糖尿病足患者截趾的危险因素分析

Analysis of risk factors of toe ampution in the patients with diabetic foot

目的探讨糖尿病足(DF)患者截趾的相关危险因素。方法选取2013年10月至2016年5月阜阳市人民医院内分泌科住院治疗的206例DF患者,按是否给予截趾治疗分为非截趾组(99例)和截趾组(107例)。比较两组患者年龄、性别、职业、糖尿病病程、DF病程、心脑血管病史、体质指数(BMI)、收缩压(SBP)、舒张压(DBP)、足背动脉闭塞程度、Wanger分级、空腹血糖(FBG)、糖化血红蛋白(Hb A1c)、胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、超敏C反应蛋白(hs-CRP)、总胆红素(TBIL)及白细胞计数(WBCC)等,logistic回归分析DF截趾的影响因素。结果截趾组患者的年龄、糖尿病病程、DF病程、SBP、FBG、Hb A1c、TC、LDL-C、hs-CRP、TBIL、WBCC、足背动脉闭塞程度及Wanger分级、心脑血管病的患病率均高于非截趾组,差异有统计学意义(P<0.05),而两组BMI、DBP、TG、HDL-C、性别及职业的差异无统计学意义(P>0.05)。logistic回归分析显示,糖尿病病程(P=0.022)、TC(P=0.042)、LDL-C(P=0.002)、hs-CRP(P=0.002)、WBCC(P=0.000)及Wanger分级(P=0.000)是影响患者截趾的独立危险因素,TBIL是保护因素(P=0.000)。结论糖尿病病程、TC、LDL-C、hs-CRP、WBCC及Wanger分级是DF患者截趾的危险因素,TBIL可能对患者有保护作用。

Objective To investigate the related risk factors of toe amputations in the patients with diabetic foot. Methods A total of 206 patients with DF who were hospitalized in the Department of Endocrinology of Fuyang People＇s Hospital from October 2013 to May2016 were divided into non-truncated group（ 99 cases） and truncated toe group（ 107 cases）. The general informations（ age,gender,occupation,diabetes course,diabetic foot course,cardiovascular history,BMI,SBP,DBP,degree of dorsal artery occlusion and Wanger classification） and biochemical characteristics（ FBG,Hb A1 c,TC,TG,LDL-C,HDL-C,hs-CRP,TBIL and WBCC） of each group were collected and analyzed. The related factors of DF toewere assessed by Logistic analysis. Results Compared to non-amputation group,the age,duration of diabetes mellitus,course of diabetic foot,SBP,FBG,Hb A1 c,TC,LDL-C,hs-CRP,TBIL,white blood cell（ WBC） count,degree of dorsal artery occlusion and Wanger classification were all higher than those of non-truncated group,and the prevalence of cardiovascular and cerebrovascular diseases was also significantly different（ P〈0. 05）,while BMI,DBP,TG,HDL-C,sex and occupation were similar（ P〈0. 05）. Logistic regression analysis showed that the course of diabetes mellitus（ P = 0. 022）,TC（ P = 0. 042）,LDL-C（ P =0. 002）,hs-CRP（ P = 0. 002）,WBCC（ P = 0. 000） and Wanger classification（ P = 0. 000） were related risk factors of amputation. TBIL（ P = 0. 000） was a protective factor. Conclusion The course of diabetes mellitus,TC,LDL-C,hs-CR,the count of WBC and Wanger classification are the risk factors of amputation,and TBIL may be one of the protective effects of amputations.