维生素D缺乏对糖尿病足多重耐药菌感染的影响  

The effects of vitamin D deficiency on infection of multiple resistant bacteria in patients with diabetic foot

作　　者：陈鹤鸣[1] 张晓军[1] 

机构地区：[1]陕西省安康市中心医院内分泌科,陕西省安康725000

出　　处：《中国慢性病预防与控制》2014年第1期29-32,共4页Chinese Journal of Prevention and Control of Chronic Diseases

摘　　要：目的研究维生素D水平缺乏对于糖尿病足多重耐药菌感染的影响，为保护糖尿病患者的健康提供科学依据。方法于2005年11月至2009年10月，选取126例糖尿病足溃疡患者为研究对象，测定其维生素D水平，并采集患者溃疡组织进行细菌培养，记录患者各项临床资料，随访溃疡愈合后的复发情况。采用多因素非条件logistic回归分析糖尿病足多重耐药菌感染的影响因素。结果126例患者中维生素D缺乏的患者有98例（77．8％），28例患者未检测出细菌生长，98例患者检测出细菌139株。多因素非条件logistc回归分析结果表明，维生素D水平〈75nmol／L、既往住院病史及糖化血红蛋白〉6％是糖尿病足多重耐药菌感染的危险因素（OR值分别为1．601、1．391和3．957，95％C1分别为1．035—2．447、1．124～2．583和1．437～9．772）。耐甲氧西林的金黄葡萄球菌和鲍曼不动杆菌是最常见的感染菌株。维生素D正常组（I〉75nmol／L）、轻度缺乏组（50～nmol／L）、中度缺乏组（25一nmol／L）和重度缺乏组（〈25nmol／L）糖尿病足溃疡3年无复发率分别为43．O％、40．1％、25．1％及20．1％，差异有统计学意义（x2=8．575，P=0．04）。结论血糖控制不良的患者可能存在维生素D缺乏，维生素D缺乏是糖尿病足感染多重耐药菌的危险因素之一，中度及重度缺乏组糖尿病足溃疡愈合后容易复发。Objective To study the effects of vitamin D deficiency on infection of multiple resistant bacteria in patients with diabetic foot and to provide the basis for protecting the health of patients with diabetes mellitus （DM）. Methods During Nov. 2005 to Oct. 2009, the serum vitamin D levels were detected and bacteria of ulcer specimens were cultured for 126 patients with diabetic foot ulcer. The clinical data and information of ulcer recurrence were collected. The influencing factors on infection of multiple resistant bacteria in patients with diabetic foot were analyzed with multiple factor logistic regression. Results In 126 patients with diabetic foot ulcer, 98 cases （77.$%） suffered from vitamin D deficiency, no bacteria were detected in 28 cases, 139 bacterial strains were detected in 98 cases. The multiple factor logistic regression analysis showed that the low serum level （〈75 nmol/L） of vitamin D, hospitalization history and high HbAc level （〉6%） were the risk factors for infection of multiple resistant bacteria in patients with diabetic foot, the OR values were 1.601 （95%CI： 1.035-2.447）, 1.391 （95%CI： 1.124-2.853） and 3.957 （95%CI： 1.437- 9.772）, respectively. Staphylococcus aureus and Acinetobacter baumannii were main resistant bacterial strains to methicillin. The rates without diabetic foot ulcer recurrence for 3 years in four groups with normal vitamin D level （ I〉75 nmol/L）, slight vitamin D deficiency （50- nmol/L）, moderate vitamin D deficiency （25- nmol/L） and severe vitamin D deficiency （〈25 nmol/L） were 43.0%, 40.1%, 25.1% and 20.1%, respectively. There were significant differences （P〈0.05）. Conclusion The patients without controlling blood glucose may have vitamin D deficiency, which is one of risk factors for infection of multiple resistant bacteria in diabetic loots. The diabetic foot in DM patients with moderate and severe vitamin D deficiency may recur easily.

关 键 词：糖尿病足 维生素D 多重耐药菌 感染 

分 类 号：R587.1[医药卫生—内分泌]