糖尿病足截肢危险因素社区预测模型探讨

Predictive factors of diabetic foot amputation for community medical center

目的利用社区(乡村)医务所可获取的糖尿病足(DF)疾病信息,分析截肢结局的危险因素,以便早发现基层高危DF并及早专科治疗。方法回顾性研究2018年1月至2021年1月期间收治于喀什地区第一人民医院的403例DF患者,分析截肢组与非截肢组临床信息,通过Cox比例风险模型分析截肢风险,确定DF截肢危险因素。结果病程、既往DF手术史、血糖控制情况、吸烟、Wagner分级、踝肱指数(ABI)和发热等在两组间差异有统计学意义(P<0.05)。多因素Cox回归结果显示,糖尿病超过10年(HR=2.439,95%CI:1.180-5.050,P=0.016)、DF手术史(HR=2.403,95%CI:1.540-3.745,P<0.001)、血糖控制差(HR=1.879,95%CI:1.259-2.898,P=0.002)、吸烟(HR=1.644,95%CI:1.085-2.487,P=0.019)、Wagner 3-5级(HR=1.980,95%CI:1.314-2.985,P=0.001)以及低血红蛋白(HR=1.027,95%CI:1.011-1.044,P=0.001)是截肢的危险因素;糖尿病超过18年(HR=2.544,95%CI:1.055-7.874,P=0.037)、DF手术史(HR=2.525,95%CI:1.757-4.608,P=0.034)是DF大截肢的危险因素。结论根据本研究建立的Cox比例风险模型,DF手术史、糖尿病病程、血糖控制情况、吸烟、Wagner分级、ABI及血红蛋白等廉价、易获取指标,可作为DF截肢的预警指标,可在基层、社区医疗机构采纳。

Objective To analyze risk factors for amputation using information on diabetic foot(DF)at community clinics for early detection of high-risk DF at the grassroots levels and early specialist treatment.develop cost-effective and extendible method for early detection and treatment,this study evaluated risk factors for diabetic foot(DF)amputation using easily accessed data from community medical centers.Methods A total of 403 DF patients admitted to First People′s Hospital of Kashi Prefecture between Jan 2018 and Jan 2021 were enrolled.They were divided into amputation and non-amputation group according to treatment and prognosis.Multivariate cox regression and K-M method were performed to analyze the factors influencing(major)amputation.Results The significant differences were showed on duration of diabetes mellitus(DM),DF surgery history,blood glucose management,smoking,fever,Wagner grade,ankle brachial index(ABI),hemoglobin(HB)between two groups(P<0.05).The multivariate cox regression showed that DM>10 years(HR=2.439,95%CI:1.180-5.050,P=0.016),DF surgery history(HR=2.403,95%CI:1.540-3.745,P<0.001),uncontrolled blood glucose(HR=1.879,95%CI:1.259-2.898,P=0.002),smoking(HR=1.644,95%CI:1.085-2.487,P=0.019),Wagner grade 3~5(HR=1.980,95%CI:1.314-2.985),P=0.001 and hypo-HB(HR=1.027,95%CI:1.011-1.044,P=0.001)were risk factors of amputation.Additionally,DM>18years(HR=2.544,95%CI:1.055-7.874,P=0.037)and DF surgery history(HR=2.525,95%CI:1.757-4.608,P=0.034)were risk factors of major amputation.Conclusion DF patients from community medical centers with long DM duration,DF surgery history,uncontrolled blood glucose,smoking,Wagner grade 3-5,hypo-HB and ABI<0.9 should be given more attention to prevent probable amputation.