肾功能状态与糖尿病足溃疡患者预后的关系  

Association between renal function and prognosis in patients with diabetic foot ulcer

作　　者：童涛 传丰宁 何小群[2] 程庆丰[2] 刘智萍[2] 周波[2] Tong Tao;Chuan Fengning;He Xiaoqun;Cheng Qingfeng;Liu Zhiping;Zhou Bo(Department of Endocrinology,The First People's Hospital of Xiangyang,Affiliated to Hubei University of Medicine;Department of Endocrinology,The First Affiliated Hospital of Chongqing Medical University)

机构地区：[1]湖北医药学院附属襄阳市第一人民医院内分泌科,襄阳441000 [2]重庆医科大学附属第一医院内分泌科,重庆400016

出　　处：《重庆医科大学学报》2020年第3期399-404,共6页Journal of Chongqing Medical University

基　　金：国家自然科学基金资助项目(编号:81370940)。

摘　　要：目的:探究糖尿病足溃疡(diabetic foot ulcer,DFU)患者不同肾功能状态的临床特点及与预后的关系。方法:回顾性分析409例DFU患者。根据估算肾小球滤过率(estimated glomerular filtration rate,eGFR)分为3组:肾功能正常组、肾功能轻度受损组及肾功能中重度受损组,比较各组临床特征、社会经济学状况、自我管理及预后;回归分析探讨肾功能状态与预后的关系。结果:与肾功能正常组相比,肾功能受损组患者年龄更大、糖尿病病程更长、自我管理更好、合并更多的大血管及微血管病变、有更低的血红蛋白及白蛋白水平,且到中重度肾功能受损时患者发生不良结局的比例更高(43.7%vs.26.8%,χ^2=8.567,P=0.003)、死亡率更高(26.1%vs.8.3%,χ^2=16.587,P=0.001)。单因素分析显示,eGFR与不良结局显著相关(OR=1.462,95%CI=1.132~1.874,P=0.004)。进一步在不同年龄段人群进行回归分析显示,在老年患者中,随着eGFR的下降,DFU患者预后越差(OR=1.614,95%CI=1.021~2.571,P=0.040),中青年患者中未见这一显著性关系。结论:随着肾功能的恶化,DFU患者更不易愈合、死亡率更高,尤其以老年患者为甚。Objective:To investigate the clinical characteristics of patients with diabetic foot ulcers(DFUs)in different status of renal function,and to explore the association between renal function and prognosis.Methods:A total of 409 patients with DFUs were retrospectively analyzed.According to estimated glomerular filtration rate(eGFR),the patients were divided into three groups:normal renal function group,mild renal dysfunction group,and moderate to severe renal dysfunction group.The clinical characteristics,socio-economic status,self-management,and prognosis were compared between the three groups.A regression analysis was used to investigate the association between renal function and prognosis of patients.Results:Compared with the normal renal function group,the renal dysfunction groups had older age of patients,longer duration of diabetes,better self-management,more microangiopathy and macroangiopathy,and lower levels of haemoglobin and serum albumin.Moreover,the patients with moderate to severe renal dysfunction had a significantly higher proportion of individuals wtih adverse outcomes(43.7%vs.26.8%,χ^2=8.567,P=0.003)and a significantly higher mortality rate(26.1%vs.8.3%,χ^2=16.587,P=0.001).Univariate analysis showed a significant association between eGFR and adverse outcomes(OR=1.462,95%CI=1.132-1.874,P=0.004).Further regression analysis conducted in different age groups showed that the decline in eGFR was associated with poorer outcomes of DFUs in elderly patients(OR=1.614,95%CI=1.021-2.571,P=0.040),but not in young and middle-aged patients.Conclusion:Patients with DFUs have longer ulcer healing time and high mortality rate with the deterioration of renal function,especially in elderly patients.

关 键 词：糖尿病足溃疡 肾功能 预后 

分 类 号：R587.2[医药卫生—内分泌]