糖尿病足坏死性软组织感染的危险因素评估

Risk factors for diabetic foot complicated by necrotizing soft tissue infection

目的明确糖尿病足坏死性软组织感染(NSTI)的危险因素。方法回顾性分析2010年1月至2017年12月经北京大学第一医院糖尿病足防治中心收治的糖尿病足感染(DFI)患者的病历资料,按照糖尿病足国际工作组(IWGDF)指南对所有患者进行感染程度分级,根据是否存在NSTI分为NSTI组与非NSTI组,利用单因素分析和Logistic回归分析明确NSTI的危险因素,利用受试者工作特征曲线(ROC)确定危险因素的临界值。结果共141例DFI患者纳入本研究,IWGDF分级为轻度、中度、重度感染患者分别占14.9%、61.0%、24.1%。NSTI组31例,非NSTI组110例,DFI中NSTI的发生率为22.0%。单因素分析结果显示,NSTI组年龄更低,溃疡病程更短,重度感染比率、大截肢率更高,糖化血红蛋白、白细胞计数(WBC)、C-反应蛋白(CRP)水平更高,血红蛋白、血清白蛋白值更低(P<0.05)。Logistic回归分析结果显示,WBC、CRP是NSTI的危险因素(P<0.05),且临界值分别为12.00×10^(9)/L、100 mg/L。结论DFI患者合并NSTI不少见,应常规按IWGDF指南对DFI患者进行感染程度分级,对于重度感染或是WBC≥12.00×10^(9)/L、CRP≥100 mg/L的DFI患者,应及时评估创面情况,警惕NSTI可能。

Objective To identify the risk factors for diabetic foot complicated by necrotizing soft tissue infection(NSTI).Methods Based on retrospective chart review,we presented all cases of diabetic foot infection(DFI)patients treated at Diabetic Foot Treatment&Preventive Center of Peking University First Hospital from January 2010 to December 2017.The severity of DFI was assessed for all the patients using the international working group on the diabetic foot(IWGDF)classification scheme,then the patients were divided into either an NSTI group or a non-NSTI group.Both univariate and Logistic regression analyses were performed,and receiver operating characteristic curve analysis was used to identify the cutoff values of the risk factors.Results A total of 141 patients were enrolled in this study,and the rates of mild,moderate,and severe infections were 14.9%,61.0%,and 24.1%,respectively.There were 31 patients in the NSTI group and 110 patients in the non-NSTI group.The incidence of NSTI in DFI patients was 22.0%.Univariate analysis showed that the age of patients in NSTI group was younger,the duration of diabetic foot ulcer was shorter,the infection was more severe,the major amputation rate was higher,glycosylated hemoglobin,C-reactive protein(CRP),and white cell count(WBC)were higher,and albumin and hemoglobin were lower(P<0.05).Multivariate Logistic regression analysis showed that WBC and CRP were the risk factors for NSTI(P<0.05),and the cutoff values were 12.00×10^(9)/L and 100 mg/L,respectively.Conclusion It is not uncommon for DFI patients with NSTI.The severity of DFI should be routinely assessed according to the IWGDF guidelines.Clinicians should be alert to the possibility of NSTI for patients with severe infections or WBC≥12.00×10^(9)/L or CRP≥100 mg/L.