HALP评分联合预后营养指数预测老年2型糖尿病患者发生糖尿病足的价值研究

Clinical significance of HALP score combined with prognosis nutritional index in predicting diabetic foot ulcers in elderly patients with type 2 diabetes mellitus

目的探讨营养预后指数(prognostic nutritional index,PNI)联合血红蛋白-白蛋白-淋巴细胞-血小板(hemoglobin-albumin-lymphocyte-platelet,HALP)评分对老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者发生糖尿病足(diabetic foot,DF)的预测价值。方法回顾性分析2016年1月至2022年12月濮阳市安阳地区医院就诊的60岁及以上(老年)的T2DM患者的临床资料。根据T2DM患者有无糖尿病足,将老年T2DM患者分为糖尿病足组和非糖尿病足组,比较两组间PNI及HALP评分的差异情况。采用单因素和多因素logistic回归探讨老年T2DM患者发生糖尿病足的危险因素。受试者工作曲线(reciver operating characteristic,ROC)评价PNI、HALP评分及二者联合预测老年T2DM患者发生糖尿病足的价值。结果糖尿病足组的HALP评分(35.86±11.05 vs.52.63±15.76)和PNI(43.92±3.10 vs.48.48±3.53)水平明显低于非糖尿病足组,差异具有统计学意义(P<0.05)。此外,年龄[OR(95%CI):1.101(1.022~1.185),P<0.05]、BMI[OR(95%CI):1.447(1.325~1.615),P<0.05]、糖尿病病程[OR(95%CI):1.017(1.005~1.028),P<0.05]和周围神经病变[OR(95%CI):11.757(3.379~40.902),P<0.05]是老年T2DM患者发生糖尿病足的独立危险因素;HALP评分[OR(95%CI):0.908(0.881~0.936),P<0.05]和PNI[OR(95%CI):0.704(0.636~0.779),P<0.05]是老年T2DM患者发生糖尿病足的保护因素,且PNI[OR(95%CI):0.720(0.591~0.877),P<0.05]是老年T2DM患者糖尿病足发生的独立保护因素。ROC曲线结果显示,年龄[AUC(95CI%):0.685(0.615~0.755),P<0.05]、BMI[AUC(95CI%):0.756(0.687~0.824),P<0.05]、糖尿病病程[AUC(95CI%):0.679(0.596~0.761),P<0.05]、周围神经病变[AUC(95CI%):0.737(0.663~0.811),P<0.05]、HALP评分[AUC(95CI%):0.807(0.748~0.867),P<0.05]和PNI[AUC(95CI%):0.839(0.789~0.890),P<0.05]均可预测老年T2DM患者糖尿病足的发生,以PNI最佳。此外,HALP评分联合PNI能够更好的预测老年T2DM患者糖尿病足的发生,其AUC为0.843(0.792~0.893)。结论HALP评分和PNI是老年T2DM患者发生糖尿病足的有效预测指标,且二者联合具有更好的预测价值。建议临床医生给予PNI和HALP更多的关注,为老年T2DM患者提供个性化管理和诊治。

Objective To explore the predictive value of nutritional prognostic index(PNI)combined with hemoglobin-albumin-lymphocyte-platelet(HALP)score in the occurrence of diabetic foot(DF)in elderly type 2 diabetes mellitus(T2DM)patients.Methods A retrospective analysis was conducted on the clinical data of T2DM patients aged 60 years and above who visited Anyang District Hospital in Puyang City from January 2016 to December 2022.According to the presence or absence of diabetic foot,elderly T2DM patients were divided into diabetic foot group and non-diabetic foot group,and the differences in PNI and HALP scores between the two groups were compared.univariate and multivariate logistic regression were used to explore the risk factors for diabetic foot in elderly T2DM patients.The receiver operating characteristic(ROC)is used to evaluate the value of PNI,HALP scores,and their combination in predicting the occurrence of diabetic foot in elderly T2DM patients.Results The HALP score(35.86±11.05 vs 52.63±15.76)and PNI(43.92±3.10 vs 48.48±3.53)levels in the diabetic foot group were significantly lower than those of the non-diabetic foot group,with statistically significant differences(P<0.05).In addition,age[OR(95%CI):1.101(1.022-1.185),P<0.05],BMI[OR(95%CI):1.447(1.325-1.615),P<0.05],duration of diabetes[OR(95%CI):1.017(1.005-1.028),P<0.05]and peripheral neuropathy[OR(95%CI):11.757(3.379-40.902),P<0.05]are independent risk factors for diabetic foot in elderly T2DM patients;The HALP score[OR(95%CI):0.908(0.8810.936),P<0.05]and PNI[OR(95%CI):0.704(0.6360.779),P<0.05]are independent protective factors for the occurrence of diabetic foot in elderly T2DM patients,and PNI[OR(95%CI):0.720(0.5910.877),P<0.05]are independent protective factors for the occurrence of diabetic foot in elderly T2DM patients.ROC curve results showed that age[AUC(95CI%):0.685(0.615-0.755),P<0.05],BMI[AUC(95CI%):0.756(0.687-0.824),P<0.05],course of diabetes[AUC(95CI%):0.679(0.596-0.761),P<0.05],peripheral neuropathy[AUC(95CI%):0.737(0.663-0.811),P<0.05]The HALP score[AUC(95CI%):0.807(0.748-0.867),P<0.05]and PNI[AUC(95CI%):0.839(0.789-0.890),P<0.05]can both predict the occurrence of diabetic foot in elderly T2DM patients,with PNI being the best.In addition,the combination of HALP score and PNI can better predict the occurrence of diabetic foot in elderly T2DM patients,with an AUC of 0.843(95%CI:0.792-0.893).Conclusion HALP score and PNI are effective predictive indicators for the occurrence of diabetic foot in elderly T2DM patients,and the combination of the two has better predictive value.It is recommended that clinical doctors pay more attention to HALP score and PNI to provide personalized management and treatment for elderly T2DM patients.