糖尿病足发生截肢的相关危险因素的meta分析

Risk factors of amputation among patients with diabetic foot:a meta-analysis

目的通过meta分析评价糖尿病足人群发生截肢的重要危险因素。方法计算机检索Pubmed,Medline,Cochrane library,EMbase,中国期刊全文数据库(CNKI),维普中文科技期刊全文数据库(VIP),中国万方数据库,中国生物医学文献检索数据库(CBM),检索关于糖尿病足人群发生截肢危险因素的原始研究文献,将符合纳入标准的文献进行数据提取和质量评价,采用Rev Man5.2软件进行荟萃分析,选择固定效应模型或随机效应模型合并比值比(OR)值及95%可信区间(CI)分析各主要危险因素,采用敏感性分析评估结果的稳定性,用漏斗图评估文献的发表偏倚。结果符合标准的共有15篇中英文文献,共对24个主要危险因素进行meta分析,最终结果显示糖尿病足进展为截肢的重要危险因素共有18个,分别为年龄,糖尿病病程,足病病程,高血压,糖尿病周围神经病变(DPN),糖尿病周围血管病变(PAD),血肌酐(Scr),空腹血糖(FBG),糖化血红蛋白(Hb A1c),血红蛋白(Hb),血清白蛋白(Ab),白细胞计数(WBC),超敏CRP(hs-CRP),中性粒细胞百分比,甘油三酯(TG),高密度脂蛋白胆固醇(HDL-C),Wagner分级。其中踝臂指数(ABI)不是糖尿病足发生截肢的危险因素。结论对高危截肢患者应评估患者外周血管情况,而不应以ABI作为血管条件的唯一指标。

Objective To evaluate risk factors of lower extremity amputation among patients with diabetic foot by a meta-analysis.Methods A published literature search was performed through Pubmed,Medline,Cochrane library,EMbase,Chinese CNKI,VIP,CBM,Chinese Wanfang Databases for articles on risk factors of lower extremity amputation among patients with diabetic foot. The meta-analysis was performed by Revman 5.2 software. The various risk factors were analyzed by fixed effect model or random effect model pooled odds ratio（ OR） and 95% confidence interval（ CI）,and the result stability was evaluated by sensitivity analysis. The meta-analysis was performed by Revman 5. 2 software. Moreover,the funnel plot was used to assess the published bias of articles. Results Fifteen articles were included. Meta analysis showed that 18 factors such as age,course of diabetes disease,course of diabetic foot,hypertension,diabetic peripheral neuropathy（ DPN）,peripheral arterial disease（ PAD）,creatinine（ Scr）,fasting blood glucose（ FBG）,glycosylated hemoglobin A1c（ Hb A1c）,hemoglobin（ Hb）,albumine（ Ab）,white blood cell count（ WBC）,hs-CRP,percentage of neutrophils triglyceride（ TG）,high-density lipoprotein-cholesterol（ HDL-C）,Wagner grading were important risk factors for lower extremity amputation among patients with diabetic foot,but ankle brachial index（ ABI） was not the risk factor. Conclusion Peripheral vessels should be evaluated for high risk amputation patients,and ABI may be not the only vessel indicator.