糖尿病足溃疡患者并发抑郁症临床分析

The prevalence and risk factors of depression in patients with diabetes foot ulcer

目的探讨糖尿病足溃疡患者抑郁症发病情况及其与年龄、糖化血红蛋白水平、溃疡严重程度及持续时间、患者生存质量等因素的相关性。方法收集2012年9月至2014年9月淄博市第一医院门诊接收的糖尿病足溃疡患者73例。采用健康问卷抑郁分表（PHQ-9）评估患者抑郁情况及严重程度。记录患者的性别、年龄，糖尿病病程、糖化血红蛋白（HbAle）水平、糖尿病足溃疡持续时间、吸烟史等。wagner分级判断患者糖尿病足溃疡的严重程度，SF-36健康调查简表评价患者生存质量。结果根据PHQ评分，入组患者总抑郁症发病率49．3％，中重度抑郁发病率17．8％。HbAlc≥7．0％者抑郁发病率（66．7％）较HbA1c〈7．0％者（35％）明显升高（P〈0．01），中重度抑郁患者较轻度抑郁患者HbAlc不达标比率更高（P〈0．01）。wagner分级1级者抑郁发病率39．1％，2～3级抑郁发病率48．6％，4～5级抑郁发病率69．2％，wagner分级与抑郁症发病率呈明显正相关。糖尿病足溃疡持续时间〉6个月时抑郁发病率（58．1％）明显升高（P〈0．05）。SF-36量表示抑郁患者生存质量评分明显降低（P〈0．05）。结果未发现糖尿病足溃疡患者抑郁发病率与患者年龄、糖尿病病程、并发症数量及吸烟有明显相关性（P〉0．05）。结论糖尿病足溃疡患者抑郁症发病率较高，且与患者糖化血红蛋白水平、溃疡严重程度、持续时间呈正相关．抑郁症严重影响糖尿病足溃疡患者的生存质量．

Objective To explore the prevalence of depression in diabetes foot ulcer patients, and to analyze the correlation between depression morbidity and various factors such as age, HbAle level, and quality of life etc. Methods 73 diabetes foot ulcer patients admitted from Sep. 2012 to Sep. 2014 were enrolled. Depression was assessed using the 9-item patient health questionnaire （PHQ-9）. Data such as the age, sex, duration of diabetes and foot ulcer, HbA1C level, smoking were recorded. The severity of foot ulcer was evaluated by Wagner＇s classification. The quality of life was scored by short form（SF-36） health survey questionnaire. Results The morbidity of depression in diabetes foot ulcer patients was 49. 3% in total and 17. 8% in the moderate to severe depression group. The prevalence in patients with HbA1c≥7.0% was significantly higher than that in patients with HbAlc 〈7. 0% （66% vs 35% ,P 〈 0. 01 ）. Higher occurance of HbA1c≥7. 0% was found in the moderate to severe depression group compared to that in the mild depression group. The prevalence of depression was 39. 1% in grade 1 in wagner classification, 48. 6% in grade 2 to 3 in wagner classification and 69.2% in grade 4 to 5 in wagner classification, showing the two was positively correlated. When duration of foot ulcer lasted more than 6 months, the morbidity of depression（58.1% ）was significantly increased（ P 〈 0. 05 ）. The quality of life was significantly declined in patients with depression by SF-36 questionnaire （ P 〈 0. 05 ）. No association was found between the depression morbidity and the age, duration of diabetes, amount of complications or smoking （ P 〉 0.05 ）. Conclusions This study shows a high prevalence of depression symptom in diabetes foot ulcer patients. Depression is associated with I-IbAlc level, the extent and duration of foot ulcer.