糖尿病足危险因素分析

Analysis of risk factors of diabetic foot

目的探讨糖尿病（DM）患者发生糖尿病足（DF）的危险因素。方法利用病案查询系统检索1996年1月至2009年12月四川大学华西医院DF患者的总出院人数为662例，男371例，291例，平均年龄（664-11）岁；同期入院无DF的DM患者353例，男205例，女148例，平均年龄（66±9）岁。根据是否合并DF将所有患者分为DF患者组（DFP组）和非DF患者组（non．DFP组）。用卡方检验和单、多因素logistic回归分析方法对常见危险因素进行分析。结果与non—DFP组相比，DFP组糖尿病慢性并发症糖尿病肾病（DN）、糖尿病视网膜病变（DR）、周围动脉病变（PAD）、糖尿病周围神经病变（DPN）、糖尿病自主神经病变（DAN）的发生率均明显高于non—DFP组，组间差异均有统计学意义（X。=34．133、11．694、165．727、85．852、72．021，均P〈0．05）；且其肺部感染、骨质疏松的发生率更高，差异亦均有统计学意义（X2=32．619，23．932，均P〈0．05）。单因素分析显示吸烟、DN、DR、PAD、DPN、DAN是DF的危险因素（Wald=4．874、33．516、11．581、146．356、82．446、67，686，均P〈0．05）；高密度脂蛋白胆固醇（HDL—C）（Wald=25．532，P=0．000）是DF的保护性因素。多因素非条件logistic回归分析显示DN、DPN、DAN、PAD是DF的危险因素（Wald=11．007、21．484、11．963、87．427，均P〈0．05）；而HDL—C（Wald=14．971，P=0．000）是DF的保护性因素。结论DN、DPN、DAN、PAD是DF的危险因素，而HDL—C是DF的保护因素。

Objective To identify risk factors of diabetic foot （DF） in patients with diabetes mellitus. Methods All medical records of 662 DF inpatients （ DFP group ） and 353 diabetic inpatients without DF （non-DFP group ） treated from January 1996 to December 2009 in West China Hospital were retrieved. There were 371 males and 291 females in DFP group with a mean age of （66 -＋ 11 ） y, and 205 males and 148 females in non-DFP group with a mean age of （66 ＋ 9 ） y. Chi-square test, univariate logistic regression analysis and multivariate and non-conditional logistic regression analysis were used to identify the risk factors of DF. Results The incidence of diabetic nephropathy （ DN ）, diabetic retinopathy （ DR ）, peripheral arterial disease （PAD）, diabetic peripheral neuropathy （DPN） , diabetic autonomic neuropathy （DAN）in DFP group were higher than those in non-DFP group（x2 =34. 133, 11. 694, 165. 727, 85. 852, 72. 021, respectively, all P 〈 0. 05 ）. Lung infection and osteoporosis occurred more often in DFP group than in non-DFP group （ X2 = 32. 619, 23. 932, both P 〈 0. 05 ）. The univariate logistic regression analysis revealed that smoking（ Wald = 4. 874）, DN （ Wald = 33. 516） , DR （ Wald = 11. 581 ）, PAD （ Wald = 146. 356）, DPN （ Wald = 82. 446 ） and DAN （ Wald = 67. 686 ） were risk factors for DF （ all P 〈 0. 05 ）, HDL-C （ Wald = 25. 532, P 〈 O. 05 ） was protective factor against DF. Multivariate and non-conditional logistic regression analysis showed that DN （ Wald = 58. 837 ）, DPN （ Wald = 21. 484）, DAN （ Wald = 11. 963 ） and PAD （ Wald = 87.427 ） were risk factors for DF （ all P 〈 0. 05 ） , HDL-C （ Wald = 14. 971, P 〈 0. 05） was protective factor against DF. Conclusion It suggests that DN, DPN, DAN and PAD are associated with an increased risk of DF, while HDL-C is the protective factor against DF.