1型糖尿病患者的关节活动受限：微血管病变和亚临床大血管病变与性别有关，在男性和女性中表现不同。
Limited joint mobility in type 1 diabetic patients: associations with microangiopathy and subclinical macroangiopathy are different in men and women.
作者信息
Frost D, Beischer W
机构信息
Third Department of Medicine, Bürgerhospital Stuttgart, Germany.
出版信息
Diabetes Care. 2001 Jan;24(1):95-9. doi: 10.2337/diacare.24.1.95.
OBJECTIVE
To study the relationship of limited joint mobility (LJM) in type 1 diabetic patients with microvascular complications, hypertension, and early atherosclerosis and to determine whether sex has an influence on possible associations.
RESEARCH DESIGN AND METHODS
A total of 335 consecutive unselected patients (191 women and 144 men), aged 14-40 years, were studied for LJM, retinopathy, nephropathy (stages III and IV), and hypertension. Standard laboratory tests were performed; the intima-media thickness (IMT) of the carotid arteries, which reflects the extent of early atherosclerosis, was measured by high-resolution ultrasound, and plaques were identified.
RESULTS
The frequency of LJM was 33.7% (29.8% in women and 38.9% in men). Subjects with LJM had a longer diabetes duration (P < 0.001) than those without (women 16.7 +/- 9.1 vs. 10.3 +/- 6.0 years; men 15.0 +/- 9.0 vs. 9.4 +/- 6.3 years). Age, HbA1c, lipids, and systolic/diastolic blood pressure were not different between men and women with or without LJM. Men with LJM had a higher albumin excretion rate (37.1 vs. 13.1 microg/min, P < 0.05) than those without LJM and showed a higher risk of proteinuria (odds ratio 1.8, 95% CI 1.2-2.7; P < 0.05), retinopathy (2.4, 1.7-3.5; P < 0.001), and hypertension (1.7, 1.2-2.6; P < 0.05). The occurrence of these complications was not different between women with and without LJM, but only women with LJM had a greater IMT (0.59 +/- 0.13 vs. 0.55 +/- 0.10 mm, P < 0.05) and a higher risk of plaques (odds ratio 2.1, 95% CI 1.3-3.4; P < 0.05) than women without LJM. In a multiple logistic regression analysis, adjusted for age and diabetes duration, male sex independently predicted the presence of LJM. Moreover, LJM proved to be an independent predictor of retinopathy in men only.
CONCLUSIONS
LJM is an indicator of microvascular disease in men, and LJM is associated with early macrovascular disease in women.
目的
研究1型糖尿病患者关节活动受限（LJM）与微血管并发症、高血压及早期动脉粥样硬化之间的关系，并确定性别是否对可能的关联有影响。
研究设计与方法
共对335例年龄在14 - 40岁的连续入选患者（191名女性和144名男性）进行了LJM、视网膜病变、肾病（III期和IV期）及高血压的研究。进行了标准实验室检查；通过高分辨率超声测量反映早期动脉粥样硬化程度的颈动脉内膜中层厚度（IMT），并识别斑块。
结果
LJM的发生率为33.7%（女性为29.8%，男性为38.9%）。有LJM的受试者糖尿病病程长于无LJM者（P < 0.001）（女性：16.7 ± 9.1年对10.3 ± 6.0年；男性：15.0 ± 9.0年对9.4 ± 6.3年）。有无LJM的男性和女性在年龄、糖化血红蛋白、血脂及收缩压/舒张压方面无差异。有LJM 的男性白蛋白排泄率高于无LJM者（37.1对13.1μg/min，P < 0.05），且蛋白尿风险更高（比值比1.8，95%可信区间1.2 - 2.7；P < 0.05）、视网膜病变风险更高（2.4，1.7 - 3.5；P < 0.001）以及高血压风险更高（1.7，1.2 - 2.6；P < 0.05）。有无LJM的女性这些并发症的发生率无差异，但只有有LJM的女性IMT更大（0.59 ± 0.13对0.55 ± 0.10mm，P < 0.05），且斑块风险高于无LJM的女性（比值比2.1，95%可信区间1.3 - 3.4；P < 0.05）。在多因素逻辑回归分析中，校正年龄和糖尿病病程后，男性独立预测LJM的存在。此外，仅在男性中LJM被证明是视网膜病变的独立预测因素。
结论
LJM是男性微血管疾病的一个指标，而LJM与女性早期大血管疾病相关。
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