570例糖尿病足患者截肢率及截肢影响因素分析

Incidence and risk factors of amputation among 570 patients with diabetic foot ulcer

目的:了解糖尿病足患者截肢率及截肢影响因素。方法:收集2007年1月至2012年3月住院的糖尿病足患者,比较截肢与非截肢组的临床特征,采用Logistic回归分析截肢的主要影响因素。结果:570例糖尿病足患者中有88例(15.4%)接受截肢手术,截肢组足病病程、血白细胞及中性粒细胞比例、饮酒率、多发溃疡率、创面混合感染率高于非截肢组(P<0.05)。白蛋白、血红蛋白、HDL-C低于非截肢组(P<0.05)。大截肢组创面革兰氏阴性菌比例、多发溃疡率、血白细胞及中性粒细胞比例高于小截肢组,血白蛋白低于小截肢组(P<0.05)。Logistic回归分析发现足背动脉、饮酒、贫血、血白细胞是截肢的危险因素,HDL-C是截肢的保护因素。结论:足背动脉搏动差、饮酒、贫血、感染、低HDL-C是糖尿病足患者截肢的主要影响因素。

[ Objective] To evaluate the incidence of amputation among patients with diabetic foot ulcer and risk factors for amputations. [Method] Inpatients with diabetic foot ulcer were recruited from January 2007 to March 2012 . Clinical character was compared between amputation group and non- amputation group and the critical factors contributing to amputations were analyzed with logistic regression. IResult] 88 patient （ 15.4% ） underwent amputation. Higher foot ulcer duration, white blood cell count.% neutrophils percentage, rates of alcohol consumption , multiple ulcer and mixed infections and lower plasma albumin, blood hemoglobin, high - density lipoprotein- cholesterol were found in amputation group compared with the non - amputation group （ P 〈 0.05）. The major amputation group had higher white blood cell counts, neutrophils percentage, proportion of Gramnegtive bacteria, rate of multiple ulcer and lower plasma albumin than minor amputation group （ P 〈0.05）. Upon logistic regression analysis, dorsal artery of foot, alcohol consumption, anaemia, white blood cell counts were independent risk factor of amputation, HDL - C was independent protective factor of amputation. [ Conclusion] The critical influencing factor for amputation were weakness or absent pulsation of dorsal artery of foot, alcohol consumption, anaemia, infection, low HDL- C.