糖尿病足患者截肢相关危险因素分析  

Risk factors for lower extremity amputation in patients with diabetic foot

作　　者：徐波[1] 杨彩哲[1] 吴石白[1] 张妲[1] 王璐宁[1] 肖黎[1] 陈莹[1] 王晨蕊[1] 童奥[1] 周秀芳[1] 李小红[1] 关小宏[1] 

机构地区：[1]解放军空军总医院内分泌科,北京100142

出　　处：《中华内科杂志》2017年第1期24-28,共5页Chinese Journal of Internal Medicine

摘　　要：目的探讨糖尿病足患者合并截肢的相关危险因素。方法回顾性分析2001年11月至2015年4月于北京空军总医院住院的1771例糖尿病足患者的临床资料，入组患者分为截肢组和非截肢组，其中截肢组根据截肢平面分为大截肢组和小截肢组，对两组间资料进行单因素分析和多因素非条件logistic回归分析。结果1771例患者中，截肢组323例（18．24％），其中大截肢组41例（2．32％），小截肢组282例（15．92％），非截肢组1448例（81．76％）。截肢组的住院时间更长，估算的肾小球滤过率（eGFR）、空腹血糖（FPG）、糖化血红蛋白（HbA1c）、C-反应蛋白（CRP）、ESR、铁蛋白、纤维蛋白原、白细胞高于非截肢组，而血红蛋白、血清白蛋白、转铁蛋白、TC、TG、HDL-C和LDL-C低于非截肢组，差异均具有统计学意义（P〈0．05）。截肢组与非截肢组的高血压患病率（52．48％比59．98％）、冠心病患病率（21．33％比28．71％）、周围血管病变（PAD）患病率（68．11％比25．04％）差异均有统计学意义（P〈0．05）。多因素logistic回归分析显示，Wagner分级、PAD、CRP为截肢的独立危险因素。结论Wagner分级、糖尿病下肢缺血及感染与糖尿病足截肢密切相关。Objective To explore the risk factors for lower extremity amputation in patients with diabetic foot. Methods The clinical data of 1 771 patients with diabetic foot at the Air Force General Hospital of PLA from November 2001 to April 2015 were retrospectively analyzed. The patients were divided into the non-amputation and amputation groups. Within the amputation group, subjects were further divided into the minor and major amputation subgroups. Binary logistic regression analyses were used to assess the association between risk factors and lower extremity amputation. Results Among 1 771 patients with diabetic foot, 323 of them （ 18. 24% ） were in the amputation group （ major amputation： 41 ; minor amputation： 282） and 1 448 （81.76%） in the non-amputation group. Compared with non-amputation patients, those in the amputation group had a longer hospital stay and higher estimated glomerular filtration rate（eGFR） levels. Fasting plasma glucose （ FPG）, glycosylated hemoglobin （ HbA1c ）, C-reaction protein （CRP）, ESR, ferritin, fibrinogen and WBC levels of the amputation group were higher, while hemoglobin albumin, transferrin, TC, TG, HDL-C and LDL-C were lower than those of the non-amputation group （ all P 〈0.05 ）. The proportion of hypertension （ 52.48% vs 59.98% ）, peripheral vascular disease （ PAD ） （68.11% vs 25.04%）, and coronary heart disease（21.33% vs 28.71%）were different between the amputation and non-amputation groups （ all P 〈 0. 05 ）. Multivariable logistic regression analyses showed that Wagner＇s grade, PAD and CRP were the independent risk factors associated with lower extremity amputation in hospitalized patients with diabetic foot. Conclusion Wagner＇ s grade, ischemia of lower limbs and infection are closely associated with amputation of diabetic foot patients.

关 键 词：糖尿病足 截肢 危险因素 

分 类 号：R587.2[医药卫生—内分泌]