恶臭在糖尿病足神经性溃疡中的作用研究

Study on role of putrid odour in neuropathic diabetic foot ulcers

目的比较恶臭性糖尿病足神经性溃疡与无恶臭性糖尿病足神经性溃疡在临床表现、治疗及预后方面有无不同。方法收集2009年3月至2010年5月,在我院足科病房住院治疗的所有糖尿病足神经性溃疡61例患者资料,根据糖尿病足神经性溃疡有无恶臭分为恶臭组29例和非恶臭组32例。患者入院后当天收集患者基本资料,检查患者足溃疡感染情况,记录实验室数据、两组患者的治疗和预后情况。比较两组患者临床表现、实验室数据、治疗方式和预后的差异。结果恶臭组白细胞计数(WBC)13.64×109/L vs 9.15×109/L(P<0.01)、超敏C反应蛋白(hsCRP)(12.9±1.4)mg/L vs(11.9±1.1)mg/L(P<0.01)、血小板计数(PLT)346.62×109/L vs 286.97×109/L(P<0.01)明显高于非恶臭组;恶臭组和非恶臭组比较,更易发生重度感染(P<0.01)、骨髓炎(P<0.05)和坏疽(P<0.01)。最终恶臭组截肢风险明显高于非恶臭组(P<0.01)。结论恶臭组较非恶臭组更易导致坏死性深部软组织感染和坏疽,更易导致骨髓炎,而且白细胞、血小板、C反应蛋白升高,这些都使恶臭组截肢风险明显高于非恶臭组。因此糖尿病足神经性溃疡出现恶臭是一个危险信号,预示着很高的截肢风险。

Objective To compare whether there were differences in clinical characteristics,treatment and prognosis between neuropathic diabetic foot ulcers with or without putrid odour.Methods Collection was made on the data of neuropathic diabetic foot ulcer patients hospitalized in diabetic foot unit of the hospital from March 2009 to May 2010.According to ulcer with or without putrid odour,the patients were divided into putrid odour group and nonputrid odour group.We would record basic data of patients and examine foot ulcer to document baseline data of infection after the first day of admitting to hospital,record laboratory data and treatment manner and prognostic outcome.Then we compared two groups in statistic differences of clinical characteristics,laboratory data and treatment manner and prognosis.Results Collected 61 neuropathic diabetic foot ulcer patients hospitalized in our diabetic foot department,29 cases had putrid odour,32 cases had no putrid odour.WBC（13.64×109/L vs 9.15×109/L,P0.01）,high sensitive CRP（12.9±1.4） mg/L vs（11.9±1.1） mg/L（P0.01）,PLT（346.62×109/L vs 286.97×109/L,P0.01） of putrid odour group elevated more than those of nonputrid odour group.Compared with nonputrid odour group,putrid odour group caused more easily severe infection and resulted in osteomyelitis（P0.01） and gangrene（P0.01）.At last,amputation risk of putrid odour group was higher than that of nonputrid odour group（P0.01）.Conclusion Compared with nonputrid odour group,putrid group was apt to result in necrotic deep soft tissue infection,gangrene and osteomyelitis.Meanwhile,WBC,PLT and high sensitive CRP were obviously elevated,thus putrid group has higher risk of amputation than nonputrid odour group.So when neuropathic diabetic foot ulcer smells putrid odour,it was a dangerous signal for the high risk of amputation.