控制营养状态评分与糖尿病足溃疡患者截肢风险的相关性研究

Correlation Between Controlling Nutritional Status Scores and Amputation Risks in Patients with Diabetic Foot Ulcers

目的回顾性分析糖尿病足溃疡(diabetic foot ulcers,DFU)患者的临床特点及治疗结局,探讨控制营养状态(controlling nutritional status,CONUT)评分对DFU患者截肢风险及住院时间的影响。方法收集2016年1月1日–2018年12月31日中国人民解放军战略支援部队特色医学中心内分泌科收治的357例DFU患者,根据CONUT评分分为3组,0~1分为正常营养状态组(n=100)、2~4分为轻度营养不良组(n=164)、≥5为中重度营养不良组(n=93)。按是否截肢分为截肢组(n=110)与非截肢组(n=247)。比较不同CONUT评分患者的临床特征、截肢率、住院天数。采用logistic回归分析截肢的独立危险因素。结果DFU患者的总截肢率30.6%。在所有截肢中,大截肢(踝及踝以上截肢)占1.8%,小截肢占98.2%。轻度营养不良组和中重度营养不良组患者的截肢率是正常营养状态截肢率的1.5倍和3.0倍。Logistic回归分析显示中重度营养不良(CONUT评分5~12分)、白细胞计数、Wagner分级及踝肱指数是截肢的独立危险因素。结论CONUT评分与DFU患者的截肢密切相关,早期改善患者的营养状况,可降低截肢风险。

Objective To retrospectively analyze the clinical features and treatment outcomes of patients with diabetic foot ulcers(DFU),and to investigate the effect of controlling nutritional status(CONUT)scores on the amputation risks and hospital length-of-stay of DFU patients.Methods A total of 357 DFU inpatients admitted to the Department of Endocrinology,PLA Strategic Support Force Characteristic Medical Center between January 1,2016 and December 31,2018 were enrolled and analyzed retrospectively.Based on their CONUT scores,the patients were divided into 3 groups,a normal nutritional status group consisting of patients with CONUT scores 0-1(n=100),a mild malnutrition group consisting of patients with CONUT scores 2-4 scores(n=164),and a moderate-to-severe malnutrition group consisting of patients with CONUT scores≥5(n=93).According to whether they underwent amputation,patients were divided into an amputation group(n=110)and a non-amputation group(n=247).The clinical characteristics,amputation rate,and hospital length-of-stay were compared between groups with different CONUT scores.Logistic regression was conducted to analyze the independent risk factors of amputation.Results The total amputation rate of DFU patients was 30.6%.Among all amputations,the major amputation(above-the-ankle amputation)rate was 1.8%,and the minor amputation rate was 98.2%.The amputation rate in patients with mild and moderate-to-severe malnutrition were 1.5 and 3.0 times higher than those in the normal nutritional status group,respectively.Logistic regression analysis showed that the moderate-to-severe nutritional status(5-12 scores),white blood cell,Wagner classification and ankle-brachial index were independent risk factors for amputation.Conclusion CONUT score is closely associated with amputations in DFU patients.Improving the nutritional status of patients in the early stage could reduce the risk of amputation.