血清白蛋白是良好的预测糖尿病足溃疡截肢风险及医疗费用的临床指标

Serum albumin is a good predictor of amputation risk and medical cost for diabetic foot ulcers： clinical analysis of 789 inpatients

目的：回顾分析糖尿病足溃疡（DFU）患者的临床特点及治疗结局，探讨血清白蛋白（ALB）水平对DFU截肢风险及医疗费用的影响。方法收集2008年1月1日至2012年12月31日收治的789例DFU患者，根据血清ALB水平分为3组：＜30g/L为中重度低蛋白血症组（n＝83）；30～35g/L为轻度低蛋白血症组（n＝163）；≥35g/L为ALB正常组（ n＝543）。按治疗结局分为截肢组（n＝171）、非截肢组（n＝603）、死亡组（n＝15）。比较不同ALB水平患者的临床资料、截肢率、住院天数、住院费用。结果 DFU患者总截肢率为21.7%，死亡率为1.9%。在所有截肢中，大截肢（踝及踝以上截肢）占22.8%，小截肢（踝以下截肢占11.7%、截趾占65.5%）占77.2%。DFU患者平均住院时间30d，住院费用26610元。DFU截肢患者平均住院时间49d，住院费用49456元。轻度低蛋白血症和中重度低蛋白血症患者的截肢率、住院时间、住院费用分别是ALB正常组的2.0，1.2，1.7倍和2.9，1.5，2.3倍。logistic回归分析显示，Wagner分级、重度感染是截肢的独立危险因素，ALB是独立保护因素。随着ALB水平的升高，截肢率逐渐下降、住院天数逐渐缩短、住院费用逐渐减少。结论 ALB水平与DFU患者的截肢密切相关，是良好的预测DFU截肢风险及医疗费用的临床指标。

Objective To retrospectively analyze the clinical features and outcomes of diabetic foot ulcers（DFU）, and investigate the effect of serum albumin（ALB） level on the amputation risk and medical cost of the disease. Methods A total of 789 inpatients with DFU in Center of Diabetes from January 2008 to December 2012 were enrolled and analyzed retrospectively in this study. They were divided into 3 groups based on their serum levels of ALB, moderate and severe hypoalbuminemia group （〈30g/L, n=83）, mild hypoalbuminemia group（30 to 35g/L, n=163）, and normal albumin group（≥35g/L, n=543）. These patients were also assigned into amputation group（n=171）, non-amputation group（n=603）, and death group（n=15） according to the clinical outcomes. Their clinical data, amputation rate, hospital days and medical cost were compared among those with different serum level of ALB. Results The total amputation rate was 21.7%, and the mortality was 1.9%in this cohort of patients. Of all these amputations, the major amputation rate（above-the-ankle amputation） was 22.8%, and the minor amputation rate was 77.2%（11.7%for below the ankle amputation and 65.5%for toe resection）. For the patients without amputation, the average hospital stay was 30d and the medical cost was 26 610RMB, but for the patients with amputation, the stay was 49d and the cost was 49 456 RMB. The amputation rate, hospital stay, and medical cost in patients with mild, and moderate and severe hypoalbuminemia were 2.0-, 1.2-and 1.7-folds higher, and 2.9-, 1.5-and 2.3-folds higher, respectively, than those in patients with normal ALB level. Logistic regression analysis showed that the Wagner stage and severe infection were independent risk factors for amputation and the serum level of ALB was an independent protective factor. With the increase in serum ALB level, the amputation rate was lower, the hospital stay was shorter, and the medical cost decreased. Conclusion Serum ALB level is closely associated with amputation of DFU patients, and is a good predictor for the risk of amputation and medical cost.