction, and falls:analyses from the National Health and Nutrition Examination Survey[J]. Otol Neurotol,2010,31(9):1445-1450.
[14]袁艺昕.糖尿病大鼠颈性前庭诱发肌源性电位的观察及其前庭外周传入神经系统与坐骨神经的比较[D].广州:南方医科大学,2016.
[15] Group D P P R. The prevalence of retinopathy in impaired glucose tolerance and recent-onset diabetes in the diabetes prevention program[J]. Diabet Med,2007,24(2):137-144.
[16]李谨,刘博,段金萍,等.糖尿病患者的前庭功能变化特点与分析[J].中华耳科学杂志,2016,14(4):460-463.
[17]卢彬,段金萍,孟岩,等.糖调节异常与听力损害[J].首都医科大学学报,2015,36(1):98-102.
[18]龚敬,段金萍,刘博,等.糖尿病患者听力损失的临床特点分析[J].首都医科大学学报,2015,36(1):84-89.