284例糖尿病足患者的临床分析
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Clinical Analysis of 284 Diabetic Foot Cases
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    摘要:

    目的 了解糖尿病足发生的诱因、危险因素、影响病情严重程度以及截趾/肢预后的因素。方法 对2006年1月至2010年12月在内分泌科住院、符合纳入标准的284例糖尿病足患者的病例资料进行回顾性分析,用二分类Logistic回归分析确定发生重型糖尿病足和截趾/肢的危险因素。结果 284例糖尿病足患者中,男性175例,女性109例,82.4%的患者年龄>50岁,77.5%的患者糖尿病病程在5年以上,86.5%的患者糖化血红蛋白(HbA1c)>6.5%。糖尿病足溃疡好发于足趾,烧/烫伤是最常见诱因,足溃疡分泌物细菌培养阳性率高达94.8%,多并发糖尿病肾病和糖尿病视网膜病变。Wagner 3~5级(重型)患者血清白蛋白(ALB)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)、红细胞计数和血红蛋白(Hb)均低于Wagner 0~2级(轻型)患者(P<0.05),而其白细胞计数和血小板计数均高于轻型患者(P<0.05),重型患者更容易发生糖尿病酮症/酮症酸中毒和混合感染,截趾/肢都发生在重型糖尿病足患者中。截趾/肢患者的血清ALB、TC、HDLC均低于非截趾/肢患者(P<0.05),而HbA1c、白细胞计数和血小板计数均高于非截趾/肢患者(P<0.05)。Logistic 回归分析发现,白细胞计数高(OR1.093,95%CI为1.012~1.180)是发生重型糖尿病足的危险因素,HDLC(OR0.388,95%CI为0.162~0.931)是其保护性因素;HbA1c(OR1.411,95%CI为1.077~1.849)、下肢动脉闭塞(OR6.114,95%CI为1.202~31.094)为糖尿病足截趾/肢的危险因素。结论 糖尿病足多发生在血糖控制差、病程长、年龄在50岁以上的糖尿病患者,其发生常有诱因和病原菌感染。感染是重型糖尿病足发生的危险因素。感染、血糖控制差,特别是下肢动脉闭塞增加糖尿病足患者截趾/肢的风险。

    Abstract:

    Aim To investigate the causes, risk factors, severity of diabetic foot and prognostic factors of amputation. Methods 284 inpatients with diabetic foot who met the inclusion criteria were enrolled in the Endocrinology Department, from January, 2006 to December, 2010. Their clinical data were collected for retrospective study. Binary Logistic regression analysis was used to identify risk factors for the severe diabetic foot and amputation. Results Of these 284 patients, 175 were men and 109 were women. 82.4% of patients were older than 50. The diabetes duration in 77.5% patients was more than 5 years. Glycosylated hemoglobin (HbA1c) in 86.5% patients was higher than 6.5%. Diabetic foot ulcers mostly occured in the toe. The main causes of diabetic foot were burn or scald. The positive rate of bacterial culture in diabetic foot ulcer secretions was 94.8%, and diabetic foot was often accompanied with diabetic nephropathy and diabetic retinopathy. Serum albumin (ALB), total cholesterol (TC), high density lipoprotein cholesterol (HDLC), red blood cell count and hemoglobin (Hb) in patients with Wagner 3~5 (Severe group) were lower than that in patients with Wagner 0~2 (Mild group) (P<0.05), and white blood cell count and platelet count in severe group were higher than that in mild group (P<0.05). Severe patients were predisposed to diabetic ketoacidosis, diabetic

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刘石平,张 志,周智广.284例糖尿病足患者的临床分析[J].中国动脉硬化杂志,2013,21(03):257~261.

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  • 收稿日期:2012-06-25
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