中国南方与北方地区糖尿病足病危险因素分析

Differences in risk factors of diabetic foot in the patients in South and North China

目的调查并分析中国南方和北方部分医院糖尿病足病的危险因素。方法通过前瞻性地统一检查和调查方式，收集全国14家三甲医院的2004年全年门诊和住院糖尿病足病患者的社会人口学特征、代谢指标、住院天数和医疗费用等，分为南方地区和北方地区进行分析。结果634例患者中南方地区285例，北方地区349例，南北方患者在年龄（70岁vs66岁）、家庭人均月收入〉1000元者（57、7％vs45．6％）、冠心病合并率（42、6％vs61、0％）及视网膜病变合并率（35，7％vs49、5％）、糖化血红蛋白（7．90％vs8．80％）、低密度脂蛋白胆固醇（2、75mmol／Lvs2．98mmol／L）、白细胞（6．70×10^9／Lvs7．40×10^9／L）、红细胞压积（HCT：0．37vs0．38）、肌酐（87．000,mol／Lvs76.00μmol／L）、尿酸（332.54μmol／Lvs271.40μmol／L）、住院天数（19dvs22d）、足治愈率（19．1％VS10．3％）及截肢率（2．6％vs9.7％）差异均有统计学意义，而糖尿病病程、足病病程、教育水平、吸烟率、高血压、肾脏病变及周围神经病变合并率、空腹及餐后血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、血小板、尿素氮在南北方地区差异均无统计学意义。Logistic回归分析结果显示，南方地区影响糖尿病足严重程度的因素为踝肱指数（ABI）和白细胞，而北方地区的影响因素为ABI、血小板和HCT。结论北方地区的糖尿病足病患者年龄轻，糖尿病病程长，足病病程短。影响南北方糖尿病足严重程度的共同因素为ABI。

Objective To investigate the differences on the diabetic foot problems and its risk factors in south and north of China. Methods Patients with foot problems were surveyed from January 1 to December 31,2004 in 14 teaching hospitals located in different cities in China, including demographic data, present and past history of the foot problems and peripheral artery disease （ PAD）, the classification of the foot ulcers based on the Wangnergystem , control of the hyperglycemia and lipids disorder, medical cost in hospital and the diabetic complications. All the patients were divided into two groups due to their geographical data, south and north. Results There were 285 and 349 patients for the group south and group north. No significant differences were found for duration of diabetes or foot problems, fasting or post-meal glucose, total cholesterol, triglycerides, HDL-C, and the numbers of patients with smoke, hypertension, nephropathy or neuropathy between the two groups. There were significant differences for the age （70 yrs vs 66 yrs）, percentage of the patients with average person income with over RMB 1000 per month （57.7% vs 45.6% ）, coronary heart disease （ 42.6% vs 61.0% ） and retinopathy （ 35.7% vs 49. 5% ）, HbAlc （7. 90% vs 8. 80 % ） , LDL-C （2.75 mmol/L vs 2.98 mmol/L） , WBC （6.70 × 10^9 vs 7.40 × 10^9/L） , HCT（0.37 vs 0.38）, creatinine （87 μmol/L vs 76 μmol/L） and uric acid （333 mmol/L vs 271 mmol/L）, and amputation rate （2.6% vs 9.7% ） between south and north groups. Logistic analysis showed that severity of the foot problems was associated with ABI and WBC in south group, and with ABI, PLT and HCT in north group. Conclusion Diabetic foot problems were more severe, with more risk factors and with more medical cost in north patients.