糖尿病足病尿蛋白排泄及其与感染程度关系研究

The characteristics of urine protein excretion in diabetic foot disease and the association with infection

目的观察糖尿病足病患者尿蛋白排泄特点,探讨尿蛋白排泄随足病感染程度的变化。方法连续收集上海交通大学医学院附属瑞金医院2009年12月至2010年8月收治的174例糖尿病足病患者一般临床资料,包括糖尿病病情、部分生理生化指标、24 h尿蛋白定量等,据足病感染程度分为无感染、轻、中、重度感染,统计分析不同感染程度患者的临床特点,探讨尿蛋白排泄与感染程度的关系。结果中重度感染患者血红蛋白、血浆总蛋白、血浆白蛋白明显降低,24 h尿蛋白排泄量明显升高。24 h尿蛋白排泄量与感染程度及血浆白蛋白密切相关,相关系数分别为0.358、-0.425,P值均<0.001。多元逐步回归分析显示,感染严重程度是24 h尿蛋白排泄量的重要影响因素(P<0.01)。结论糖尿病足病患者尿蛋白排泄量随足病感染程度加重而增多,提示控制感染有利于减少尿蛋白。

Objective To determine the characteristics of urine protein excretion in patients with diabetic foot and to analyze the changes associated with severity of infection. Methods We analyzed the profiles of 174 consecutive patients with diabetic foot,including physiological and biochemical indices and quantified 24-hour urine protein excretion. All subjects were further grouped by the severity of infection-namely, no infection, mild, moderate and severe infection. The clinical features in patients with different severity of infection were analyzed, and the correlation between urine protein excretion and infection was assessed. Results Significantly lower levels of hemoglobin, plasma total protein and serum albumin and markedly increased urine protein excretion were found in patients with moderate-to-severe infection. The 24-hour urine protein excretion was considerably correlated with the severity of infection （r =0. 358 ,P 〈0. 001 ） and serum albumin （r = - 0. 425, P 〈 0. 001 ）. Multiple stepwise regression analysis showed that severity of infection was predominantly associated with 24-hour urine protein excretion （ P 〈 0. 01 ）. Conclusion Higher urine protein excretion in patients with diabetic foot is associated with the severity of infection, suggesting that effective control of infection may appear beneficial to reducing urine protein excretion.