糖尿病足溃疡患者下肢截肢的预测因素

Predictive Factors of Lower Limb Amputation in Patients with Diabetic Foot Ulcer

目的预测糖尿病足溃疡患者接受下肢截肢术的风险。方法该研究随访了2019年5月—2021年4月入住该院烧伤科的68例可能接受下肢截肢术的糖尿病足患者,直至出院或死亡。记录人口统计学和糖尿病相关信息及足部溃疡特征。在进行相关的实验室和影像学检查的同时,对患者进行周围神经病变、周围动脉疾病和医学合并症的评估。研究终点为溃疡愈合、下肢截肢术、住院时间和病死率。结果在随访期间有24例受试者(35.29%)接受下肢截肢术。下肢截肢术的单因素预测因素是溃疡持续时间超过1个月、外周动脉疾病、Wagner评分≥4、白细胞增多和骨髓炎,伤口感染和蛋白尿。在多元回归分析中,只有3个变量成为下肢截肢术的重要独立预测指标,包括溃疡持续时间超过1个月(OR=10.29,95%CI:4.049~26.128)、外周动脉疾病(OR=2.84,95%CI:1.524~5.109)和骨髓炎(OR=5.58,95%CI:2.933~10.780)。结论溃疡持续时间超过1个月,外周动脉疾病,Wagner评分≥4,蛋白尿、白细胞增多,伤口感染和骨髓炎是糖尿病足住院患者接受下肢截肢术的重要预测指标。及时注意这些危险因素可能会降低患者截肢率。

Objective To predict the risk of lower extremity amputation in patients with diabetic foot ulcers.Methods The study followed up 68 diabetic foot patients who were admitted to the burn department of the hospital from May 2019 to April 2021,who may undergo lower limb amputation until they were discharged or died.Record demographic and diabetes-related information and characteristics of foot ulcers.While carrying out relevant laboratory and imaging examinations,patients were evaluated for peripheral neuropathy,peripheral arterial disease,and medical comorbidities.The study endpoints were ulcer healing,lower limb amputation,length of hospital stay,and fatality rate.Results During the follow-up period,24 subjects(35.29%)underwent lower limb amputation.The univariate predictors of lower limb amputation were ulcer lasting longer than 1 month,peripheral arterial disease,Wagner score≥4,leukocytosis and osteomyelitis,wound infection and proteinuria was also an important predictor.In the multiple regression analysis,only three variables became important independent predictors of lower extremity amputation,including ulcer lasting more than 1 month(OR=10.29,95%CI:4.049-26.128),peripheral artery disease(OR=2.84,95%CI:1.524-5.109)and whether there was osteomyelitis(OR=5.58,95%CI:2.933-10.780).Conclusion Ulcer lasting longer than 1 month,peripheral arterial disease,Wagner score≥4,proteinuria,leukocytosis,wound infection and osteomyelitis are important predictors of lower extremity amputation in hospitalized diabetic foot patients.Timely attention to these risk factors may reduce the patient's amputation rate.