抑郁情绪对Wagner3级糖尿病足溃疡住院患者预后的影响

Depression impacts prognosis of the patients with Wagner grades 3 diabetic foot ulcers

目的 通过对糖尿病足溃疡住院患者进行心理评估,探讨抑郁情绪对患者预后的影响.方法 对2010年6月至2011年5月因糖尿病足病住院的168例Wagner 3级足溃疡患者应用抑郁自评量表进行评估,按照抑郁程度分为不伴抑郁组和伴抑郁组,采用logistic回归分析抑郁情绪对糖尿病足患者足溃疡愈合以及对足溃疡愈合的患者行截肢手术的影响.结果 Wagner 3级患者中伴抑郁症者95例（56.5％）,不伴抑郁症者73例（43.5％）.卡方检验证实伴抑郁者溃疡不愈合率较不伴抑郁者显著增加（分别为18.9％和6.8％,OR=2.779,95％ CI：1.120 ～9.023）,logistic回归分析发现,在依次调整了与足溃疡预后密切相关的感染程度与动脉病变程度以及年龄、糖化血红蛋白、合并症Charlson评分等因素后,抑郁仍是患者溃疡不愈合的危险因素（OR=3.569,95％CI：1.220～10.442）.进一步对溃疡愈合组患者进行logistic回归发现,在依次调整上述因素后,抑郁情绪的存在也是溃疡愈合组患者截肢的危险因素（OR=2.793,95％ CI：1.361 ～ 5.732）.结论 糖尿病足溃疡患者普遍存在抑郁情绪并对患者预后产生不利影响.对其进行筛查并给予必要的心理治疗,可降低住院糖尿病足溃疡患者的手术风险.

Objective To evaluate the impact of depression on prognosis of Wagner grade 3 diabetic foot ulcer patients by a psychological assessment.Methods One hundred and sixty-eight patients suffered from Wagner grade 3 diabetic foot ulcers hospitalized in the Tianjin Metabolic Diseases Hospital from June 2010 to May 2011 were included in the study.Their psychological disorders were evaluated by a self-rating depression scale （SDS） to identify depression.Patients complicated with depression or not were divided into two groups accordingly.Unhealing rate and amputation risk of the patients in the two groups were compared using Chi-square test and logistic regression,respectively.Results Ninety-five out of 168 patients （56.5％） were identified as depression and the others （73 out of 168,43.5％） were not.The unhealing rate of the patients complicated with depression was significantly higher than that of the patients without depression analyzed by Chi-square test （18.9％ and 6.8％ respectively,OR =2.779,95％ CI：1.120-9.023）.Logistic regression analysis indicated that depression was a risk factor of unhealed ulcers （OR =3.569,95％ CI：1.220-10.442） after the factors related to prognosis of diabetic foot ulcer were adjusted step-by-step,including infection,arterial disease,age,glycosylated hemoglobin A1e and Charlson grading of complications.Healed patients were further analyzed by logistic regression analysis.Healing after amputation rate is higher among the patients complicated with depression than that of the patients without depression after the adjustment mentioned above （OR =2.793,95％ CI：1.361-5.732）.Conclusion Depression is common among patients with Wagner grade 3 diabetic foot ulcers and has adverse effects on the prognosis of the patients.It implies that identification of depressed should be a routine process for diabetic foot ulcer patients to improve wound healing and reduce amputation rate.