The Change Of Sex Hormone And Its Association With Prognosis In Diabetic Patients With Foot Ulcers

Objectives: To analyze the change of sex hormone in diabetic foot patients and to investigate the association between sex hormone and the prognosis of diabetic patients with foot ulcers.Methods: Clinical material from 362 hospitalized patients(of which 204 were males and158 were females) with diabetic foot ulcers were collected. Another 225 patients with matching age who had high risk of diabetic foot ulcers were selected as contrast. Sex hormone from those patients including luteinizing hormone, follicle stimulating hormone,prolactin, testosterone, free testosterone, androstenedione(only in female),dehydroepiandrosterone(only in female), estradiol, progesteron, and sex hormone binding globulin were tested within 48 hours on admission to analyze its association with the severity of diabetic foot ulcers. All the patients with diabetic foot ulcers were followed-up for 6 months to observe the impact of sex hormone on prognosis including ulcer healing,ulcer recurrence, occurrence of cardiovascular and cerebrovascular events, and death.Results: In male diabetic foot patients, serum concentration of testosterone(P=0.005 for trend) and free testosterone(P=0.0027 for trend) decreased while that of estradiol(P=0.0012 for trend) increased with the growth of Wagner grade. For postmenopausal female patients, with the growth of Wagner grade, serum concentration of testosterone,free testosterone and estradiol increased(P=0.041,0.035,<0.0001 for trend respectively).With the severity of infection steps up, serum concentration of free testosterone decreased(P=0.007 for trend) in male patients while the level of estradiol increased(P=0.02 for trend) in postmenopausal female patients. Estradiol was found to be positively correlated with the occurrence of cerebrovascular and cardiovascular events(OR=1.11, P=0.03 in male patients; OR=1.019,P=0.03 in postmenopausal female patients). In men, estradiol was positively related to death(OR=1.01, P=0.04).Conclusions: Serum concentration of estradiol and testosterone were correlated with Wagner grade and the severity of diabetic foot infection. The level of estradiol may suggest the outcomes of patients with diabetic foot ulcers.