糖尿病足溃疡危险因素分析

观察23例糖尿病足溃疡患者的年龄、糖尿病病程、空腹血糖、血清总蛋白、血清白蛋白、血清肌酐、血清尿素氮及溃疡发生的位置,并与20例无溃疡糖尿病患者进行对比分析。结果显示：两组患者糖尿病病程、空腹血糖、血清总蛋白、血清白蛋白有显著性差异,年龄,血清肌酐、尿素氮、无显著性差异,糖尿病足溃疡患者右足溃疡发生率（86％）显著高于左足（39％）,双母趾溃疡发生率（65％）高于部位（35％）,但无显著性差异,结果提示：糖尿病程、高血糖、低蛋白血症及足部受力过多和压迫是糖尿病足溃疡发生的危险因素。     

糖尿病足溃疡感染多重耐药铜绿假单胞菌的危险因素及预后分析

目的 探讨糖尿病足溃疡（DFU）感染多重耐药铜绿假单胞菌（MDRPA）的危险因素及其对预后的影响. 方法 将117例DFU感染铜绿假单胞菌（PA）患者根据是否感染MDRPA分为非MDR-PA（N-MDRPA）组和MDRPA组,分析DFU感染MDRPA的危险因素及其对预后的影响. 结果 入院前抗生素应用史、入院前因同一溃疡住院史和骨髓炎是DFU患者感染MDRPA的独立危险因素.MDRPA组较N-MDRPA组截肢/趾率高（32.6％ vs 16.2％,P＜0.05）,治愈率低（20.9％vs41.9％,P＜0.05）. 结论 入院前抗生素应用史、入院前因同一溃疡住院史和骨髓炎是DFU患者感染MDRPA的独立危险因素.MDRPA可导致创面预后差,增加截肢/趾风险.     

老年糖尿病患者糖尿病视网膜病变的危险因素分析

目的探讨老年2型糖尿病患者糖尿病视网膜病变的患病率及相关危险因素。方法测定190例60岁及以上2型糖尿病患者糖化血红蛋白、胰岛素、C肽等各生化指标并检测眼底,根据眼底病变程度将患者分为糖尿病无视网膜病变(无病变组)、无增殖期视网膜病变(无增殖期组)及增殖期视网膜病变(增殖期组)3组,比较各组糖尿病病程及糖化血红蛋白等检测指标。结果无病变组103例,无增殖期组59例,增殖期组28例。3组糖尿病病程分别为(121.1±93.3)(、149.6±112.1)及(182.2±83.6)个月,差异有统计学意义(P<0.05);糖化血红蛋白分别为(8.7±2.3)、(9.7±2.1)及(9.5±1.8)%,差异有统计学意义(P<0.05);尿白蛋白(56.0±185.6)、(234.2±535.1)及(229.9±513.9)mg/L,(P<0.01)。Logistic回归结果显示糖尿病病程、尿白蛋白和糖化血红蛋白是糖尿病视网膜病变的独立危险因素(OR值分别为1.004、1.002和1.143)。结论在老年2型糖尿病视网膜病变患者中,糖尿病病程、尿白蛋白和糖化血红蛋白是3个独立的危险因素。     

2型糖尿病足溃疡68例危险因素分析

<正>近年来我国糖尿病发病率迅猛增加,糖尿病足溃疡(DFU)的发生率也在随之增多,DFU是糖尿病严重的并发症之一,本研究总结近5年来首都医科大学潞河教学医院内分泌科住院的DFU患者的临床资料,探讨2型糖尿病(T2DM)患者DFU的危险因素。1对象与方法1.1研究对象首都医科大学潞河教学医院内分泌科2010年2月至2014年2月住院的530例T2DM     

老年2型糖尿病患者糖尿病肾病危险因素分析

糖尿病肾病（DN）可进展为终末期肾病（ESRD）。在所有老年ESRD患者中41％为DN所致，75岁以上者比例更高。本文对60岁以上568例2型糖尿病患者的临床资料及生化指标进行了分析，探讨DN的危险因素。     

