老年2型糖尿病患者下肢微循环障碍的影响因素研究  

A Study on the Influencing Factors of Microcirculatory Dysfunction in Elderly Patients with Type 2 Diabetes Mellitus

作　　者：赵佩伊 陈鑫大 费思佳 潘琦[1,2] Zhao Peiyi;Chen Xinda;Fei Sijia;Pan Qi(Department of Endocrinology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院、内分泌科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]中国医学科学院北京协和医学院研究生院,北京100730

出　　处：《中华老年医学杂志》2025年第4期421-428,共8页Chinese Journal of Geriatrics

基　　金：国家自然科学基金(82270881,82200928);国家高水平医院临床科研基金(BJ-2023-130)。

摘　　要：目的应用非侵入性检测技术评估下肢微循环障碍,探究老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者微循环障碍的影响因素及与糖尿病微血管并发症之间的相关性。方法回顾性纳入2024年3月至2025年1月于北京医院内分泌科住院的老年T2DM患者共417例,根据测定的下肢经皮氧分压和/或温控激光多普勒血流变化,分为微循环障碍组(290例,69.54%)及微循环正常组(127例,30.46%)。采用两独立样本t检验、Mann-Whitney U检验、χ^(2)检验对两组间的差异进行统计学分析,并通过多因素logistic回归分析微循环障碍的影响因素。结果在控制混杂因素后,多因素回归分析结果显示,性别为女性是微循环障碍的保护因素(OR=0.456,95%CI:0.291~0.715,P<0.001)。进一步按照性别分层,在老年男性T2DM患者中,糖尿病病程(OR=1.075,95%CI:1.024~1.128,P=0.004)、糖化血红蛋白(OR=1.346,95%CI:1.101~1.645,P=0.004)、体质指数(OR=1.244,95%CI:1.095~1.412,P<0.001)、临床诊断糖尿病周围神经病变(OR=2.576,95%CI:1.181~5.619,P=0.017)是微循环障碍的危险因素。在老年女性T2DM患者中,临床诊断糖尿病周围神经病变(OR=2.869,95%CI:1.480~5.562,P=0.002)、神经传导检测异常(OR=2.023,95%CI:1.080~3.790,P=0.028)、糖尿病肾病(OR=2.451,95%CI:1.130~5.317,P=0.023)是微循环障碍的危险因素。结论微循环障碍在老年T2DM患者中存在明显的性别差异,其中男性患者下肢微循环障碍的发生率更高,应注重心血管风险因素的管理;而女性则面临更高的微血管并发症发生风险,应注重微循环障碍及微血管并发症的早期筛查。Objective This study used non-invasive diagnostic techniques to assess microcirculatory dysfunction in the lower extremities,investigate its influencing factors in elderly patients with type 2 diabetes,and explore its correlation with diabetic microvascular complications.Methods A total of 417 elderly patients with type 2 diabetes mellitus(T2DM)hospitalized in the Department of Endocrinology at Beijing Hospital between March 2024 and January 2025 were retrospectively enrolled.Based on transcutaneous oxygen pressure(TcPO2)and/or temperature-controlled laser Doppler flowmetry(LDF)blood flow changes in the lower limbs,participants were categorized into a microcirculatory dysfunction group(290 cases,69.54%)and a normal microcirculation group(127 cases,30.46%).Statistical analyses,including independent samples t-tests,Mann-Whitney U tests,andχ^(2) tests,were applied to compare intergroup differences.Multivariate stepwise logistic regression was conducted to identify risk factors for microcirculatory dysfunction.Results After adjusting for confounding factors,multivariate regression analysis revealed female sex as a protective factor for microcirculation dysfunction(OR=0.456,95%CI:0.291-0.715,P<0.001).Gender-stratified analysis further demonstrated indicated that in elderly male T2DM patients,diabetes duration(OR=1.075,95%CI:1.024-1.128,P=0.004),hemoglobin A 1c(OR=1.346,95%CI:1.101-1.645,P=0.004),body mass index(OR=1.244,95%CI:1.095-1.412,P<0.001)and clinically diagnosed diabetic peripheral neuropathy(OR=2.576,95%CI:1.181-5.619,P=0.017)were significant risk factors for microcirculatory dysfunction.In elderly female T2DM patients,clinically diagnosed diabetic peripheral neuropathy(OR=2.869,95%CI:1.480-5.562,P=0.002),abnormal nerve conduction study(OR=2.023,95%CI:1.080-3.790,P=0.028),and diabetic nephropathy(OR=2.451,95%CI:1.130-5.317,P=0.023)were identified as significant risk factors.Conclusions Significant gender disparities exist in microcirculatory dysfunction among elderly T2DM patients.Male patients exhibit a hig

关 键 词：糖尿病 2型 老年人 糖尿病并发症 微循环障碍 

分 类 号：R587.2[医药卫生—内分泌]