2型糖尿病患者并发足病及足溃疡加重危险因素分析

Risk factors analysis of foot disease and foot ulcer aggravation in patients with type 2 diabetes mellitus

目的探讨糖尿病足发生和溃疡加重的危险因素,为其预防、治疗和护理提供依据。方法回顾分析2017年12月-2018年10月在我院内分泌科接受治疗的156例2型糖尿病患者,以是否并发足病分为糖尿病组和糖尿病足组,各78例。记录两组患者相关资料,采用单因素分析及Logistic回归分析糖尿病足危险因素。糖尿病足组根据足溃疡程度进行Wagner分级,分析足溃疡加重的因素,并进行足溃疡程度影响因素有序多分类Logistic回归分析。结果通过单因素分析,糖尿病足组的年龄、病程、收缩压、中性粒细胞百分比、球蛋白、淋巴细胞百分比、淋巴细胞绝对值、白蛋白、性别、外伤感染、糖尿病周围血管病变、糖尿病周围神经病变与糖尿病组比较,差异有统计学意义(P<0.05);经Logistic回归分析,淋巴细胞百分比、球蛋白、性别、外伤感染、糖尿病周围血管病变为糖尿病足危险因素,糖尿病周围血管病变为最危险因素。糖尿病足溃疡程度与白蛋白、白球比、外伤感染有关,差异有统计学意义(P<0.05);经足溃疡程度影响因素有序多分类Logistic回归分析,年龄、收缩压、低密度脂蛋白胆固醇、外伤感染、周围血管病变是导致足溃疡加重的影响因素,外伤感染是主要影响因素。经Spearman相关分析,足溃疡程度与中性粒细胞百分比呈正相关,与白球比、白蛋白呈负相关(P<0.05)。结论早期关注年龄、收缩压、外伤感染、低密度脂蛋白胆固醇、周围血管病变、营养状态指标等因素可以为糖尿病足预防及溃疡加重提供参考依据。

Objective To explore the risk factors of diabetic foot and ulcer aggravation, and to provide basis for prevention, treatment and nursing. Methods Retrospective analysis of 156 patients with type 2 diabetes who were treated in our hospital from December 2017 to October 2018, 78 patients with diabetes were in the diabetic group, and 78 patients with diabetic foot were in the diabetic foot group. The data of the two groups were recorded. Univariate analysis and logistic regression were used to analyze the risk factors of diabetic foot. According to the degree of foot ulcer, Wagner classification was used to analyze the factors of aggravation of foot ulcer, and the ordered multi-class logistic regression analysis of the factors affecting the degree of foot ulcer was performed. Results The age, course of disease, systolic pressure, neutrophil percentage, globulin, lymphocyte percentage, absolute lymphocyte value and albumin of diabetic foot group were significantly different from those of diabetic foot group(P<0.05). The occurrence of diabetic foot was related to gender, traumatic infection, diabetic peripheral vascular disease and diabetic peripheral neuropathy(P<0.05). Logistic regression analysis showed that lymphocyte percentage, globulin, sex, traumatic infection, diabetic peripheral vascular disease were risk factors for diabetic foot, and diabetic peripheral vascular disease was the most risk factor. The degree of diabetic foot ulcer was related to albumin, albumin ratio and traumatic infection, and the difference was statistically significant(P<0.05). The influencing factors of foot ulcer were analyzed by logistic regression. Age, systolic pressure, low density lipoprotein cholesterol, traumatic infection and peripheral vascular lesions were the influencing factors of foot ulcer aggravation, and traumatic infection was the main influencing factor. Spearman correlation analysis showed that the degree of foot ulcer was positively correlated with the percentage of neutrophils, negatively correlated with the ratio of white globules and albumin(P<0.05). Conclusion Early attention to age, systolic blood pressure, traumatic infection, low density lipoprotein cholesterol, peripheral vascular lesions, nutritional status index and other related factors can provide reference for the prevention of diabetic foot and ulcer aggravation.