| 不同肾功能状态糖尿病足溃疡住院患者临床特点和预后分析 |
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| 引用本文： | 陈大伟,龚洪平,任妍,李燕,陈利鸿,唐薇薇,高赟,王椿,冉兴无.不同肾功能状态糖尿病足溃疡住院患者临床特点和预后分析[J].四川大学学报(医学版),2023,54(1):165-170. |
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| 作者姓名： | 陈大伟 龚洪平 任妍 李燕 陈利鸿 唐薇薇 高赟 王椿 冉兴无 |
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| 作者单位： | 1.四川大学华西医院 内分泌代谢科 糖尿病足诊治中心 （成都 610041） |
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| 基金项目： | 四川省科技厅项目（No. 2021JDKP0044、No. 2021YFS0014）和四川大学华西医院学科发展1.3.5工程项目（No. ZYGD18025）资助 |
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| 摘 要： | 目的 探讨不同肾功能状态下糖尿病足溃疡住院患者的临床特点及预后。 方法 采用回顾性分析方法，将962例糖尿病足溃疡住院患者按不同肾功能状态分为3组，分别比较各组临床特点差异。同时，对患者进行门诊或者电话随访，分析患者预后状态及死亡危险因素。 结果 临床特点分析:相对于正常及轻度肾功能损害组，中、重度肾功能损害组糖尿病病程较长（P<0.001）； Wagner分级4级患者比例较高（P均<0.05）；合并高血压、冠心病、外周动脉病变比例较高（P均<0.05）；糖化血红蛋白、血红蛋白水平较低（P均<0.05）；中性粒细胞比例、降钙素原水平较高（P均<0.05）。其中，中度肾功能损害组年龄较大（P<0.001）,踝肱指数较低（P<0.001）；重度肾功能损害组Wagner分级3级和5级患者比例更高（P均<0.05）。预后分析:通过门诊及电话随访了748例患者，中位随访时间41月，其中239例患者死亡，全因死亡率为31.9%，3组的死亡率分别为25.8%、46.2%（P<0.001）、59.4%（P<0.001），中重度肾功能损害组生存率明显低于正常及轻度肾功能损害组（P均<0.001）。单因素Cox回归分析显示年龄、合并冠心病、合并外周动脉病变、肾功能程度损害、足溃疡Wagner分级为4～5级与全因死亡相关。多因素Cox回归分析显示中重度肾功能损害为糖尿病足溃疡患者全因死亡的独立危险因素（P<0.001）。 结论 随着糖尿病患者肾功能损害加重，伴DFU患者表现出更复杂的临床特点、更高的心血管事件风险和更高的死亡率。预防肾脏损害和足溃疡发生，关注中重度肾功能损害伴足溃疡患者心血管风险，降低死亡率是非常必要的。
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| 关 键 词： | 糖尿病足 足溃疡 肾功能试验 死亡率 危险因素 |
| 收稿时间： | 2022-09-05 |
Clinical Characteristics and Prognosis of Diabetic Foot Ulcers Patients of Different Renal Function Statuses |
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| CHEN Da-wei,GONG Hong-ping,REN Yan,LI Yan,CHEN Li-hong,TANG Wei-wei,GAO Yun,WANG Chun,RAN Xing-wu.Clinical Characteristics and Prognosis of Diabetic Foot Ulcers Patients of Different Renal Function Statuses[J].Journal of West China University of Medical Sciences,2023,54(1):165-170. |
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| Authors: | CHEN Da-wei GONG Hong-ping REN Yan LI Yan CHEN Li-hong TANG Wei-wei GAO Yun WANG Chun RAN Xing-wu |
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| Affiliation: | 1.Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China |
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| Abstract: | Objective To explore the clinical characteristics and the prognosis of diabetic foot ulcers (DFU) inpatients of different renal function statuses. Methods A retrospective analysis of 962 inpatients with DFU was conducted. The patients were divided into three groups according to their renal function statuses, and the clinical characteristics of the three groups were compared to identify differences. In addition, the patients were followed up in outpatient clinics or by telephone and their prognostic status and risk factors for death were analyzed. Results Analysis of the clinical characteristics showed that, compared with diabetic patients with normal renal function or mild renal function impairment, diabetic patients with moderate and severe renal function impairment had a longer course of disease (P<0.001). Patients with foot ulcers of Wagner grade 4 predominates the moderate and severe renal function impairment groups (P<0.05). Patients in the moderate and severe renal function impairment groups had a relatively higher proportion of comorbidities, including hypertension, coronary heart disease, and peripheral arterial disease (P<0.05). These patients had relatively lower levels of glycosylated hemoglobin and hemoglobin (all P<0.05) and relatively higher levels of neutrophil ratio and procalcitonin (all P<0.05). Of the two groups, patients in the moderate renal function impairment group were older (P<0.001) and had lower ankle-brachial index (P<0.001). The severe renal function impairment group had a higher proportion of patients with foot ulcers of Wagner grades 3 and 5 (all P<0.05). For the purpose of conducting prognostic analysis, 748 patients were followed up in outpatient clinics or by telephone for a median length of 41 months. Among them, 239 died. The all-cause mortality was 31.9%, and the mortality in the three groups was 25.8%, 46.2% (P<0.001), and 59.4% (P<0.001), respectively. The survival rate of patients in the moderate and severe renal function impairment groups was significantly lower than those in the normal renal function and mild renal function impairment groups (P<0.001). Univariate Cox regression analysis showed that age, concomitant coronary heart disease and peripheral arterial disease, degree of renal function impairment, and foot ulcers of Wagner grade 4 and 5 were associated with all-cause deaths. Furthermore, multivariate Cox regression analysis showed that moderate and severe renal function impairment was an independent risk factor for all-cause deaths in DFU patients (P<0.001). Conclusions As renal function impairment worsens, patients with DFU present clinical characteristics of greater complexity, higher risks of cardiovascular events, and higher mortality. It is essential to prevent kidney damage and foot ulcers, to pay attention to the cardiovascular risks of DFU patients with moderate and severe renal function impairment, and to reduce mortality. |
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