初发糖尿病足溃疡患者足溃疡复发影响因素分析  

Risk factors for foot ulcer recurrence in diabetic patients with new-onset foot ulcers

作　　者：莫泽纬[1] 陈道雄[1] 高勇义[1] 全会标[1] 陈存仁[1] 王斐[1] 张华川[1] MO Zewei;CHEN Daoxiong;GAO Yongyi;QUAN Huibiao;CHEN Cunren;WANG Fei;ZHANG Huachuan(Department of Endocrinology,Hainan Provincial People＇ s Hospital,Haikou,Hainan 570311,China)

机构地区：[1]海南省人民医院内分泌科,海南海口570311

出　　处：《中国热带医学》2018年第7期716-719,共4页China Tropical Medicine

基　　金：海南省卫计委医学科研项目(No.15A200084)

摘　　要：目的探讨初发糖尿病足溃疡(diabetic foot ulcer,DFU)患者溃疡复发率和影响复发的高危因素。方法收集2011年1月—2015年12月住院的初发DFU患者227例的临床资料,对患者随访至2017年6月以获得DFU复发情况及分析影响复发高危预测因素。结果 189例(83.3%)完成随访,平均随访(3.736±1.391)年,中位随访时间3.570年。189例中85例(45.0%)溃疡复发,平均溃疡复发时间(2.738±1.545)年,中位溃疡复发时间2.370年。1年、3年、5年溃疡复发分别为29例、67例、82例。1年、3年、5年溃疡复发的发病密度分别为15.5%、39.4%和57.2%。溃疡复发组对比无复发组,年龄(≥60岁)、足底溃疡、周围血管病变、糖尿病周围神经病变所占比例升高,差异有统计学意义(P<0.05)。两组的男性、糖尿病病程(≥10年)、糖尿病足溃疡病程(≥1月)、吸烟、Hb A1c(≥7.5%)、Wagner分级(≥3级)、截肢、糖尿病肾病、糖尿病视网膜病变、体重指数(≥24 kg/m2)、高血压病、血脂异常所占比例差异无统计学意义(P>0.05)。年龄、溃疡部位、周围血管病变、糖尿病周围神经病变是溃疡复发预测因素。溃疡部位(HR=1.886,95.0%CI 1.204~2.955)、周围血管病变(HR=1.801,95.0%CI 1.083~2.995)、糖尿病周围神经病变(HR=2.903,95.0%CI 1.565~5.384)是溃疡复发的独立高危预测因素。结论糖尿病足溃疡远期复发率高,应对影响复发高危因素进行早期干预。Objective To investigate the recurrence rate and risk factors for foot ulcer recurrence in diabetic patients with new-onset foot ulcers. Methods A total of 227 patients admitted to Hainau Provincial People＇ s Hospital fi＇om January 2011 to December 2015 were enrolled into the study. The patients were followed up until June 2017, patients＇ data were collected to analyze the recurrence rate and predictive risk factors for foot ulcer recurrence. Results A total of 189 cases （83.3%） completed the follow-up, the average follow-up time was （3.736±1.391） years, the median follow-up time was 3.570 years. Of the 189 cases, 85 cases （45.0%） had recurrent foot ulcer. The average foot ulcer recurrent time was （2.738± 1.545） years, the median foot ulcer recurrent time was 2.370 years. 29 cases recurred within 1 year, 67 cases recurred within 3 year, 82 cases recurred within 5 year. The incidence denbetic of diabetic foot ulcer recurrence in 1, 3 and 5 years were 15.5%, 39.4% and 57.2% respectively. Compared with the group without foot ulcer recurrence, the proportion of age （≥60 years old）, plantar ulcer, peripheral vascular disease and diabetic peripheral neuropathy increased in the recurrent group （P 〈 0.05）. The proportions of men, diabetic duration （≥10 years）, diabetic foot ulcer duration （≥1 month）, smoking, HbAlc （≥7.5%）, Wagner classification （≥3 grade）, amputation, diabetic nephropathy, diabetic retinopathy, body mass index （≥24 kg/m2）, thypertension, dyslipidemia were no statistical significance between the two groups （P〉0.05）. Age, ulcer site, peripheral arterial disease and diabetic peripheral neuropathy were predictors of ulcer recurrence. Ulcer site （HR=1,886, 95.0% CI 1.204-2.955）, peripheral arterial disease （HR=1.801, 95.0% CI 1.083- 2.995） and diabetic peripheral neuropathy （HR=2.903, 95.0% CI 1.565-5.384） were independent predictive risk factors of ulcer recurrence. Conclusions The long-term recurrence rate of diabetic foot

关 键 词：糖尿病足溃疡 足溃疡复发 足底溃疡 糖尿病周围神经病变 周围血管病变 

分 类 号：R587.1[医药卫生—内分泌]