不同程度感染的糖尿病足溃疡患者临床特点及预后分析  

Clinical characteristics and prognosis of the infections in patients with diabetic foot ulcer

作　　者：许蕾[1] 钱鸿洁[1] 张杉杉[1] 顾雪明[1] 蔡慧丽[1] 顾俊义[1] 施建元[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,远洋分院内科,上海市内分泌代谢病临床医学中心糖尿病足病分中心,上海市内分泌代谢病研究所,200025

出　　处：《中华内分泌代谢杂志》2013年第2期116-119,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的 分析糖尿病足溃疡感染的临床特点，探讨感染严重程度对患者预后的影响。方法 收集506例住院糖尿病足溃疡患者的资料，比较不同感染程度的患者的临床特点，观察患者溃疡治愈率、截肢率及死亡率，分析相关影响因素。结果 糖尿病足溃疡患者入院时的总体感染率为95.8%；随访1年内总体愈合率为80.6%，大小截肢率为23.3%，死亡率为8.1%。随着感染严重程度的增加，溃疡深度逐渐加重，患者血糖、血脂控制变差，蛋白水平降低，尿蛋白排出增加，截肢率、死亡率不断升高。截肢的相关危险因素为感染严重程度、糖尿病血管并发症及年龄（P〈0.05）；死亡的相关危险因素为Wagner级别、年龄、白细胞计数、白蛋白水平（P〈0.05）。结论 足溃疡的感染程度与溃疡严重程度呈正相关，并严重影响患者全身状态及预后,提示需要及时控制。Objective Clinical characteristics of the infection in diabetic foot ulcers （DFU） were analyzed in regard to the severity of infection and the related prognosis. Methods The data from 506 hospitalized patients with DFU were collected, the rates of healed ulcer, amputation, and mortality were followed for 1 year. These patients were divided into different groups according to the grades of ulcer and severity of infection. Statistics was made to find their clinical characteristics and association to outcomes. Results The rate of infection in patients with DFU was 95.8%. Within one year, 80.6% of patients had ulcers cured, 23.3% of them underwent amputation of toes or legs, and 8.1% of them died. Elevated Wagner grade, severe infection, poorly controlled hyperglycemia and lipidemia, decreased serum proteins, and marked proteinuria led to worsened DFU and increased risk of amputation and death. The degree of ulcers, diabetic vascular complication, and aging were the main risk factors of amputation; in addition, abnormal white blood cell counts and lowered serum albumin were risk factors of fatality（P〈0.05）. Conclusion Diabetic foot infection is positively correlated with the grading of Wagner classification, and seriously affects the general condition and prognosis of patients, suggesting that more attention should be paid to the infection control.

关 键 词：糖尿病足溃疡 糖尿病足感染 截肢 死亡率 

分 类 号：R587.2[医药卫生—内分泌]