2型糖尿病合并下肢动脉病变患者再次截肢的危险因素分析及预测模型建立  

Risk factors and prediction model development for lower limb re-amputation in patients with type 2 diabetes-related lower extremity arterial disease

作　　者：张磊[1] 严疆豪 李新喜[1] 田野[1] 罗军[1] Zhang Lei;Yan Jianghao;Li Xinxi;Tian Ye;Luo Jun(Department of Vascular Thyroid Surgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,Xinjiang,China)

机构地区：[1]新疆医科大学第一附属医院血管甲状腺外科,新疆乌鲁木齐830054

出　　处：《中国血管外科杂志(电子版)》2025年第1期55-60,共6页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)合并下肢动脉病变(lower extremity arterial disease,LEAD)患者再次截肢的独立危险因素,并尝试建立LEAD合并T2DM再次截肢的预测模型。方法回顾性分析2018年1月至2022年12月新疆医科大学第一附属医院治疗的510例LEAD合并T2DM的病例,按是否再次截肢分成再次截肢组(99例)和单次截肢组(411例),将所有变量纳入二元Logistic回归分析,然后采用向后法筛选变量,建立预测模型。结果多因素Logistic回归分析发现,饮酒史[比值比(odds ratio,OR)=2.050,95%置信区间(confidence interval,CI)=1.034~3.952]、凝血酶原时间(OR=1.193,95%CI=1.084~1.335)、胆固醇(OR=1.262,95%CI=1.011~1.578)、外周动脉疾病史(OR=1.925,95%CI=1.101~3.501)、Wagner分级4~5级(OR=2.887,95%CI=1.332~6.168)是LEAD合并T2DM患者再次截肢的独立危险因素。创建的列线图预测模型受试者工作特征曲线的曲线下面积为0.708(95%CI=0.648~0.768),特异度为74.9%,灵敏度为58.6%,内部验证的C指数为0.707,Brier评分为0.137。结论饮酒史、凝血酶原时间、胆固醇、外周动脉疾病、Wagner分级4~5级是LEAD合并T2DM患者再次截肢的独立危险因素。基于本研究建立的LEAD合并T2DM再次截肢风险预测列线图模型具有较好的区分度和校准度。Objective To explore the independent risk factors for re-amputation in patients with type 2 diabetes mellitus(T2DM)complicated with lower extremity arterial disease(LEAD),and to establish a prediction model for re-amputation in patients with LEAD and T2DM.Methods 510 cases of LEAD complicated with T2DM treated in the First Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2022 were analyzed retrospectively.The patients were divided into re-amputation group(99 cases)and single amputation group(411 cases)according to whether they had re-amputation.All variables were included in binary logistic regression analysis,and the backward method was used to screen variables and establish a prediction model.Results Multivariate logistic regression analysis showed that alcohol consumption history[odds ratio(OR)=2.050,95%confidence interval(CI)=1.034-3.952],prothrombin time(OR=1.193,95%CI=1.084-1.335),cholesterol(OR=1.262,95%CI=1.011-1.578),history of peripheral arterial disease(OR=1.925,95%CI=1.101-3.501),and Wagner grade 4 and 5(OR=2.887,95%CI=1.332-6.168)were the independent risk factors for re-amputation in patients with LEAD and T2DM.The area under the receiver operating characteristic curve of nomogram model was 0.708(95%CI=0.648-0.768),the specificity was 74.9%,and the sensitivity was 58.6%.The internal validation C-index of the model was 0.707,and the Brier score was 0.137.Conclusion Alcohol consumption history,prothrombin time,cholesterol,peripheral arterial disease history and Wagner grade 4-5 are the independent risk factors for reamputation in patients with LEAD and T2DM.The nomogram model for predicting the risk of re-amputation in patients with LEAD and T2DM established in this study has good discrimination and calibration.

关 键 词：外周动脉疾病 糖尿病 截肢 危险因素 列线图 预测模型 

分 类 号：R587.2[医药卫生—内分泌]