糖尿病足患者大截肢的影响因素分析  

Analysis of influencing factors of major amputation in patients with diabetic foot

作　　者：程国鹏 梁桂花 刘国庆[2] 侯文谭 韩君铭 陈青[1] 王默 李秋 Cheng Guopeng;Liang Guihua;Liu Guoqing;Hou Wentan;Han Junming;Chen Qing;Wang Mo;Li Qiu(Department of Endocrinology and Metabolism,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging(Shandong First Medical University),Ministry of Education,Jinan 250021,China;Department of Endocrinology and Metabolism,Shengli Oilfield Central Hospital,Dongying 257034,China;Department of Vascular Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Department of Endocrinology and Metabolism,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging(Shandong First Medical University),Ministry of Education,Shandong Clinical Research Center of Diabetes and Metabolic Diseases,Shandong Institute of Endocrine and Metabolic Diseases,“Innovation China”Innovation Base of Stem Cell and Gene Therapy for Endocrine Metabolic Diseases,Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases,Jinan 250021,China)

机构地区：[1]山东第一医科大学附属省立医院内分泌代谢病科,内分泌糖脂代谢与脑老化教育部重点实验室,济南250021 [2]胜利油田中心医院内分泌代谢病科,东营257034 [3]山东第一医科大学附属省立医院血管外科,济南250021 [4]山东第一医科大学附属省立医院内分泌代谢病科,内分泌糖脂代谢与脑老化教育部重点实验室,山东省糖尿病与代谢疾病临床医学研究中心,山东省内分泌与代谢病研究所“科创中国”内分泌代谢性疾病干细胞与基因治疗创新基地,山东省内分泌与代谢性疾病防治工程实验室,济南250021

出　　处：《中华糖尿病杂志》2024年第9期1020-1028,共9页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金(81541023);山东省自然科学基金(ZR2023ZD28);代谢性血管疾病四川省重点实验室2023年开放课题(2023MVDKL-K1)。

摘　　要：目的探讨糖尿病足患者大截肢的影响因素。方法为横断面研究。选取2012年1月1日至2020年12月31日于山东省立医院住院的糖尿病足患者为研究对象,收集研究对象性别、白蛋白、血红蛋白、足部溃疡发生部位(足背、足趾、足底、足踝、足跟)、外周动脉疾病(PAD)评分、TEXAS分级结果。根据住院的时间段将糖尿病足患者分为2012—2014年组、2015—2017年组、2018—2020年组。采用二元logistic回归分析法分析糖尿病足患者的影响因素。结果共纳入糖尿病足患者1767例,其中男性1120例,女性647例。二元logistic回归分析结果显示,白蛋白(OR=0.855,95%CI 0.834~0.940,P<0.001)、血红蛋白(OR=0.980,95%CI 0.966~0.993,P=0.004)、PAD评分(OR=1.649,95%CI 1.489~1.826,P<0.001)、足背部位发生溃疡(OR=2.678,95%CI 1.290~5.559,P=0.008)、TEXAS分级(OR=1.649,95%CI 1.122~2.424,P=0.011)均是糖尿病患者发生大截肢的影响因素。2012—2014年组结果显示,白蛋白(OR=0.777,95%CI 0.628~0.962,P=0.021)、足踝部位发生溃疡(OR=52.339,95%CI 1.978~1384.918,P=0.018)、PAD评分(OR=1.703,95%CI 1.157~2.506,P=0.007)均是糖尿病足患者大截肢的影响因素。2015—2017年组结果显示,白蛋白(OR=0.855,95%CI 0.776~0.941,P=0.001)、血红蛋白(OR=0.965,95%CI 0.944~0.987,P=0.002)、PAD评分(OR=1.475,95%CI 1.270~1.713,P<0.001)、TEXAS分级(OR=1.727,95%CI 1.042~2.864,P=0.034)均是糖尿病足患者大截肢的影响因素。2018—2020年组结果显示,白蛋白(OR=0.888,95%CI 0.806~0.979,P=0.017)、血红蛋白(OR=0.974,95%CI 0.949~0.999,P=0.043)、白细胞(OR=1.153,95%CI 1.035~1.283,P=0.010)、PAD评分(OR=2.142,95%CI 1.747~2.627,P<0.001)、足底部位发生溃疡(OR=3.317,95%CI 1.041~9.448,P=0.042)均是糖尿病足患者大截肢的影响因素。结论白蛋白、血红蛋白、PAD评分、TEXAS分级是糖尿病足大截肢的影响因素。随着时间变化,PAD评分在大截肢影响因素中的比重先降低后升高,但总体呈增高趋势。白蛋�Objective To investigate the influencing factors of major amputation in patients with diabetes foot.Methods This was a cross-sectional study.Patients with diabetic foot who were hospitalized in Shandong Provincial Hospital from January 1,2012 to December 31,2020 were selected as the study subjects.Sex,albumin,hemoglobin,site of foot ulcer(dorsum of foot,toe,sole,ankle,heel),peripheral artery disease(PAD)score and TEXAS scale results were collected.According to the period of hospitalization,diabetic foot patients were divided into 2012-2014 group,2015-2017 group and 2018-2020 group.The influencing factors of diabetic foot patients were analyzed by binary logistic regression analysis.Results A total of 1767 patients with diabetic foot were included,including 1120 males and 647 females.Binary logistic regression analysis showed that albumin(OR=0.855,95%CI 0.834-0.940,P<0.001),hemoglobin(OR=0.980,95%CI 0.966-0.993,P=0.004)and PAD score(OR=1.649,95%CI 1.489-1.826,P<0.001),ulceration occurred in the dorsal part of the foot(OR=2.678,95%CI 1.290-5.559,P=0.008),TEXAS grade(OR=1.649,95%CI 1.122-2.424,P=0.011)were influencing factors of major amputation.The results of the 2012-2014 group showed that albumin(OR=0.777,95%CI 0.628-0.962,P=0.021),foot and ankle ulcer(OR=52.339,95%CI 1.978-1384.918,P=0.018),PAD score(OR=1.703,95%CI 1.157-2.506,P=0.007)were the influencing factors of major amputation in diabetic foot patients.The results of the 2015-2017 group showed that albumin(OR=0.855,95%CI 0.776-0.941,P=0.001),hemoglobin(OR=0.965,95%CI 0.944-0.987,P=0.002)and PAD scores(OR=1.475,95%CI 1.270-1.713,P<0.001),TEXAS grade(OR=1.727,95%CI 1.042-2.864,P=0.034)were the influential factors for major amputation in diabetic foot patients.The results of the 2018-2020 group showed that albumin(OR=0.888,95%CI 0.806-0.979,P=0.017),hemoglobin(OR=0.974,95%CI 0.949-0.999,P=0.043),white blood cells(OR=1.153,95%CI 1.035-1.283,P=0.010),PAD score(OR=2.142,95%CI 1.747-2.627,P<0.001),plantar ulcer(OR=3.317,95%CI 1.041-9.448,P=0.042)were influential

关 键 词：糖尿病足 截肢 大截肢 影响因素 

分 类 号：R587.2[医药卫生—内分泌]