糖尿病足患者Wanger分级及抗生素用药频度的相关危险因素分析

Risk factors analysis for Wanger classification and antibiotic defined daily doses in patients with diabetic foot

目的:探讨住院糖尿病足患者Wanger分级及抗生素用药频度的相关危险因素。方法:选取2013年7月至2016年9月在东南大学附属中大医院就诊的429例糖尿病足患者为研究对象,采用回顾性分析研究方法,收集患者年龄、相关生化指标、抗生素使用相关情况、病原菌培养及多药耐药情况、基础合并疾病、糖尿病足Wanger分级以及出院时溃疡预后情况等指标,进行多元线性回归和有序Logistic回归分析。结果:根据纳入排除标准,最后筛选出280例符合要求的病例。有序Logistic回归分析发现,年龄(P<0.01)、血清白蛋白(P<0.01)、糖尿病病程(P<0.05)、双下肢血流动力学评估情况(P<0.01)为糖尿病足Wanger分级的危险因素;多元线性回归分析发现,年龄(P<0.01)、合并肾脏疾病(P<0.05)、血清白蛋白(P<0.01)为抗生素用药频度的危险因素。结论:年龄相对小、血清白蛋白水平低、糖尿病病程长、双下肢血流动力学评估情况差的患者足病Wanger分级更高;而年龄相对小、血清白蛋白水平低、未合并肾脏疾病的糖尿病足患者抗生素用药频度大。

Objective: To analyze the risk factors of Wanger classification and antibiotic defined daily doses(DDDs) in hospitalized diabetic foot patients. Methods: 429 patients with diabetic foot in Zhongda Hospital Affiliated to Southeast University from July 2013 to September 2016 were selected as the subjects. The basic information of age, biochemical index, antibiotic utilization, pathogen culture and multidrug resistance, complication, diabetic foot, and prognosis of ulcer at discharge were collected by retrospective analysis. Multiple linear regression and ordered Logistic regression were used to analyze the data. Results: According to inclusion and exclusion criteria, 280 eligible cases were finally included. Ordered Logistic regression analysis showed that age(P<0.01), serum albumin(P<0.01), duration of diabetes mellitus(P<0.05) and hemodynamic assessment of both lower limbs(P<0.01) were risk factors for diabetic foot classification;multiple linear regression analysis showed that age(P<0.01), kidney disease(P<0.05) and serum albumin(P<0.01) were the related risk factors of DDDs of antibiotics. Conclusion: Young age, low serum albumin level, long course of diabetes, and poor hemodynamic assessment of both lower extremities are risk factors for deteriorated foot disease. Diabetic foot patients with young age, low serum albumin level and no kidney disease tend to have greater intensity of antibiotic use.