糖尿病足患者溃疡愈合后5年复发和死亡的随访结果及其危险因素分析  

Five-year follow-up analysis of recurrence and death after ulcer healing in patients with diabetic foot

作　　者：王美君 许洪梅 葛甜甜[1] 邢秋玲[3] 宋振强[1] 丁敏[1] Wang Meijun;Xu Hongmei;Ge Tiantian;Xing Qiuling;Song Zhenqiang;Ding Min(National Health Commission Key Laboratory of Hormones and Development,Tianjin Key Laboratory of Metabolic Diseases,Department of Podiatry,Diabetic Foot Treatment Centre,Chu Hsien-I Memorial Hospital&Tianjin Institute of Endocrinology,Tianjin Medical University,Tianjin 300134,China;National Health Commission Key Laboratory of Hormones and Development,Tianjin Key Laboratory of Metabolic Diseases,Department of Nursing,Chu Hsien-I Memorial Hospital&Tianjin Institute of Endocrinology,Tianjin Medical University,Tianjin 300134,China;National Health Commission Key Laboratory of Hormones and Development,Tianjin Key Laboratory of Metabolic Diseases,Department of Medical Record Statistics,Chu Hsien-I Memorial Hospital&Tianjin Institute of Endocrinology,Tianjin Medical University,Tianjin 300134,China)

机构地区：[1]天津医科大学朱宪彝纪念医院足病科糖尿病足诊疗中心天津市内分泌研究所国家卫健委激素与发育重点实验室天津市代谢性疾病重点实验室,300134 [2]天津医科大学朱宪彝纪念医院护理部天津市内分泌研究所国家卫健委激素与发育重点实验室天津市代谢性疾病重点实验室,300134 [3]天津医科大学朱宪彝纪念医院病案统计科天津市内分泌研究所国家卫健委激素与发育重点实验室天津市代谢性疾病重点实验室,300134

出　　处：《中华糖尿病杂志》2021年第3期227-232,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：天津市教委科研计划项目 (2018KJ047)。

摘　　要：目的探讨糖尿病足患者溃疡愈合后5年复发和死亡结局,并对其危险因素进行分析。方法采用前瞻性队列研究的方法,选择2013年1月至2014年12月在天津医科大学朱宪彝纪念医院足病科住院的糖尿病足溃疡愈合的317例患者为研究对象,随访5年后记录患者足溃疡复发和死亡的情况,并分别采用二元logistic回归法和Cox比例风险回归模型进行危险因素分析。结果317例患者中完成随访者292例,随访率92.1%。随访患者5年累计复发率为71.2%(208/292)。5年间同一部位复发率29.8%(62/208),多次复发率41.3%(86/208),前足部位的复发率最高为32.7%(68/208),具有骨髓炎的122例患者中溃疡复发率为73.8%(90/122)。5年累计死亡率为39.7%(116/292),复发患者的死亡率高于未复发患者[分别为44.2%(92/208)和28.6%(24/84)],差异具有统计学意义(P<0.05)。多因素logistic回归分析结果显示:年龄、骨髓炎、足部护理行为、照顾者反应、糖化血红蛋白、下肢动脉粥样硬化性病变(LEAD)分期、终末期肾病为糖尿病足患者溃疡复发的独立影响因素(P<0.05)。Bathel指数、照顾者反应、糖化血红蛋白、LEAD分期、终末期肾病、心脏事件为死亡的独立影响因素(P<0.05)。结论糖尿病足溃疡复发的危险因素主要是年龄、骨髓炎、足部护理行为;患者死亡的危险因素是Bathel指数、心脏事件;照顾者反应、糖化血红蛋白、LEADⅣ期、肾病5期同时是患者溃疡复发和死亡的危险因素。Objective To explore the recurrence and death outcomes of the patients with diabetic foot for 5 year follow-up after ulcer healing,and analyze the risk factors.Methods A prospective cohort study was conducted in 317 patients with diabetic foot and ulcer healing who were hospitalized in the Department of Diabetic Foot Disease of Tianjin Medical University Chu Hsien-I Memorial Hospital from January 2013 to December 2014.The ulcer recurrence and death of patients after 5 years of continuous follow-up were recorded,and binary logistic regression and Cox proportional hazard regression models were used to analyze risk factors,respectively.Results Follow-up was completed in 292 of 317 patients(follow-up rate of 92.1%).The 5-year cumulative recurrence rate in follow-up patients was 71.2%(208/292),the recurrence rate of the same site was 29.8%(62/208),multiple recurrence rate was 41.3%(86/208),the highest recurrence rate was 32.7%in the forefoot area(68/208),and the ulcer recurrence rate of the 122 patients with osteomyelitis was 73.8%(90/122).The cumulative five-year mortality rate was 39.7%(116/292).The mortality rate of patients with recurrence was higher than that of patients without recurrence[44.2%(92/208)vs 28.6%(24/84),P<0.05].Multivariate analysis showed that age,osteomyelitis,foot care behavior,caregiver reaction,glycated hemoglobin A1c,limb extremity arterial disease(LEAD)stage,and end-stage renal disease were independent influencing factors for ulcer recurrence in patients with diabetic foot(P<0.05).Bathel index,caregiver reaction,glycated hemoglobin A1c,LEAD stage,end-stage renal disease,and cardiac events were independent influencing factors of death(P<0.05).Conclusions The risk factors of ulcer recurrence are mainly age,osteomyelitis and foot care behavior.The risk factors for death are Bathel index and cardiac events.Moreover,caregiver reaction,glycated hemoglobin A1c,LEAD stageⅣ,kidney disease stage 5 are the risk factors of both ulcer recurrence and death.

关 键 词：糖尿病足 溃疡 愈合 复发 死亡 

分 类 号：R587.2[医药卫生—内分泌]