住院2型糖尿病患者糖尿病高危足筛查及影响因素分析

Identifying At-risk Foot and Associated Factors Among Hospitalized Patients with Type 2 Diabetes

目的调查住院2型糖尿病患者中糖尿病高危足的患病率及相关影响因素。方法对838例住院2型糖尿病患者进行高危足病筛查,用振动感觉阈值和踝肱指数评估并筛选出存在神经病变和/或血管病变的患者,即糖尿病高危足患者;并将其分为三类:单纯性神经病变、单纯性血管病变、神经血管混合性病变。用logistic回归模型评估其可能的影响因素。结果糖尿病高危足的患病率为30.6%。神经病变和血管病变具有类似的危险因素,包括年龄增长每20岁,发生神经病变的风险比[95%可信区间]为3.73[2.59-5.37],发生血管病变的风险比为4.01[1.98-8.11]);糖尿病病程≥10年的风险比分别为1.69[1.13-2.54],3.29[1.49-7.24];收缩压≥140 mmHg的风险比分别为1.96[1.31-2.93],2.90[1.38-6.10]。神经病变还与重度吸烟史(2.69[1.15-6.31])、超敏C反应蛋白水平升高(1.30[1.04-1.62])有关;血管病变还与高密度脂蛋白胆固醇水平偏低(3.42[1.31-8.96])、甘油三酯水平偏高(2.74[1.26-5.97])有关。结论住院2型糖尿病患者中糖尿病高危足患病率高;这可能与年龄增长、糖尿病病程延长、高血压、吸烟、炎症反应和脂代谢紊乱有关。

Objective To investigate the prevalence and associated factors of diabetic at-risk foot among hospitalized patients with type 2 diabetes.Methods 838 hospitalized patients with type 2 diabetes were screened for at-risk foot.Neural and vascular disorders were evaluated by assessing vibration perception thresholds and ankle brachial indexes(ABIs).Individuals with neural and/or vascular disorder were identified as at-risk patients and further classified into three subtypes:isolated neural disorder,isolated vascular disorder and mixed disorder.Potential associated factors were examined using logistic regression models.Results The prevalence of diabetic at-risk foot was 30.6%.Isolated neural and vascular disorders shared specific risk factors,including age per 20-year increment(odds ratio[95%confidence interval],3.73[2.59-5.37],4.01[1.98-8.11]),diabetic duration≥10 years(1.69[1.13-2.54],3.29[1.49-7.24])and systolic blood pressure≥140 mmHg(1.96[1.31-2.93],2.90[1.38-6.10]),respectively.In addition,isolated neural disorder was associated with heavy smoking history(2.69[1.15-6.31])and increased high-sensitivity C-reactive protein levels(1.30[1.04-1.62]),respectively.Isolated vascular disorder was linked with decreased HDL cholesterol levels(3.42[1.31-8.96])and increased triglycerides levels(2.74[1.26-5.97]),respectively.Conclusion Diabetic at-risk foot is epidemic among hospitalized patients with type 2 diabetes.Aging,long-term diabetes,hypertension,smoking,inflammatory response and dyslipidemia may be associated with the prevalence of diabetic at-risk foot.