218例糖尿病足患者临床特征及高危因素分析  

An analysis of clinical characteristics and high-risk-factors in 218 cases with diabetic foot

作　　者：李惠琴[1] 苏晓飞[1] 丁波[1] 罗勇[1] 夏斯桂[1] 马建华[1] 

机构地区：[1]南京医科大学附属南京医院（南京市第一医院）内分泌科,210029

出　　处：《中华内分泌代谢杂志》2012年第6期492-495,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的对218例糖尿病足患者的临床资料进行分析，以探讨糖尿病足严重程度与全身状况的关系以及糖尿病足严重性的高危因素。方法回顾性分析2006年至2010年在本院内分泌科住院的218例糖尿病足的临床资料，比较不同Wagner分级者的空腹及餐后血糖、HbA1c、血红蛋白、血清白蛋白、血肌酐、尿素氮、纤维蛋白原水平；同时分析血管病变、神经病变、感染等因素在糖尿病足严重性中的作用及糖尿病足不同Wagner分级者的预后情况。结果（1）Wagner5级患者的空腹血糖、餐后血糖水平高于Wagner1级患者，有统计学意义（P〈0．01），HbA1c与Wagner1级无统计学意义。（2）Wagner5级患者的血红蛋白、总胆固醇、血清白蛋白明显降低，血白细胞、血肌酐、纤维蛋白原升高，与Wagner1级患者相比有统计学意义（P〈0．01）。（3）Wagner2级及以上患者的股总动脉内膜中层厚度明显增加，与Wagner1级患者相比具有统计学差异（P〈0．05）。（4）Logistic回归分析示，血红蛋白、纤维蛋白原、HbA。股总动脉内膜中层厚度、细菌感染与糖尿病足病情的严重性独立相关。（5）随着Wagner分级级别的增高，住院天数逐渐增多：Wagner5级者预后最差，死亡率最高。结论糖尿病足Wagner5级者的血红蛋白、总胆固醇、血清白蛋白水平更低；白细胞、血肌酐、纤维蛋白原更高；股总动脉内膜中层厚度更厚；血红蛋白、纤维蛋白原、HbA1c、股总动脉内膜中层厚度及感染是糖尿病足病情严重性的高危因素，Wagner5级糖化血红蛋白不能作为此类患者血糖控制是否良好的指标。Wagner级别越高，住院天数越长，预后越差。Objective To explore high-risk factors that affect the severity of diabetic foot ulcers and the relationship between the severity of diabetic foot ulcers and the general somatic conditions by analyzing clinical data of 218 diabetic foot patients. Methods A retrospective analysis of the clinical data of 218 diabetic foot patients, admitted from 2006 to 2010 was performed. Fasting and postprandial blood glucose （ FBG and PBG） , glycosylated hemoglobin, hemoglobin, serum albumin, serum creatinine, as well as serum urea nitrogen and fibrinogen were determined in patients with different Wagner levels. The effects of peripheral arterial disease, neuropathy, infections and other factors on severity of diabetic foot ulcers, and the prognosis of those patients with different Wagner levels were analyzed. Results （ 1 ） FBG and PBG in Wagner 5 patients were significantly higher than those in Wagner 1, but there was no statistical significance in HbAic difference. （2） Hemoglobin, total cholesterol, serum albumin in Wagner 5 patients were decreased significantly; white blood cells, serum creatinine and fibrinogen were increased significantly （ P〈0.01 ）. （ 3 ） The intima-media thickness （IMT） of femoral artery in Wagner 2-and-above patients was increased significantly compared with that in Wagner 1 （ P〈 0.05 ）. （4） Logistic regression analysis showed that hemoglobin, fibrinogen, glycated hemoglobin, femoral artery intima-media thickness, and bacteria] infection were correlated independently with the severity of diabetic foot ulcers. （ 5 ） The hospitalized days were increased with rising Wagner levels ; the prognosis of Wagner 5 patients was the worst, with the highest mortality in the group. Conclusions Changes in blood level of hemoglobin, fibrinogen, along with higher HbA1c and femoral artery IMT, as well as infections are high-risk factors of severity in diabetic foot patients. HbA1c is not a good indicator of blood glucose control in patients with Wagner 5 grade. The higher the Wagner

关 键 词：糖尿病足 血红蛋白 纤维蛋白原 感染 

分 类 号：R587.2[医药卫生—内分泌]