糖尿病足及溃疡发生的临床特点分析

Analysis of clinical characteristics of the occurence of diabetic foot and ulcers

目的探讨2糖尿病患者发生糖尿病足(DF)及溃疡的临床特点,为防治糖尿病足提供依据。方法 2型糖尿病患者按有、无糖尿病足分组,每组各89例,对其临床资料进行回顾性分析。结果 (1)两组比较,年龄、糖尿病病程、糖化血红蛋白、血清白蛋白、尿素氮、肌酐、胆固醇、吸烟、冠心病、糖尿病周围神经病变、糖尿病外周血管病变、糖尿病肾病等因素差异有统计学意义(P<0.05);多因素非条件Logistic回归分析显示,与糖尿病足发病相关的危险因素包括年龄、糖尿病周围神经病变、血清白蛋白、糖尿病肾病,差异有统计学意义(P<0.05);糖尿病病程、糖化血红蛋白、肌酐、吸烟、冠心病、糖尿病外周血管病变使糖尿病足发生的相对危险度增加(OR>1),但差异无统计学意义。(2)DF以同时合并有周围神经病变和外周血管病变者(76.40%)居多;足溃疡诱因包括烫伤、自发水疱破损、穿鞋摩擦伤等;溃疡以单发(58.43%)居多,合并坏疽者10.11%,部位多在足趾,以干性坏疽居多。足溃疡合并感染以单纯感染居多。溃疡分级以Wagner分级1～2级者(70.79%)居多,预后较好;Wagner分级3～5级者,预后不佳。结论年龄、血清白蛋白水平、糖尿病周围神经病变、糖尿病肾病是糖尿病足发病的独立危险因素。足溃疡以单发、表浅及同时合并有周围神经病变和外周血管病变者多见;合并感染者以单种病原菌感染居多;Wagner分级越高预后越差。溃疡的诱发因素多与防护不当有关,对糖尿病患者进行足防护知识教育极其重要。

Objective To analyze the clinical characteristics of diabetic foot and ulcers in patients with type 2 diabetes mellitus (T2DM),and provide the basis for the prevention and treatment of diabetic foot.Methods Patients with T2DM were grouped according to whether they had diabetic foot.Every group had 89 cases,and their clinical data were analyzed by retrospective analyses.Results (1)The occurrence of diabetic foot was correlated with age,duration of diabetes,HbA1c,serum albumin,BUN,SCr,TC,history of smoking,CHD,DPN,PAD,DN (P<0.05).Logistic regression analysis showed that the occurrence of diabetic foot was significantly correlated with age,serum albumin,DPN and DN;while the duration of diabetes,HbA1c,SCr,smoking,CHD,DPV increase the occurence of diabetes foot in the relative risk(OR>1),but the difference is not significant.(2)The mixture of ischemic and neuropathic ulcers were most common (76.4%).Predisposing causes of ulcers includes scald,rupture of spontaneous blister,injury of shoes friction,scratch damage,bump.In 58.4% of patients with diabetes foot,only one ulcer was detected,and mainly located at toes or planta.10.11% of these patients were accompanied with gangrene,mainly gangrene of one toe or toes.70.79% of the ulcers were at the wagner stage 1 or 2,and may have better prognosis;while those above 3,may have worse prognosis.Conclusions Age,the level of serum albumin,DPN and DN are independent risk factors of diabetes foot with T2DM.Single,superficial ulcers and the ones with both DPN and PAD are most common.The majority of diabetes foot infections are monomicrobial.The higher wagner stage the patients had,the worse effects the patients would have.Predisposing factors of ulcer are mostly related to inappropriate protection.