垂体-性腺轴功能在男性糖尿病足溃疡患者中的变化及其与预后的相关性  

The change of functional status of pituitary-gonadal axis in male patients with diabetic foot ulcer and its association with prognosis

作　　者：何泱[1] 许蕾[1] 钱泓洁[1] 张杉杉[1] 顾雪明[2] 顾俊义[2] 施建元[2] 沈亚萍[2] 汤正义[1] 宁光[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌代谢病科、上海市内分泌代谢病研究所、上海市内分泌代谢病临床医学中心糖尿病足分中心,200025 [2]上海交通大学医学院附属瑞金医院远洋分院内科

出　　处：《中华内分泌代谢杂志》2015年第1期23-27,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：上海市科学技术委员会科研计划项目（13441900302）

摘　　要：目的 分析男性糖尿病足溃疡（DFU）患者的性激素水平与病情严重性的相关性,探讨男性DFU患者预后的影响因素.方法 收集204例男性DFU患者和63例高危DFU患者的基本资料,测定这些患者入院时血中卵泡刺激素、黄体生成素、催乳素、雌二醇、孕酮、睾酮、游离睾酮（FT）、性激素结合球蛋白水平;随访观察DFU患者6个月溃疡愈合、复发、心脑血管事件及死亡情况.结果 随着Wagner级别增加,男性患者体内雌二醇水平上升（P趋势 =0.001 2）,睾酮、FT水平下降（P趋势值分别为0.005、0.0027）;随着DFU感染加重,男性患者体内催乳素呈升高趋势（P趋势=0.021）,FT水平下降（P趋势=0.007）;患者体内雌二醇水平增高是DFU患者心脑血管事件发生（OR=1.11,P＜0.05）和死亡（OR=1.01,P＜0.05）的危险因素.结论 男性DFU患者垂体-性腺轴功能发生异常改变,多项指标似可提示病情严重性并帮助判断预后.Objective To investigate the association of sex hormones with the severity of diabetic foot ulcer （DFU）,and to analyze the influential factors of proguosis in male patients with DFU.Methods The clinical data of 204 hospitalized male patients with DFU and 63 male patients with high risk of DFU were collected.Serum concentrations of sex hormones from these patients,including FSH,LH,prolactin,estradiol,progesterone,testosterone,free testosterone （FT）,and sex hormone binding globulin were tested at admission.Patients were followed for 6 months to observe the rate of wound healing and recu rrence,the occurrences of cardiovascular and cerebrovascular events,as well as the all-cause death.Results In male patients with DFU,the serum concentration of estradiol increased gradually with the increase of Wagner grades （Ptrend =0.001 2）,while testosterone and FT decreased（Ptrend =0.005 and P =0.002 7）.The serum concentration of prolactin increased with the severity of infection（Ptrend =0.021）,while FT（Ptrend =0.007） decreased.High level of estradiol was one of the risk factors associated with the occurrences of cardiovascular and cerebrovascular events（OR =1.11,P〈0.05） and death （OR =1.01,P〈0.05） in male patients with DFU.Conclusions The hormones secreted from pituitary-gonadal axis are changed in male patients with DFU.Abnormality of these hormones might suggest the severity and prognosis of DFU.

关 键 词：糖尿病足溃疡 雌二醇 睾酮 游离睾酮 

分 类 号：R587.2[医药卫生—内分泌]