常见不同细菌感染对糖尿病足溃疡患者预后影响的三年随访分析  

Effects of common bacterial infections in patients with diabetic foot ulcer on long-term outcome-3 years follow-up

作　　者：张杉杉[1] 王淑敏[2] 何泱[2] 许蕾[2] 钱泓洁[2] 顾雪明[2] 汤正义[2] Zhang Shanshan;Wang Shumin;He Yang;Xu Lei;Qian Hongjie;Gu Xueming;Tang Zhengyi(Department of Endocrine and Metabolic Diseases, Shengli Oilfield Central Hospital, Dongying 257034, China;Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Yuanyang Subdivision for Diabetic Foot Disease. Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China)

机构地区：[1]胜利油田中心医院内分泌科,东营257034 [2]上海交通大学医学院附属瑞金医院内分泌代谢病科,上海市内分泌代谢病临床医学中心糖尿病足分中心,200025

出　　处：《中华内分泌代谢杂志》2019年第8期678-684,共7页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的观察常见不同细菌感染对DFU患者病情及3年内预后的影响。方法在细菌培养阳性的DFU病例中,筛选单一感染常见的6个菌种共计203例、混合感染62例患者,进行入组病情分析和随访3年预后指标。根据愈合、复发、截肢、心脏事件、脑血管事件、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。结果单一与混合感染组比较,基线病情及随访过程中心脑血管事件、死亡等无显著差别。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、大肠埃希菌、肺炎克雷伯菌;各组间基线临床指标及复发、心脑血管事件、死亡无显著差异。金黄色葡萄球菌感染患者严重下肢动脉病变(8.5%)、Wagner 3级及以上(48.9%)、中重度感染比例(34.0%)显著低于其他组别,愈合率(93.6%)高于其他组别(均P<0.05)。严重下肢动脉病变、心功能3级以上、eGFR<60 ml·min^-1·(1.73 m2)^-1、DFU病程大于30天是愈合的主要危险因素;Wagner 3级及以上是小截肢的主要危险因素;严重下肢动脉病变、血红蛋白小于90 g/L是大截肢的主要危险因素;心功能3级以上是心脏事件的主要危险因素;心功能3级以上、白蛋白小于30 g/L是死亡的主要危险因素(均P<0.05)。结论不同细菌感染的DFU足部病情及足溃疡愈合率有差别,心脑血管事件、死亡无显著差异。Objective Most common infected bacteria were found to analyze their effects on clinical characteristics and 3-year outcome of patients with diabetic foot ulcer (DFU). Methods Materials of cases with positive bacterial culture were selected from DFU patients. 203 cases were infected with the most common 6 strains of mono-bacteria, and 62 cases were infected with multi-bacteria. Data were grouped according to the most common 6 infected bacteria. The outcomes of healing, recurrence, amputation, cardiac events, cerebrovascular events and death were calculated of 3 years after hospitalization. Clinical characteristics of mono- and multi-infected groups and these 6 mono-bacterial infection groups, and risk factors to outcome were analyzed. Results No significant difference was found in baseline clinical characteristics, cardiac and cerebrovascular events, and death during follow-up between mono- and multi-infected groups. The most common 6 infected bacteria were staphylococcus aureus, pseudomonas aeruginosa, proteus, enterococcus faecalis, escherichia coli and klebsiella pneumoniae. Among these groups, there were no significant differences of baseline clinical characteristics and recurrence, cardiac and cerebrovascular events, and death except for the foot ulcer and foot ulcer related prognosis. In staphylococcus aureus infected group, severe lower extremity arterial disease (8.5%), Wagner grade 3-5 (48.9%), moderate and severe infection rate (34.0%) were significantly lower than other groups, and the healing rate (93.6%) was higher than other groups (all P<0.05). Severe lower extremity arterial disease, cardiac function grading over 3(NYHA), eGFR<60 ml·min^-1·(1.73 m2)^-1, duration of DFU over 30 days were the main risk factors for ulcers′ healing. Wagner grade over 3 was main risk factor for minor amputation. Severe lower extremity arterial disease, Hb<90g/L were the main risk factors for major amputation. Cardiac function grading over 3(NYHA) was main risk factor for cardiac events, and also for death. ALB<30 g/

关 键 词：糖尿病足溃疡 细菌感染 创面愈合 心脑血管事件 死亡 

分 类 号：R587.2[医药卫生—内分泌]