2型糖尿病患者周围神经病变危险因素分析

目的 探讨T2DM住院患者糖尿病周围神经病变（DPN）患病率及危险因素. 方法 选取T2DM住院患者205例,以多伦多临床评分系统（TCSS）评分作为DPN诊断标准,分为DPN组和无DPN（NDPN）组,比较两组各项指标. 结果 DPN患病率43.9％.DPN组年龄（57.76±12.50）vs（49.50±13.28）岁]、病程[（8.12±2.50）vs（5.67±1.99）年]、体重[（62.50±10.46） vs （67.03±13.43）kg]、DBP[（82.79±13.69）vs（86.98±12.18） mmHg]、BUN[（10.15±1.52）vs（41.35±5.66）μmol/L]、Scr[（102.79±61.56）vs（74.61±34.26）μmol/L]、UAlb/Cr[（211.66±26.78）vs（44.21±9.77）mg/24 h]和DR患病率[41（45.5％） vs 20（17.4％）]与NDPN组比较差异有统计学意义（P＜0.01）.Logistic多元回归分析显示,年龄、病程、UAlb/Cr、合并DR与DPN发生呈正相关. 结论 年龄、病程、UAlb/Cr、合并DR可能是T2DM住院患者发生DPN的危险因素.     

糖尿病的危险因素分析

随机选择852名人群进行糖尿病复查,其中发现2型糖尿病患者31例,对所选病例对照研究,寻找糖尿病危险因素。结果研究发现年龄、肥胖、糖尿病家庭史为2型糖尿病危险因素。     

糖尿病患者并发胆囊结石危险因素分析

为了探讨胆结石形成与糖尿病的关系 ,笔者对36例糖尿病患者进行血脂测定 ,并与非糖尿病患者进行比较。现报告如下。1　资料与方法1 .1　一般资料　随机选择 36例糖尿病和 35例非糖尿病患者。糖尿病患者均符合 WHO诊断标准 ,男 2 1例 ,女 1 5例 ;年龄 1 8～ 70岁 ,平均 5 6岁 ;平均糖尿病病程 6年 ,其中 1型 4例 ,2型 32例。 36例糖尿病患者均有不同程度的周围神经病变和植物神经病变的临床表现 ,其中四肢麻木 31例 ,四肢针刺样疼痛及烧灼样疼痛 2 8例 ,腹胀 2 6例 ,早饱 1 5例 ,餐后不适1 0例 ,便秘 2 0例 ,恶心或 /和呕吐 2例 ,吞咽阻挡…     

糖尿病肾病并心肌损害的危险因素分析

目的 探讨糖尿病肾病（ＤＮ）并心肌损害的危险因素。方法 比较糖尿病肾病伴或不伴心肌损害的临床特征及其心肌损害的危险因素。结果 ＤＮ伴心肌损害组病程长（Ｐ〈０．０５）,空腹血糖及糖化血红蛋白高（Ｐ〈０．０１）,高血压发生率高（Ｐ〈０．０１）,且肾脏损害越重,死亡率越高,血ＢＵＮ水平和继发高血压与ＤＮ的心肌损害直接相关。ＤＮ与糖尿病性心肌病的发生时间无并行关系。结论 糖尿病病程长,血糖控制不佳,高血压     

住院2型糖尿病患者合并尿路感染危险因素分析

目的：分析住院2型糖尿病患者尿路感染的患病情况及其临床特点,并探讨2型糖尿病患者合并尿路感染的危险因素。方法回顾性地分析香港大学深圳医院2013年10月至2014年9月内分泌与代谢科住院的2型糖尿病患者共249例,收集相应临床资料,比较尿路感染组与非感染组患者年龄、性别、体质量指数、糖尿病病程、糖化血红蛋白（HbA1c）、估算肾小球滤过率（eGFR）、肌酐、尿微量白蛋白/肌酐（ACR）、24h尿微量白蛋白定量、尿糖等指标的异同,分析2型糖尿病患者合并尿路感染的危险因素。结果住院2型糖尿病患者合并尿路感染的患病率为16.1%;年龄、性别、eGFR、ACR、24h尿微量白蛋白定量、肌酐在两组之间差异具有统计学意义（P＜0.05）,女性、年龄越大、肾功能越差、尿微量白蛋白越多的患者越易合并尿路感染。而尿糖、糖尿病病程、HbA1c、体质量指数在各组之间差异无统计学意义。logistic回归分析显示性别、肌酐是尿路感染的独立危险因素。结论2型糖尿病患者合并尿路感染与性别、肌酐相关,女性、肾功能不良的患者是高危人群。     

