436例糖尿病足截肢相关因素分析

摘要

Objective To investigate the risk factors related to amputation in the patients with diabetic foot ulcer.Methods Four-hundred and thirty-six diabetic patients with foot ulcer were retrospectively investigated regarding their demographic data,diabetes and related diseases treatment,severity and size of foot deers,with and without infection,and blood biochemistry parameters.The patients were divided into two groups:i.e.with and without amputation.Results Ninety-seven patients(22.2%)underwent amputation.No significant statistic differences in age,sex,blood glucose level,and foot ulcer duration were found between two groups.Higher prevalence of peripheml vascular disease(94.8% vs 86.1%,P<0.05),higher white blood cell counts[(10.80±6.03 vs 8.09±3.59)×10~9/L,P<0.01],and raised high sensitivity C-reactive protein levelI(10.2±6.2 vs 6.9±6.1)retool/L.P<0.01] and lower plasma albumin[(35.0±5.1 vs 36.8±5.0)g/L,P<0.01],blood hemoglobin[(104.3±18.9 vs 114.1±21.0)g/L.JP<0.01],serum total cholesteroll(4.2±0.9 vs 4.7±1.3)mmool/L,P<0.01],triglycerides[(1.2±0.5 vs 1.6±1.3)mmol/L,P<0.01],high-density lipoprotein-cholesterol[(1.1±0.5 vs 1.2±0.3)mmol/L.P<0.01],and low-density lipoprotein.cholesterol[(2.7±0.8 vs 3.0±1.0)mmool/L,P<0.05]levels were found in amputation group compared with the non-amputation group.Multiple logistic regression showed that peripheral vascular disease.white blood cells,cholesterol,and high sensitivity C.reactive protein were the independent risk factors of amputation.Conclusions The severity of diabetic foot ulcer,peripheral artery disease,inflammation factors,and malnutrition are important factors leading to amputation due to the unhealed ulcers.%目的 研究与糖尿病足溃疡截肢相关的重要因素.方法 回顾性分析436例糖尿病足溃疡患者的人口学资料、糖尿病及相关疾病治疗、足溃疡严重程度、溃疡大小、是否合并感染和血生化结果.根据是否截肢将436例患者分为未截肢组和截肢组.结果 436例患者中有97例患者被截肢,截肢率为22.2%.与未截肢组患者相比,截肢组患者的年龄、性别、足病病程和血糖水平差异无统计学意义.但截肢组的外周血管疾病发病率更高(94.8%vs 86.1%,P<0.05),血白细胞计数[(10.80±6.03 vs 8.09±3.59)×10~9/L,P<0.01]、超敏C反应蛋白[(10.2+6.2 vs 6.9+6.1)mmol/L,P<0.01]明显增高,血浆白蛋白[(35.0±5.1 vs 36.8±5.0)g/L,P<0.01]、血红蛋白[(104.3±18.9 vs 114.1±21.0)g/L,P<0.01]、血清总胆固醇[(4.2±0.9 vs 4.7±1.3)mmol/L,P<0.01]、甘油=三酯[(1.2±0.5 vs 1.6±1.3)mmol/L,P<0.01]、高密度脂蛋白胆固醇[(1.1±0.5 vs 1.2±0.3)mmo/L,P<0.01]、低密度脂蛋白胆固醇[(2.7±0.8 vs 3.0±1.0)mmol/L,P<0.05]明显降低.多因素逐步logistic回归分析显示,外周血管病变、血白细胞计数、血清总胆同醇、超敏C反应蛋白为截肢的独立危险因素.结论 足溃疡严重程度、外周血管病变、炎症因素和营养不良可能是截肢相关的重要因素.