糖尿病足病病情严重性与全身情况和甲状腺功能状态的关系  

Relations of severity of diabetic foot disease to thyroid function and general body status

作　　者：张杉杉[1] 顾雪明[1] 刘宏[1] 周云飞[1] 蔡慧丽[1] 顾俊义[1] 施建元[1] 徐茜[1] 汤正义[1] 宁光[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌代谢病科,上海市内分泌代谢病临床医学中心远洋分院糖尿病足分中心,上海市内分泌代谢病研究所,200025

出　　处：《中华内分泌代谢杂志》2009年第6期604-607,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的分析糖尿病足病病情严重性与全身状态和甲状腺功能指标的相关性，探讨足病不同状态的严重性和需要注意的指标，方法95例糖尿病足病和31例足病高危患者，根据Wagner分级分为6组，分别统计分析他们的糖尿病病情、血浆白蛋白、血液中血红蛋白、尿蛋白、血清肌酐和甲状腺功能指标，观察这些指标与Wagner分级的关系。结果随着糖尿病足病Wagner级别增加，平均HbA1C水平上升，内源性胰岛素分泌减少，血液中白蛋白与血红蛋白含量逐渐下降，尿蛋白排出逐级上升，血液中T3、T4、FT3水平也不断下降。这些指标在各Wagner级别组间有显著差别（均P〈0．05）；到Wagner4级以上，它们具体数值改变更显著，与Wagner0和1级的比较差异有统计学意义（均P〈0．05）；等级相关性分析显示这些指标与Wagner分级呈显著相关性（均P〈0．05）；其中HbA1c和甲状腺功能是糖尿病足病病情严重性的主要相关因素。结论Wagner4级以上糖尿病足病患者病情已经达到危重状态，提示需要全面干预。Objective To analyze the relations of thyroid function and general body status to the Wagner grades of diabetic foot disease （DFD） ,and to investigate the indicators of severity to DFD. Methods Ninety-five patients with confirmed DFD and 31 patients with high risk factors to DFD were classified into 6 groups according to Wagner grades. Their HbA1c, C-peptides, serum albumin, blood hemoglobin,24 h urine protein excretion, serum ereatinine,functional parameters of thyroid, and dependability to Wagner grades were analyzed. Results With increasing of Wagner grades, HbA1c： and 24 h urine albumin excretion were increased gradually. Intrinsic insulin secretion,serum albumin, blood hemoglobin, T3, T4, and FT3 were decreased. These indicators had significant differences among Wagner grades （ all P 〈 0. 05 ）. In the patients of Wagner 4 and 5, these indicators were apparently abnormal,which had remarkable discrepancies compared to Wagner 0 and 1 （all P〈0.05 ）. They had distinct dependability to Wagner grades （ all P〈0.05 ）. Among them, HbA1c and parameters of thyroid function were the main correlation factors. Conclusion In patients with Wagner 4 and 5, DFD has attained a highly severe status and the treatment of DFD should be imminent and intensive.

关 键 词：糖尿病足 白蛋白 血红蛋白 甲状腺功能 

分 类 号：R587.2[医药卫生—内分泌]