The change of sex hormone level in postmenopausal women with diabetic foot ulcer and its association with prognosis

Abstract

Objectives To investigate the association of sex hormone with the severity of diabetic foot ulcer (DFU) and its effect on prognosis of DFU in postmenopausal women. Methods From January 2012 to January 2013, clinical data from 158 postmenopausal women with DFU and 162 postmenopausal women with high risk of DFU admitted to Diabetic Foot Center of Ruijin Hospital were collected. The severity of DFU was evaluated on admission. Serum concentration of sex hormone, included follicle stimulating hormone (FSH), lutenizing hormone (LH), prolactin (PRL), estradiol (E2), progesterone (P), testosterone (T), free testosterone (FT), dehydroepiandrosterone (DHEAS), androstenedione (AD) and sex hormone-binding globulin (SHBG) were tested within 48 hours after admission. The association between sex hormone and the severity of DFU was analyzed by using multiple linear regression. All these patients with DFU were followed up for 6 months to observe their outcomes including ulcer healing, recurrence, and non-fatal cardiovascular and cerebrovascular events. Logistic regression was used to analyze the impact of sex hormones on the outcome of DFU. Results Serum concentrations of E2, T, FT increased (t=4.47, 2.03, 2.16 respectively;P=0.0001, 0.0410, 0.0350 respectively for trend) with the Wagner grades of DFU in postmenopausal women. Similarly, serum concentration of E2 increased (t=2.41;P=0.02 for trend) with the severity of infection. The level of E2 was positively correlated with the occurrence of non- fatal cardiovascular and cerebrovascular events (OR=1.109, 95%CI:1.002-1.037, P<0.05). Conclusions Serum concentration of E2 and T/FT were associated with the severity of DFU in postmenopausal women. The change of E2 might imply the occurrence of non-fatal cardiovascular and cerebrovascular events. Key words: Postmenopause; Diabetic foot ulcer; Estradiol; Testorone