住院糖尿病高危足患者临床特征及预后分析

Clinical characteristics and prognosis analysis of diabetic inpatients with high-risk diabetic foot

目的通过分析糖尿病高危足患者临床资料及预后,为糖尿病足溃疡的预防提供临床依据。方法对2012年1月1日-2018年12月31日在四川大学华西医院住院的糖尿病高危足患者进行了回顾性分析,按照既往是否有足溃疡或者截肢(趾)史,分为高风险组和低风险组。比较两组患者的临床特征,并随访患者从出院至2021年1月31日,对患者生存及溃疡复发或新发状况进行了评估。结果最终纳入患者123例,高风险组患者29例,低风险组患者94例。两组患者的糖尿病病程、吸烟史、饮酒史、受教育程度、接受正规治疗比例、定期监测血糖比例、体质量指数、合并糖尿病周围神经病变、胼胝、足畸形、糖尿病肾病、糖尿病视网膜病变、糖尿病心脏自主神经病变、糖尿病胃肠自主神经病变、高血压、冠心病的比例和实验室检查结果差异无统计学意义(P>0.05)。高风险组的女性比例(51.7%vs.29.8%)、年龄[(69.8±10.3)vs.(64.4±11.3)岁]、合并下肢动脉病变比例(62.1%vs.34.4%)、合并高尿酸血症比例(27.6%vs.10.6%)高于低风险组(P<0.05)。在随访(67±20)个月后,有25.8%的患者溃疡复发或新发,有24.2%的患者死亡,死亡原因最常见为糖尿病并发症(43.8%)。患者总体1、3、5年累积死亡率分别为4.5%、12.7%、20.6%;3年、5年复发或新发溃疡率分别为8.3%、18.2%。低风险组和高风险组患者5年复发或新发溃疡率分别为10.3%、40.3%,两组溃疡复发状况存在差异(P=0.004)。结论相比无溃疡或截肢史的糖尿病高危足患者,有溃疡或截肢史患者合并下肢动脉病变及高尿酸血症的比例更高。有溃疡或截肢史患者的复发或新发溃疡风险高于既往无溃疡或截肢史患者。

Objective To provide a clinical basis for the prevention of diabetic foot ulcers by analyzing the clinical data and prognosis of high-risk diabetic foot patients.Methods A retrospective analysis was performed on highrisk diabetic foot patients who were hospitalized in West China Hospital of Sichuan University between January 1,2012and December 31,2018.Patients were divided into high-risk group and low-risk group according to whether they had a history of foot ulcer or amputation.The clinical characteristics of the two groups of patients were compared.The patients were followed up from hospital discharge to January 31,2021,and their survival and ulcer recurrence or newonset status were evaluated.Results Finally,123 patients were included,including 29 patients in the high-risk group and94 patients in the low-risk group.There was no statistical difference in the duration of diabetes,smoking history,drinking history,education level,proportion of receiving regular treatment,proportion of regular blood glucose monitoring,body mass index,proportion of diabetic peripheral neuropathy,callus,foot deformity,diabetic nephropathy,diabetic retinopathy,diabetic cardiac autonomic neuropathy,diabetic gastrointestinal autonomic neuropathy,hypertension,coronary heart disease and laboratory test results between the two groups(P>0.05).The proportion of women(51.7%vs.29.8%),age[(69.8±10.3)vs.(64.4±11.3)years],proportion of lower extremity arterial disease(62.1%vs.34.4%),proportion of hyperuricemia(27.6%vs.10.6%)in the high-risk group were higher than the low-risk group(P<0.05).After follow-up(67±20)months,25.8%of the patients had ulcer recurrence or new onset,and 24.2%of the patients died.The most common cause of death was diabetes complications(43.8%).The overall 1-,3-,and 5-year cumulative mortality rates of the patients were 4.5%,12.7%,and 20.6%,respectively.The 3-and 5-year recurrence or new ulcer rates were 8.3%and18.2%,respectively.The 5-year recurrence or new ulcer rates in the low-risk group and high-risk group were 10.3%and 40.3%,respectively,and there was a difference in ulcer recurrence between the two groups(P=0.004).Conclusions Compared with high-risk diabetic foot patients without ulcer or amputation,patients with a history of ulcer or amputation have higher rates of lower extremity arterial disease and hyperuricemia.Patients with a history of ulceration or amputation have a higher risk of recurrent or new ulceration than patients without a history of ulceration or amputation.