血清25羟维生素D_(3)水平与糖尿病足创面愈合相关性的巢式病例对照研究  

The Correlation between Serum 25(OH)D_(3) Levels and Diabetic Foot Wound Healing:a Nested Case-control Study

作　　者：武云凤 骆燕洪 蒋平南 吴旻 杨嘉 阳琰 陈霞 蔡玉兰 WU Yunfeng;LUO Yanhong;JIANG Pingnan;WU Min;YANG Jia;YANG Yan;CHEN Xia;CAI Yulan(Department of Endocrinology,the Second Affiliated Hospital of Zunyi Medical University,Zunyi 563006,China;Department of Endocrinology and Metabolism,Affiliated Hospital of Zunyi Medical University,Zunyi 563099,China;Department of Endocrinology,Kweichow Moutai Hospital,Zunyi 550002,China)

机构地区：[1]遵义医科大学第二附属医院内分泌科,贵州省遵义市563006 [2]遵义医科大学附属医院内分泌与代谢病科,贵州省遵义市563099 [3]贵州茅台医院内分泌科,贵州省遵义市550002

出　　处：《中国全科医学》2024年第15期1811-1816,共6页Chinese General Practice

基　　金：国家自然科学基金资助项目(82260167,82060159);贵州省科技计划项目(黔科合基础-ZK[2022]一般639);遵义市科技计划项目(遵市科合HZ字[2022]279号);遵义医科大学附属医院博士科研启动资金[院字(2021)6号];遵义市联合基金项目[遵市科合HZ字(2022)332号]。

摘　　要：背景糖尿病足(DF)是糖尿病患者严重的慢性并发症之一。我国糖尿病患者DF发病率高达15%,预后不佳,年截肢率高达22%,年死亡率高达11%,医疗费用高,极大地降低了患者的生活质量和预期寿命。维生素D在DF创面愈合中可能发挥积极作用,但目前尚缺乏足够的临床研究来证实这一效应。目的探索血清25羟维生素(OH)D_(3)[25(OH)D_(3)]与DF创面愈合的相关性。方法采用巢式病例对照研究方法,选择2020—2021年在遵义医科大学附属医院住院治疗的Wagner分级2~4级的DF患者为研究对象。患者出院后随访3个月,将DF创面仍未愈合者55例作为病例组。根据病例组患者的年龄、性别和Wagner分级进行1∶2匹配,获得DF创面在出院后3个月内愈合者110例作为对照组。患者在入院后,补充维生素D治疗前,抽取静脉血2 mL,用于检测血清25(OH)D_(3)水平。收集患者详细基线资料、生化及影像学指标:基本资料包括一般人口学特征(年龄、性别、居住地、受教育程度)、BMI、糖尿病病程及家族史、住院时间、生活习惯(饮酒、吸烟情况)、高血压病史及Wagner分级;生化指标包括25(OH)D_(3)、糖化血红蛋白(HbA1c)、红细胞沉降率(ESR)、C反应蛋白(CRP);行核磁共振检查确定患者是否合并骨髓炎。采用Logistic回归分析探讨不同25(OH)D_(3)水平与DF创面愈合的关系。结果病例组患者的糖尿病病程较对照组长(P<0.001),有糖尿病家族史比例低于对照组(P=0.046),血清25(OH)D_(3)水平低于对照组(P<0.001);病例组和对照组患者吸烟情况比较,差异有统计学意义(P<0.001)。两组患者的年龄、性别、居住地、BMI、住院时间、受教育程度、饮酒情况、有高血压病史比例、Wagner分级、骨髓炎发生率、HbA1c、ESR、CRP比较,差异均无统计学意义(P>0.05)。在校正了年龄、性别、居住地、受教育程度、BMI、饮酒情况、吸烟情况、高血压病史、糖尿病家族史、�Background Diabetic foot(DF)is one of the most serious chronic complications in patients with diabetes.There is an incidence of DF of 15%in China,with a poor prognosis,an amputation rate of 22%,and a mortality rate of 11%,which greatly reduces the quality of life and life expectancy of patients with DF.DF wound healing may benefit from vitamin D,however,sufficient clinical studies are lacking to confirm this claim.Objective To explore the correlation between serum 25(OH)D_(3) and DF wound healing.Methods A nested case-control study method was used to select DF patients with Wagner grading 2-4 who were hospitalized in the Affiliated Hospital of Zunyi Medical University from 2020 to 2021.The patients were discharged from the hospital and followed up for 3 months,and 55 patients whose DF wounds still had not healed were selected as the case group.As the control group,110 patients whose DF wounds healed within 3 months of discharge were matched 1∶2 according to their age,gender,and Wagner grade with the patients in the case group.In the early stages of treatment,2 mL of venous blood was obtained and serum 25(OH)D_(3) levels were determined before vitamin D supplementation.Detailed basic data,biochemical and imaging indices of the patients were collected,including general demographics(age,gender,place of residence,education),BMI,diabetes duration and family history,hospitalization duration,lifestyle habits(alcohol consumption,smoking status),history of hypertension and Wagner classification.The biochemical parameters included 25(OH)D_(3),glycosylated hemoglobin(HbA1c),erythrocyte sedimentation rate(ESR),and C-reactive protein(CRP).An MRI was performed to determine if the patient had osteomyelitis.Logistic regression was used to analyze the relationship between different 25(OH)D_(3) levels and DF wound healing.Results The duration of diabetes in the case group was longer than that in the control group(P<0.001),the proportion of patients with a family history of diabetes was less than that in the control group(P=0.046

关 键 词：25羟维生素D_(3) 糖尿病足 伤口愈合 配对病例对照研究 

分 类 号：R344.8[医药卫生—基础医学]