糖尿病足溃疡患者截肢的危险因素分析  

Analysis of risk factors for amputation in patients with diabetic foot ulcer

作　　者：王傑 查天建[1] 刘梦云 刘小龙[1] 姚俊杰 张健[1] Wang Jie;Zha Tianjian;Liu Mengyun;Liu Xiaolong;Yao Junjie;Zhang Jian(Department of Burn and Wound Repair,People′s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China;Department of Medical Education,Xinjiang 474 Hospital,Urumqi 830000,China)

机构地区：[1]新疆维吾尔自治区人民医院烧伤创面修复科,乌鲁木齐830000 [2]新疆四七四医院医教部,乌鲁木齐830000

出　　处：《中国医师杂志》2025年第3期402-407,共6页Journal of Chinese Physician

基　　金：新疆维吾尔自治区人民医院院内课题(20220224)。

摘　　要：目的了解糖尿病足溃疡(DFU)患者截肢的危险因素,以改善DFU患者的预后并降低截肢率。方法回顾性分析2017年1月—2021年8月新疆维吾尔自治区人民医院收治的359例DFU患者的临床资料,根据是否行截肢手术分为截肢组(161例)和非截肢组(198例)。收集两组患者的人口统计学特征、Wagner分级等数据。使用向前步进法logistic回归分析以确定截肢的独立危险因素,进一步使用受试者工作特征(ROC)曲线评价各危险因素对DFU患者截肢的预测价值。结果截肢组与非截肢组之间既往截肢手术史、外周血管疾病(PVD)、糖尿病足继发骨髓炎、糖尿病肾病(DN)、血管球囊成形手术史比例及Wanger分级、K^(+)、年龄、白细胞计数、C-反应蛋白、高密度脂蛋白胆固醇(HDL-C)、估算肾小球滤过率、心肌肌钙蛋白T、心肌肌钙蛋白I、乳酸差异有统计学意义(均P<0.05)。既往截肢手术史(OR=2.329,95%CI:1.092~4.970,P=0.029)、DN(OR=4.091,95%CI:2.222~7.532,P<0.001)、PVD(OR=2.556,95%CI:1.487~4.395,P=0.001)、糖尿病足继发骨髓炎(OR=6.332,95%CI:3.595~11.153,P<0.001)、Wagner分级均为DFU患者截肢的独立危险因素,HDL-C(OR=0.392,95%CI:0.182~0.842,P=0.016)则为DFU患者截肢的保护因素。且上述因素联合预测DFU患者截肢的准确率高,其ROC曲线下面积为0.839(95%CI:0.798~0.880),灵敏度为83%,特异度为73%(P<0.05)。结论既往截肢手术史、DN、PVD、糖尿病足继发骨髓炎、Wagner分级为DFU患者截肢的独立危险因素,而HDL-C为DFU患者截肢的保护因素。进一步调查研究将有助于建立糖尿病足风险预测分层系统,从而实现更好地个体化治疗。ObjectiveTo investigate the risk factors of amputation in patients with diabetic foot ulcer(DFU)in order to improve the prognosis and reduce the amputation rate.MethodsThe clinical data of 359 DFU patients admitted to the People′s Hospital of Xinjiang Uygur Autonomous Region from January 2017 to August 2021 were retrospectively analyzed,and they were divided into amputation group(161 cases)and non-amputation group(198 cases)according to whether amputation surgery was performed.Demographic characteristics,Wagner grading and other data of the two groups were collected.Forward step logistic regression analysis was used to identify independent risk factors for amputation,and receiver operating characteristic(ROC)curves were used to evaluate the predictive value of each risk factor for amputation in DFU patients.ResultsThere were significant differences between the amputation and non-amputation groups in terms of previous amputation history,peripheral vascular diseases(PVD),diabetic foot secondary osteomyelitis,diabetic nephropathy(DN),history of angioplasty,Wanger grade,K^(+),age,white blood cell count,C-reactive protein,high density lipoprotein cholesterol(HDL-C),estimated glomerular filtration rate,cardiac troponin T,and cardiac troponin I,lactic acid(all P<0.05).Previous amputation history(OR=2.329,95%CI:1.092-4.970,P=0.029),DN(OR=4.091,95%CI:2.222-7.532,P<0.001),PVD(OR=2.556,95%CI:1.487-4.395,P=0.001),diabetic foot secondary osteomyelitis(OR=6.332,95%CI:3.595-11.153,P<0.001),Wagner grade were independent risk factors for amputation in DFU patients,HDL-C(OR=0.392,95%CI:0.182-0.842,P=0.016)were protective factors for amputation in DFU patients.Moreover,the combined accuracy of the above factors in predicting amputation in DFU patients was high,and the area under ROC curve was 0.839(95%CI:0.798-0.880),sensitivity was 83%,and specificity was 73%(OR=0.05).ConclusionsPrevious amputation history,DN,PVD,diabetic foot secondary osteomyelitis and Wagner grade are independent risk factors for amputation in DFU patients,wh

关 键 词：糖尿病足 截肢术 危险因素 

分 类 号：R587.2[医药卫生—内分泌]