老年糖尿病足截肢及死亡危险因素分析  

Study of risk factors for amputation and death in elderly diabetic foot

作　　者：袁晓勇[1] 陆迪菲 齐心[2] 刘林[1] 刘瑾[2] 袁戈恒[1] 刘彦君 杨金奎[4] 布秀君 王迎菊 李玉凤[7] 邓微[8] 鞠上[9] 丁明超[10] 张俊清[1] 郭晓蕙[1] YUAN Xiaoyong;LU Difei;QI Xin;GUO Xiaohui(Department of Endocrinology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院内分泌科,100034 [2]北京大学第一医院烧伤整形科 [3]解放军第三〇六医院内分泌科 [4]首都医科大学附属北京同仁医院内分泌科 [5]北京市丰台区医院内分泌科 [6]北京市密云区医院内分泌科 [7]北京市平谷区医院内分泌科 [8]北京积水潭医院内分泌科 [9]北京中医药大学东直门医院周围血管科 [10]航天中心医院外周血管介入科

出　　处：《中国糖尿病杂志》2020年第9期657-662,共6页Chinese Journal of Diabetes

基　　金：北京市科委“糖尿病特定人群诊疗规范和临床路径研究”(D141107005314003)。

摘　　要：目的分析北京地区住院老年糖尿病足(DF)特点,探讨影响其预后的因素。方法选取2010年1月至2014年12月于北京9家医院住院的DF患者1646例,对符合纳入标准的907例进行统计,分析患病特点、实验室生化指标、死亡及截肢的影响因素。结果 907例DF患者中,≥65岁老年患者489例(53.9%),男289例,女200例,平均年龄(75.18±6.27)岁,平均DM病程(14.6±8.33)年,HbA1c(8.36±3.38)%,截肢99例(20.2%),死亡率12例(2.5%),住院时间22(14,30)d,住院费用22100(12431,40968)元。与<65岁患者比较,≥65岁老年患者DM病程、冠心病、脑血管病发病率及住院费用升高,吸烟率、红细胞计数、TG、FPG、HbA1c降低(P<0.01)。Logistics回归分析显示,年龄、血尿酸、HDL-C是截肢的影响因素,白细胞计数是死亡的独立危险因素。结论 DF老年患者占比大,DM病程长,合并疾病多,治疗难度大、住院费用高。与其他患者不同,老年患者截肢的危险因素为低HDL-C、营养状态差,死亡的危险因素为严重感染。Objective To investigate the characteristics of diabetic foot(DF)in hospitalized elderly patients in Beijing,and to study the prognosis factors of DF in elderly patients.2010 to December,2014,1646 DF cases from nine hospitals in Beijing were reviewed,907 cases were included according to the standards.Patients older than 65 years were called elderly.The disease characteristics,laboratory tests,the influence factors of amputation and death were analyzed.Results Among the 907 DF cases,elderly patients accounted for 53.9%(489).The mean age of the elderly patients was(75.18±6.27)years old,and the proportion of male and female was 289/200.Of the elders,the mean diabetic duration was(14.6±8.33)years,HbA1c(8.36±3.38)%,the amputation rate 20.2%(99),the mortality rate 2.5%(12),the length of hospitalization 22(14,30)days,and the hospitalization cost 22100(12431,40968)yuan.Compared with young patients,elderly patients had longer diabetic duration,more concomitant diseases(coronary heart disease and cerebrovascular disease),higher hospitalization cost,and lower smoking rate.RBC,TG,FPG(fasting plasma glucose)and HbA1c were lower in aged patients.In elderly diabetic foot,age,UA and HDL-C were influence factors for amputation according to logistic regression,while WBC was independent risk factors for death.Because of longer diabetic duration and more complicated diseases,therapy for elderly DF is more difficult and expensive.Different from those of young patients,the risk factors for amputation of elderly DF were low HDL-C and poor nutritional status,while that for death was severe infection.

关 键 词：老年 糖尿病足 死亡 截肢 危险因素 

分 类 号：R687.5[医药卫生—骨科学] R587.2[医药卫生—外科学]