糖尿病足溃疡愈合及截肢的相关因素分析

Analysis of related factors of healing and amputation of diabetic foot ulcer

目的分析糖尿病足溃疡愈合及截肢的相关影响因素。方法收集308例糖尿病足病患者的资料,其中回访成功143例,按照足溃疡是否愈合分为愈合组(93例)和未愈合组(50例),按照足溃疡是否截肢分为截肢组(50例)和未截肢组(258例),分别以愈合和截肢为因变量,回顾性分析308例患者的临床资料,研究影响足病患者愈合和截肢的相关因素。结果年龄、血红蛋白(Hb)、瓦格纳分级、受教育程度、极低密度脂蛋白(VLDL)、前白蛋白(PA)、肾小球滤过率(e GFR)、高血压(HBP)、最大溃疡面积、足背动脉搏动情况在愈合组与非愈合组之间存在显著差异(P<0.05);而血小板、尿酸(UA)、降钙素原、高密度脂蛋白(HDL)、载脂蛋白(apo A)、足背动脉搏动情况、足溃疡的性质、足溃疡的特征、瓦格纳分级及负压吸引治疗在截肢组与非截肢组间均有显著差异(P<0.05)。结论足溃疡愈合的保护因素有Hb、PA、e GFR、受教育程度、足背动脉搏动情况;足溃疡愈合的危险因素有HBP、年龄、瓦格纳分级、VLDL、最大溃疡面积、糖尿病肾病;其中PA、足背动脉搏动是足溃疡愈合独立的保护因素,而VLDL、糖尿病肾病是糖尿病足溃疡愈合独立的危险因素。截肢的保护因素有溃疡的性质、负压吸引治疗、足背动脉搏动、HDL、apo A;截肢的危险因素有溃疡的特征、瓦格纳分级、血小板、降钙素原、UA;其中溃疡特征、瓦格纳分级、降钙素原是截肢独立的危险因素,而负压吸引治疗是截肢独立的保护因素。

Objective To analyze related influencing factors of healing and amputation of diabetic foot ulcer. Methods 308 patients with diabetic foot were collected. 143 cases of them were payed a return visit, 308 patients were divided into two groups according to the healing of foot ulcers, healing group （93 cases） and non healing group （50 cases）, according to whether the foot ulcers, they were divided into amputation group （50 cases） and the non amputation group （258 cases） , healing and amputation were the dependent variables, respectively. Retro- spective analysis of clinical data of 308 cases were studied the related factors of healing and amputation in patients with foot disease. Results Age, hemoglobin （Hb） ,Wagner grades, educational degree, very low density lipoprotein （VLDL）, prealbumin （PA） and lipoprotein diabetic nephropathy, the glomernlar filtration rate （GFR）, hypertension （HBP）, maximum area of ulcer, footdorsal artery pulsatility in healing group and non healing groups had significant difference （ P 〈 0. 05 ） ;thus platelet, uric acid （ UA）, calcitonin high density lipoprotein （ HDL）, lipoprotein （ apoA）, the nature of the dorsal artery pulsatility, and foot ulcers foot and the characteristics of foot ul- cers, Wagner grades and negative pressure attract treatment between the amputation group and non amputationgroup had significant difference （P 〈 0. 05）. Conclusion The protective factors of foot ulcer healing include Hb, PA, diabetic nephropathy, eGFR, the degree of education, and the beating of the dorsal artery of the foot, The risk factors for the healing of foot ulcer are HBP, age, Wagner grades, VLDL, the largest area of ulcer, and diabetic nephropathy. PA, the foot dorsal artery pulsation are the independent protective factors for ulcer healing, while VLDL and diabetic nephropathy are the independent risk factors of diabetic foot ulcer healing. The protective factors of amputation are the nature of ulcer, negative pressure suction therapy, the beating of the dorsal artery of foot, HDL and apoA,The risk factors of amputation are characterized by ulceration, Wagner grades, platelet, calcitonin, UA, Among them, the ulcer characteristics, Wagner grades, calcitonin are the independent risk factors of amputation, and the negative pressure suction treatment is an independent protective factor for amputation.