相关指标评价糖尿病足溃疡严重程度的临床意义

Clinical Significance of the Related Clinical Indicators on the Evaluation of the Severity of Diabetic Foot Ulcer

目的研究与糖尿病足溃疡Wagner分级严重程度相关的临床指标。方法回顾性分析436例糖尿病足溃疡患者的人口学数据资料、并发症情况及血生化结果。根据Wagner分级将436例患者进行分组,分析有关指标与足溃疡严重程度的关系。结果 436例患者中Wagner1、2、3、4～5级分别为84例(19.3%)、116例(26.6%)、122例(28.0%)、114例(26.1%)。随着溃疡严重程度的增加,血白细胞计数(WBC)、中性粒细胞百分比、超敏C反应蛋白(S-CRP)、红细胞沉降率(ESR)、尿白蛋白/肌酐比值(A/C)逐渐增高,血红蛋白(Hb)、血浆白蛋白(Alb)、血清总胆固醇(CHO)、高密度脂蛋白胆固醇(HLD-C)浓度逐渐下降,各组间比较差异有统计学意义(P<0.05);等级相关分析显示,糖尿病外周动脉病变(PAD)患病率、WBC、中性粒细胞百分比、S-CRP、ESR、尿A/C、感染合并营养不良等与Wagner分级呈正相关,而Hb、Alb、CHO、HLD-C则与足溃疡Wagner分级呈负相关(P<0.05)。结论外周动脉病变、感染和营养不良与糖尿病足溃疡严重程度相关。

Objective To Analyze the relationship of relative clinical parameters with the severity of diabetic foot ulcer. Methods 436 diabetic patients with foot ulcer were retrospectively investigated for their demographic data, diabetic complications and biochemistry results. According to Wagner classification system, the patients were divided into four groups. The relationship between these parameters and the ulcer severity was evaluated. Results The percentage of the patients with Wagner 1, 2, 3, 4-5 was 19.3%, 26.6%, 28% and 26.1%, respectively. White blood cell counts （WBC）, percentage of neutrophilic granulocyte, sensitive C reactive protein （S-CRP）, erythroeyte sedimentation rate （ESR）, urine albumin/creatinine （A/C） were parallel increased with the severity of the diabetic foot ulcer, but hemoglobin （Hb）, serum albumin （Alb）, serum total cholesterol tiC）, high density lipoprotein cholesterol （HDL-C） were significantly decreased. It was showed that prevalence of diabetic peripheral artery diseases （PAD）, WBC, percentage of neutrophilic granulocyte, S-CRP, ESR, urine A/C, infections and malnutrition positively and Hb, Alb, TC, HLD-C negatively were correlated with the severity of the foot ulcer （P〈0.05）. Conclusion PAD, inflammation factors and malnutrition are the important factors involved in the prognosis of diabetic foot ulcer.