下肢血管超声参数联合炎症指标对糖尿病足溃疡负压封闭引流术后创面愈合的预测价值

Predictive Value of Ultrasound Parameters of Lower Limb Blood Vessels Combined with Inflammatory Indicators for Wound Healing After Negative Pressure Closure Drainage of Diabetes Foot Ulcer

目的 分析下肢血管超声参数联合炎症指标对糖尿病足溃疡(DFU)患者负压封闭引流(VSD)术后创面愈合的预测价值。方法 回顾性分析我院烧伤整形科2018年7月至2022年10月收治的110例DFU患者临床资料,所有患者均采用VSD治疗,术后约2周根据创面愈合评价标准评估创面愈合情况,分析影响患者创面愈合的危险因素。结果术后约2周患者愈合38例、好转51例、无效21例,创面愈合有效率为80.91%(89/110)。创面愈合有效与无效患者间Wagner分级、CRP、NLR、ABI、管腔内径、BMI、ALB和Hb水平比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,CRP>60.22 mg/L、NLR>8.85、ABI≤0.605、管腔内径≤1.505 mm是导致创面愈合无效的独立危险因素(P<0.05)。CRP、NLR、ABI、管腔内径单独预测创面愈合的ROC曲线下面积分别为0.753、0.771、0.813、0.716,4项指标联合预测的曲线下面积为0.881,明显高于单项指标。将CRP>60.22 mg/L、NLR>8.85、ABI≤0.605、管腔内径≤1.505 mm各赋值为1分,110例患者中评估为0分患者创面愈合有效率为100.00%(39/39),1分为96.55%(28/29),2分为77.78%(14/18),3分为45.45%(5/11),4分为23.08%(3/13)。结论 术前CRP、NLR、ABI、管腔内径4项指标有助于预测DFU患者VSD术后创面愈合效果,联合评估能够明显提高预测价值。

Objective To analyze predictive value of ultrasound parameters of lower limb blood vessels combined with inflammatory indicators for wound healing after vacuum sealing drainage(VSD)in patients with diabetes foot ulcer(DFU).Methods Retrospectively selected 110 DFU patients admitted to our Burn and Plastic Surgery Department from July 2018 to October 2022 for the study.All patients were treated with VSD.The wound healing was evaluated according to the wound healing evaluation criteria about two weeks after operation,and clinical data of patients were collected,and risk factors affecting the wound healing were analyzed.Results About 2 weeks after operation,38 cases were healed,51 cases were improved,and 21 cases were ineffective.The effective rate of wound healing was 80.91%(89/110).There were significant differences in Wagner grade,CRP,NLR,ABI,lumen diameter,BMI,ALB and Hb between patients with effective and ineffective wound healing(P<0.05).Multivariate Logistic regression analysis showed that CRP>60.22 mg/L,NLR>8.85,ABI≤0.605,lumen diameter≤1.505 mm were independent risk factors leading to ineffective wound healing(P<0.05).The area under the ROC curve predicted by CRP,NLR,ABI and lumen diameter alone for wound healing was 0.753,0.771,0.813 and 0.716,respectively.The area under the curve predicted by the combination of four indicators was 0.881,which was significantly higher than the single indicator.The values of CRP>60.22 mg/L,NLR>8.85,ABI≤0.605,and lumen diameter≤1.505 mm were assigned as 1 point.The effective rate of wound healing was 100.00%(39/39),96.55%(28/29),77.78%(14/18),45.45%(5/11),and 23.08%(3/13)in 110 patients.Conclusion The preoperative CRP,NLR,ABI and lumen diameter would be helpful to predict the wound healing effect of DFU patients after VSD,and the combined evaluation can significantly improve the predictive value.