常见不同细菌感染对糖尿病足溃疡患者病情和短期预后的影响  

Effects of common bacterial infections in patients with diabetic foot ulcer on clinical characteristics and shortterm outcome

作　　者：张杉杉[1] 赵连礼[2] 何泱[1] 许蕾[1] 钱泓洁[1] 郭凯[1] 王淑敏[1] 顾雪明[1] 汤正义[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分中心.上海市内分泌代谢病研究所,200025 [2]山东省东营市胜利油田中心医院内分泌科

出　　处：《中华内分泌代谢杂志》2017年第1期11-16,共6页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的分析常见细菌感染的糖尿病足溃疡（DFU）患者病情特点，探讨不同病原菌对足溃疡病情及短期预后的影响。 方法从1025例DFU患者中筛选细菌培养阳性的病例，选取感染最多见的5个菌种，以菌种分组，进行病情分析和观察3个月随访结果，根据愈合、未愈、截肢、死亡等病情结局，分析各组间差别与不同结局的相关危险因素。 结果常见感染菌种为金黄色葡萄球菌、铜绿假单胞菌、变形杆菌、粪肠球菌和大肠埃希菌，占720例培养阳性的405例；入院时各组别相应临床指标基本无差别，但金黄色葡萄球菌、铜绿假单胞菌感染患者Wagner 1-2级病变比例分别为55.0%、71.1%，轻中度感染比例分别为77.5%、84.2%，变形杆菌、粪肠球菌、大肠埃希菌感染患者Wagner 3-5级比例分别为49.2%、52.8%、63.2%；粪肠球菌、大肠埃希菌组重度感染比例分别为38.2%、42.1%；金黄色葡萄球菌、铜绿假单胞菌组3个月愈合比例超过47%；变形杆菌、粪肠球菌、大肠埃希菌组愈合比例低于40%，截肢比例均在40%以上（均P〈0.05）；心功能3级以上、严重下肢动脉病变、HbA1C〉9%是影响足溃疡愈合、导致截肢的主要危险因素（均P〈0.05）。结论不同细菌感染的DFU病情有一定的差别，变形杆菌、粪肠球菌、大肠埃希菌感染的DFU患者足部病情相对较重，短期预后相对较差。Objective To analyze the effects of common infected bacteria on clinical characteristics and short-term outcomes of patients with diabetic foot ulcer（DFU）.Methods A total of 720 patients with positive bacterial culture were selected from 1 025 cases of DFU. These patients were divided into five groups according to the 5 most common infected bacteria. The outcomes of healing, no-healing, amputation, and death were calculated 3 months after hospitalization. The clinical characteristics of these 5 bacterial groups and risk factors for outcome were analyzed.Results The 5 most common infected bacteria were staphylococcus aureus, pseudomonas aeruginosa, proteus, enterococcus faecalis, and escherichia coli, which included 405 among 720 positively cultured cases. Among these groups, there were no differences in clinical characteristics except for the foot ulcer. In staphylococcus aureus and pseudomonas aeruginosa infected groups, 55.0% and 71.1% patients were at Wagner 1-2 degree, while 77.5% and 84.2% patients were with mild to moderate infection. In proteus, enterococcus faecalis, and escherichia coli infected groups, 49.2%, 52.8%, and 63.2% patients were at Wagner 3-5 degree, respectively. The percentages of severe infected patients in enterococcus faecalis and escherichia coli groups were 38.2% and 42.1%, respectively. Healing rates of 3 months in staphylococcus aureus and pseudomonas aeruginosa groups were over 47%. In proteus, enterococcus faecalis, and escherichia coli groups, the healing rates were lower than 40%, with amputation rate over 40%（all P〈0.05）. With the cardiac function grading over 3（NYHA）, severe lower extremity arterial disease, and HbA1C〉9% were found to be the main risk factors for amputation and ulcers healing（P〈0.05）.Conclusions Clinical characteristics of DFU patients infected with different kinds of bacteria were manifested significantly different. The foot conditions of DFU patients infected with proteus, enterococcus faecalis, and escherichia coli were relatively more

关 键 词：糖尿病足溃疡 细菌感染 创面愈合 截肢 

分 类 号：R587.2[医药卫生—内分泌]