探讨糖化血红蛋白在2型糖尿病足合并感染中的价值

The value of hemoglobin A（1c） in type 2 diabetic patients with infected foot

目的 探讨糖化血红蛋白在2型糖尿病足患者合并感染中的水平变化的意义.方法 回顾性纳入159例糖尿病足患者（Wagner分级1～5）,糖尿病足感染（DFI）组（n=75）,非糖尿病足感染（NDFI）组（n=84）,记录上述患者临床资料.结果 159例糖尿病足患者中男性占64.2％,平均年龄（68.8±11.6）岁,平均糖尿病病程（9.6±7.4）年,HbA1C水平（7.0±3.9）％；溃疡病程（19.4± 15.0）天,溃疡部位以足趾多见（45.3％）；Wagner分级法中以1～2级最多,占28.3％ ～ 40.3％；并发症相关病变依次是周围神经病变（52.8％）,下肢血管病变（30.8％）,糖尿病肾病（20.1％）；共检出91株病原菌,其中革兰阳性球菌占50.5％,以金黄色葡萄球菌检出率最高为28.6％；革兰阴性杆菌占41.8％,以大肠埃希菌检出为主占22.0％；DFI组溃疡病程、HbA1c水平显著高于NDFI组（P＜0.01）,而年龄、糖尿病病程在两组间差异无统计意义（P＞0.01）.结论 糖尿病足是多方面因素共同作用的结果,评估DFI患者病情时,有必要监测HbA1c水平,进行个体化治疗.

Objective To evaluate the value of HbA 1 c in type 2 diabetic patients with infected foot.Methods 159 type 2 diabetic patients with infected foot ulcers （Wagner＇ s grade 1-5） were retrospectively enrolled and divided into diabetic foot infection group （n=75） and no diabetic foot infection group （n=84）,recording demographic characteristics.Results 159 type 2 diabetic patients with infected foot ulcers were analyzed,male accounting for 64.2％,the average age of （68.8 ± 11.6） years old,the average duration of diabetes of （9.6 ± 7.4） years.The level of HbA 1C was （7.0 ± 3.9）％.The duration of ulcer was （19.4 ± 15.0） days and toe lesions was commoner （45.3％）,28.3％-40.3％ of ulcers were Wagner staged 1 or 2.Most of patients had diabetic complications including peripheral neuropathy （52.8％）,lower extremity vascular disease （30.8％）,diabetic nephropathy （20.1％）.A total of 91 isolates were detected.Among them,50.5％ were gram-positive cocci,the majority were Staphylococcus aureus （28.6％）; 41.8％ were gram-negative bacilli,the majority were Escherichia coli （22.0％）.The duration of ulcer and the level of HbAlc in DFI group were significantly higher than those in NDFI group （P ＜ 0.01）.However,age and duration of diabetes in two groups showed no significant differences （P ＞ 0.01）.Conclusions Diabetic foot is the result of multiple factors.It is necessary to monitor the level of HbA I c for individualized treatment.