摘要
目的搜集糖尿病合并勃起功能障碍(erectile dysfunction,ED)患者的相关临床指标,构建临床预测模型以评判该类患者继发心血管疾病(cardiovascular disease,CVD)事件的预测价值,并验证该临床模型的相关应用性。方法选择2014年7月至2016年1月湖北省十堰市人民医院诊治的糖尿病ED患者为研究对象,对其进行为期18个月的随访以确认预后转归,依据随访结果分析与继发CVD风险存在影响的相关临床指标,并通过应用性分析验证其临界值对继发CVD时间窗的评判效能。结果最终纳入317例糖尿病ED患者,其中,11例患者失访,32例患者于随访期内继发CVD事件,274例患者未见相关异常。①Cox回归分析显示,糖尿病ED继发CVD的风险模型由年龄(HR=1.178,P<0.05)、体重指数(body mass index,BMI)评分(HR=1.420,P<0.05)、稳定性伴侣(HR=-0.518,P<0.05)、国际勃起功能问卷表-5(International Index of Erectile Function 5,IIEF-5)评分(HR=0.459,P<0.05)、睾酮(testosterone,TT)含量(HR=0.524,P<0.05)、小动脉弹性(Compliance-2,C_2)系数(HR=0.710,P<0.05)、锻炼频率:每周>2次(HR=0.742,P<0.05)组成。其中,年龄、BMI、IIEF-5评分为危险性因素,稳定性伴侣、TT含量、C_2系数、锻炼频率:每周>2次为保护性因素。②通过ROC曲线以进一步量化各项影响因素(连续性变量)对于糖尿病ED继发CVD的预测效能:BMI临界值取33.251 Kg/m^2、TT含量临界值取1.432 ng/ml、C_2系数临界值取5.481 ml/min Hg×100均可以获取最佳预测敏感性和特异度。③依据临界值变量评判不同分组对于继发预后转归差异的应用效能:BMI≥33.251 Kg/m^2的糖尿病ED患者随访期内继发CVD的时间窗显著缩短(Log-Rank test=5.191,P<0.05),TT<1.432 ng/ml的糖尿病ED患者随访期内继发CVD的时间窗显著缩短(Log-Rank test=6.022,P<0.05),C_2<5.481 ml/min Hg×100的糖尿病ED患者随访期内继发CVD的时间窗显著缩短(Log-Rank test=4.279,P<0.05)。结论年龄、BMI、稳定性伴侣、IIEF-5评分、TT含量、C_2系数、锻炼频率:每周>2次是糖尿病ED继发CVD的独立影响因素,且BMI≥33.251 Kg/m^2、TT<1.432 ng/ml、C_2<5.481 ml/min Hg×100对于该患者群体继发CVD具有显著评判效能。
Objective To collect the clinical parameters of patients with diabetic erectile dysfunction ( ED) in order to construct a clinical prediction model to evaluate the predictive value of cardiovascular disease (CVD) events in these patients and to verify the applicability of the clinical model. Methods The patients with diabetic ED in People's Hospital Affiliated to Hubei University of Medicine from July 2014 to January 2016 were enrolled and followed up for 18 months to confirm the prognosis. Relevant clinical indicators of secondary CVD were analyzed based on the follow-up analysis, and the applicability analysis was performed to verify the effectiveness of critical value for secondary CVD window. Results A total of 317 patients with diabetic ED were enrolled, including 11 cases lost, 32 cases with concurrent CVD events during follow-up and 274 cases without any abnormality. A Cox regression analysis showed that the risk model of secondary CVD events was assessed by age ( HR = 1. 178, P < 0. 05 ), body mass index ( BMI) score ( HR = 1. 420, P < 0. 05 ), stable sexual partner (HR =0. 518, P < 0. 05), International Index of Erectile Function 5 (IIEF-5) score (HR =0.459, P < 0. 05 ), testosterone (TT)content ( HR = 0. 524, P < 0. 05 ), Compliance-2 ( C2) coefficient ( HR = 0. 742, P < 0. 05 ) and the exercise frequency of over twice per week ( HR = 0. 742, P < 0. 05 ), where age, BMI, IIEF-5 score were the risk factors while stable sexual partner, TT content, C2 coefficient, exercise frequency of over twice a week were the protective factors.(2)The ROC curve was used to further quantify the predictive efficacy of each influencing factor ( continuous variable) for ED secondary CVD in diabetic patients: the critical value of BMI, TT and C2 was 33. 251 Kg/m^2, 1. 432 ng/ml and 5. 481 ml/min Hg×100 respectively to obtain the best predictive sensitivity and specificity.(3)The effectiveness of different groups in judging the difference of secondary prognosis was evaluated according to the critical variables: Patients with BMI≥33. 251 Kg/m2 experienced a significantly shorter time window of secondary CVD during follow-up ( Log-Rank test = 5. 191, P < 0. 05 );Patients with TT < 1. 432 ng/ml had a significantly shorter secondary window of secondary CVD during follow-up ( Log-Rank test = 6. 022, P < 0. 05 );Patients with C2 < 5. 481 ml/min Hg×100 had a significantly shorter time window of secondary CVD during follow-up (Log-Rank test = 4.279, P<0. 05). Conclusions Age, BMI, stable sexual partner, IIEF-5 score, TT content, C2 coefficient, exercise frequency over twice per week are the independent influencing factors of secondary CVD of patients with diabetic ED, and BMI≥33. 251 Kg/m^2, TT <1.432 ng/ml, C2 <5.41 ml/min Hg×100 has significant evaluation value.
作者
谢子平
林燕
谢胜
王万荣
李韬
王金国
XIE Ziping;Lin Yan;XIE Sheng;WANG Wamong;LI Too;WANG Jinguo(Department of Andrology,People's Hospital Affiliated to Hubei University of Medicine,Shiyan 442000,Hubei,China;Department of Pharmacy,People's Hospital Affiliated to Hubei University of Medicine,Shiyan 442000,Hubei,China)
出处
《中国性科学》
2019年第3期55-61,共7页
Chinese Journal of Human Sexuality
关键词
勃起功能
糖尿病
心血管疾病
影响因素
Erectile function
Diabetes mellitus
Cardiovascular disease
Influencing factors
作者简介
通讯作者:林燕,E-mail:xie721119@sina.com.
