2型糖尿病足截肢危险因素及血脂综合指数对下肢动脉钙化的预测效能

Risk factors for amputation of type 2 diabetic foot and predictive efficacy of lipid composite index on lower extremity arterial calcification

目的探讨2型糖尿病足患者截肢的危险因素及血脂综合指数(LCI)对2型糖尿病足患者并发下肢动脉钙化(LEAC)的预测效能。方法收集2018年3月至2021年4月于秦皇岛市第一医院诊治的80例2型糖尿病足患者的临床资料,所有患者入院后均行彩色多普勒超声检查,根据是否发生LEAC将患者分为钙化组(n=31)和非钙化组(n=49)。比较钙化组与非钙化组患者的血脂相关指标[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)],并计算LCI。采用受试者操作特征(ROC)曲线分析血脂相关指标对2型糖尿病足患者并发LEAC的预测效能。采用多因素Logistic回归模型分析2型糖尿病足患者截肢的危险因素。结果钙化组患者的TG水平、TC水平、LDL-C水平、LCI均明显高于非钙化组患者,而HDL-C水平明显低于非钙化组患者,差异均有统计学意义(P<0.01)。ROC曲线分析结果显示,LCI对2型糖尿病足患者并发LEAC的预测效能最高。LCI预测2型糖尿病足患者并发LEAC的曲线下面积(AUC)为0.899,高于TG、TC、LDL-C、HDL-C单独预测的AUC(P<0.05)。单因素分析结果显示,截肢患者的年龄、TG水平、TC水平、LDL-C水平、LCI、多重耐药菌感染率、Wagner分级≥3级的患者比例均高于未截肢患者,溃疡面积大于未截肢患者,而HDL-C水平低于未截肢患者,差异均有统计学意义(P<0.05)。截肢患者与未截肢患者的性别比较,差异无统计学意义(P>0.05)。多因素回归分析结果显示,年龄较高、LCI过高、Wagner分级≥3级均是2型糖尿病足患者发生截肢的危险因素(P<0.05)。结论LCI能够有效评估2型糖尿病足患者的LEAC情况,年龄较高、LCI过高、Wagner分级≥3级的2型糖尿病足患者存在较高的截肢风险。

Objective To investigate the risk factors of amputation in patients with type 2 diabetic foot and the predictive power of lipid comprehensive index(LCI)for lower extremity arterial calcification(LEAC)in patients with type 2 diabetic foot.Method The clinical data of 80 patients with type 2 diabetic foot who were diagnosed and treated in First Hospital of Qinhuangdao from March 2018 to April 2021 were collected.All patients underwent color Doppler ultrasonography after admission.Patients were divided into the calcification group(n=31)and the non-calcification group(n=49)according to the occurrence of LEAC.The blood lipid related indicators[triglyceride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C)]in the calcification group and the non-calcification group were compared,and their LCI were counted.The receiver operating characteristic(ROC)curve was used to analyze the predictive power of blood lipid related indicators in patients with type 2 diabetic foot complicated by LEAC.Multivariate Logistic regression was used to analyze the risk factors of amputation in patients with type 2 diabetic foot.Result The levels of TG,TC,LDL-C,and LCI in the calcification group were higher than those in the non-calcification group,while the HDL-C level was lower than that in the non-calcification group,the differences were statistically significant(P<0.05).The results of the ROC curve analysis showed that LCI had the highest predictive power for LEAC in patients with type 2 diabetic foot.The area under the curve(AUC)of LCI for predicting type 2 diabetic foot patients complicated with LEAC was 0.899,which was higher than the AUC predicted by TG,TC,LDL-C,and HDL-C alone(P<0.05).The results of the univariate analysis showed that the age,TG level,TC level,LDL-C level,LCI,multidrug-resistant bacterial infection rate,and Wagner grade≥3 in patients with amputation were higher than those in patients without amputation,the ulcer area was larger than that in patients without amputation,and the level of HDL-C was lower than that in patients without amputation,and the difference was statistically significant(P<0.05).There was no significant difference in gender between the amputated patients and the non-amputated patients(P>0.05).The results of multivariate regression analysis showed that older age,high LCI,and Wagner grade≥3 were all risk factors for amputation in patients with type 2 diabetic foot,and the differences were statistically significant(P<0.05).Conclusion LCI could effectively assess the LEAC of patients with type 2 diabetic foot.and patients suffering type 2 diabetic foot with older age,high LCI,and Wagner grade≥3 have a higher risk of amputation.