糖尿病足患者截肢相关危险因素分析  

Risk factors for amputation in patients with diabetic foot

作　　者：童涛 田欣 杨文健 周兴建 程庆丰[2] 周波[2] TONG Tao;TIAN Xin;YANG Wenjian;ZHOU Xingjian;CHENG Qingfeng;ZHOU Bo(Department of Endocrinology,Xiangyang First People′s Hospital Affiliated to Hubei University of Medicine,Xiangyang,Hubei 441000,China;Department of Endocrinology,the First Hospital Affiliated to Chongqing Medical University,Chongqing 441000,China)

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,441000 [2]重庆医科大学附属第一医院内分泌科,400016

出　　处：《重庆医学》2020年第23期3889-3892,3896,共5页Chongqing medicine

基　　金：国家自然科学基金项目(81370940)。

摘　　要：目的探讨糖尿病足(DF)患者截肢的危险因素。方法回顾性分析2015年1月至2019年3月于重庆医科大学附属第一医院住院的391例DF患者临床资料,按照住院期间是否截肢分为截肢组及非截肢组,比较两组一般资料、实验室检查、糖尿病并发症及合并症、足溃疡的特征及治疗等方面的差异,多因素回归分析DF患者截肢的相关危险因素。结果截肢组患者较非截肢组患者年龄更大、白细胞总数更高、感染程度更重,独居、合并有外周动脉疾病、深溃疡、Wagner≥3级、清创、使用2种及以上的抗生素、下肢血运重建的比例更多,但有更低的清蛋白水平。多因素logistic回归分析显示Wagner分级(OR=1.813,95%CI:1.115~2.847,P=0.010)、外周动脉疾病(OR=5.681,95%CI:2.801~11.524,P=0.001)、感染(OR=2.881,95%CI:1.088~3.449,P=0.025)及独居(OR=4.924,95%CI:1.700~14.262,P=0.003)是DF患者截肢的独立危险因素。结论Wagner分级、下肢血供较差、严重的感染及独居与DF患者截肢密切相关,临床医师应早期识别并进行干预。Objective To explore the risk factors for amputation in patients with diabetic foot(DF).Methods A total of 391 DF patients in the hospital from January 2015 to March 2019 were retrospective analyzed.The patients were assigned to either the amputation group or non-amputation group according to whether amputation occurred during hospitalization.The general information,laboratory tests,comorbidities and complications associated with diabetes,ulcer characteristics and its intervention were compared between the two groups.Multivariable logistic regression analysis was performed to assess the association between the risk factors associated with amputation.Results Compared with the non-amputation group,the patients with amputation were likely to be older,higher level of white blood cell more serions degree of infection.Moreover,the proportion of alone-living,peripheral arterial disease,deeper ulcer,Wagner grade≥3,debridement,the use of 2 or more antibiotics and lower limb revascularization was more common,but albumin level was lower.Furthermore,multivariable logistic regression analysis showed that Wagner′s grade(OR=1.813,95%CI:1.115-2.847;P=0.010),peripheral artery disease(OR=5.681,95%CI:2.801-11.524;P<0.001),infection(OR=2.881,95%CI:1.088-3.449;P=0.025)and living alone(OR=4.924,95%CI:1.700-14.262;P=0.003)were independent risk factors for amputation in patients with diabetic foot.Conclusion Wagner grade,severe ischemia of lower limbs,serious infection and living alone are closely associated with amputation of DF patients,so clinicians should pay attention and intervene.

关 键 词：糖尿病足 截肢术 危险因素 感染 独居 

分 类 号：R587.2[医药卫生—内分泌]