Autonomic neuropathy and diabetic foot ulceration

Autonomic function was studied in three groups of insulin-dependent diabetic patients. Heart rate changes during deep breathing and on standing were significantly less in 28 patients with a recent history of foot ulceration compared with 40 patients with peripheral neuropathy but without ulceration (p less than 0.001) and 54 patients without neuropathy (p less than 0.001). Sympathetic function was assessed in 36 of these patients from peripheral arterial diastolic flow patterns obtained by Doppler ultrasound measurements and expressed as the pulsatility index (PI). Patients with a history of ulceration (n = 10) showed considerably increased diastolic flow (PI = 4.28 +/- 0.53, mean +/- S.E.M.) compared with 12 neuropathic patients with no history of ulceration (PI = 7.80 +/- 0.68, p less than 0.002) and 14 patients without neuropathy (PI = 9.55 +/- 0.89, p less than 0.002). Severely abnormal autonomic function occurs in association with neuropathic foot ulceration, but patients without ulcers have lesser degrees of autonomic neuropathy, thus a causal relationship has not been established.     

Risk factors for non-ischaemic foot ulceration in diabetic nephropathy.

It is recognized that diabetic patients with nephropathy frequently have macrovascular disease leaving them at risk of ischaemic foot lesions. In order to assess non-vascular risk factors for foot ulceration 64 patients were stratified into four groups: microalbuminuria, albuminuria with creatinine clearance greater than 40 ml min-1, chronic renal failure (clearance less than 40 ml min-1), and a non-nephropathic diabetic control group. Vibration perception threshold was measured by biothesiometry, peroneal nerve conduction velocity by conventional methods, and dynamic foot pressure by pedobarography. Vibration perception threshold was elevated in all three groups when compared with age-matched normal and diabetic control groups. Mean vibration perception threshold was 20.8 +/- 8.6 (+/- SD) in the microalbuminuria group (p less than 0.001 compared with age-matched normal control group), 28.1 +/- 5.6 (p less than 0.001) in the albuminuria group, 38.9 +/- 9.4 (p less than 0.001) in the renal failure group, 14.8 +/- 5.2 in the diabetic control group and 12.3 +/- 2.9 in the normal control group. Peroneal motor conduction velocity was reduced in all three groups when compared with normal control subjects, microalbuminuria 38.6 +/- 4.2 m s-1 (p less than 0.001), albuminuria 38.0 +/- 6.1 m s-1 (p less than 0.01), renal failure 35.5 +/- 1.2 m s-1 (p less than 0.001), diabetic control 40.6 +/- 1.8 m s-1, and normal 43.1 +/- 2.3 m s-1.(ABSTRACT TRUNCATED AT 250 WORDS)     

Autonomic denervation may be a prerequisite of diabetic neuropathic foot ulceration

Studies using visceral (cardiovascular) autonomic function testing have left doubt as to the importance of autonomic neuropathy in the development of diabetic neuropathic foot ulceration. A test for peripheral autonomic denervation has been developed (acetylcholine sweatspot test), dependent on intradermal acetylcholine causing secretion by innervated sweat glands, detected by starch/iodine discoloration. The response is photographed and quantified using a grid (normal score = 0 or 1; abnormal = 5 to 60). The sweatspot test was applied to the feet of 19 diabetic patients with a history of foot ulceration, 17 with neuropathic pain, 8 complaining of numbness, and to 15 diabetic control patients. The sweatspot test score of the foot ulcer patients (median 54) was very much greater than that of the other groups (pain group, 4, p less than 0.005; numbness group, 2, p less than 0.01; diabetic control group, 2, p less than 0.0001). All the patients with neuropathic foot ulceration had peripheral autonomic denervation. The results suggest that autonomic denervation in the feet is always present in patients with diabetic neuropathic foot ulceration. Tests of peripheral autonomic denervation such as the acetylcholine sweatspot test may be useful to identify patients at risk of neuropathic foot ulceration.     

Wound classification is more important than site of ulceration in the outcome of diabetic foot ulcers

The importance of wound classification and site of ulceration was evaluated in 314 consecutive diabetic patients with foot ulcers. The ulcers were classified as superficial (through the full thickness of the dermis; n = 150), deep (n = 50), osteomyelitis and/or abscess (n = 46), minor gangrene (n = 39) or major gangrene (n = 29). Wound healing was defined as intact skin for at least 6 months. In patients with superficial and deep ulcers, primary healing occurred in 88% and 78%, respectively, compared with 57% in those patient who developed an abscess and/or osteomyelitis. Only 2 out of 68 patients with gangrene healed (through mummification) without amputation. Patients with gangrene had lower ankle and toe blood pressure than patients with all other types of ulcers. There were only marginal differences in primary healing rate between different ulcer sites. The highest rate was seen in ulcers localized to the metatarsal heads (78%). Patients with multiple ulcers had the lowest primary healing rate (5%) compared with single ulcers at all sites. These differences were probably due to circulatory factors, since patients with multiple ulcers had lower distal perfusion pressures compared with all other groups.     

Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients

Purpose

To evaluate the effectiveness of home temperature monitoring to reduce the incidence of foot ulcers in high-risk patients with diabetes.

Methods

In this physician-blinded, 18-month randomized controlled trial, 225 subjects with diabetes at high risk for ulceration were assigned to standard therapy (Standard Therapy Group) or dermal thermometry (Dermal Thermometry Group) groups. Both groups received therapeutic footwear, diabetic foot education, regular foot care, and performed a structured foot inspection daily. Dermal Thermometry Group subjects used an infrared skin thermometer to measure temperatures on 6 foot sites twice daily. Temperature differences >4°F between left and right corresponding sites triggered patients to contact the study nurse and reduce activity until temperatures normalized.

Results

A total of 8.4% (n = 19) subjects ulcerated over the study period. Subjects were one third as likely to ulcerate in the Dermal Thermometry Group compared with the Standard Therapy Group (12.2% vs 4.7%, odds ratio 3.0, 95% confidence interval, 1.0 to 8.5, P = .038). Proportional hazards regression analysis suggested that thermometry intervention was associated with a significantly longer time to ulceration (P = .04), adjusted for elevated foot ulcer classification (International Working Group Risk Factor 3), age, and minority status. Patients that ulcerated had a temperature difference that was 4.8 times greater at the site of ulceration in the week before ulceration than did a random 7 consecutive-day sample of 50 other subjects that did not ulcerate (3.50 ± 1.0 vs 0.74 ± 0.05, P = .001).

Conclusions

High temperature gradients between feet may predict the onset of neuropathic ulceration and self-monitoring may reduce the risk of ulceration.     

糖尿病患者勃起功能障碍的相关因素分析

调查了226例男性2型糖尿病患者（T2DM），分析了年龄、病程、HbA1c、血压、吸烟、饮酒等因素对发生勃起功能障碍的影响。糖尿病患者勃起功能障碍（DED）患病率为67．7％，病程每增加5年、年龄每增加10岁、HbA1c每增加2％、收缩压每增加30mmHg、吸烟史、饮酒史OR分别为1．9617、1．2519、2．3207、1．1219、1．6745（P均〈0．05）、4．3671（P均〈0．01）。     

持续股动脉输注脲激酶治疗糖尿病足的临床研究

目的 观察采用微量动脉泵(微量泵)持续股动脉输注脲激酶治疗糖尿病足溃疡的临床疗效.方法 选择2型糖尿病并发足溃疡患者(Wagner 3级及以下者),无内脏出血倾向,无严重心肾肝功不全,在抗感染、降糖治疗及局部创面处理的同时,给予微量泵持续股动脉输注脲激酶治疗.结果 28例糖尿病足溃疡全部愈合,平均住院9±5 天.结论 微量泵持续股动脉输注脲激酶是治疗糖尿病足溃疡的一种有效方法,可减少截肢,缩短住院时间.必须掌握本疗法的适应证和禁忌证.     

A longitudinal study of foot ulceration and its risk factors in community-based patients with type 2 diabetes: The Fremantle Diabetes Study

Aims

To determine the prevalence and associates of foot ulcer, and the subsequent incidence and predictors of first-ever hospitalisation for this complication, in well-characterised community-based patients with type 2 diabetes.

Methods

Baseline foot ulceration was ascertained in 1296 patients (mean age 64 years, 48.6% male, median diabetes duration 4.0 years) recruited to the longitudinal Fremantle Diabetes Study between 1993 and 1996. Incident hospitalisation for foot ulceration was monitored through validated data linkage until end-December 2010.

Results

At baseline, 16 participants (1.2%) had a foot ulcer which was independently associated with intermittent claudication, peripheral sensory neuropathy (PSN) and diabetes duration (P ≤ 0.01). The incidence of hospitalisation for this complication in those without prior/prevalent foot ulceration was 5.21 per 1000 patient-years. This rate and other published data suggest that 1 in 7–10 foot ulcers require hospitalisation. In a Cox proportional hazards model, intermittent claudication and PSN were significant independent predictors of time to admission with foot ulceration, in addition to retinopathy, cerebrovascular disease, HbA_1c, alcohol consumption, renal impairment, peripheral arterial disease and pulse pressure (P ≤ 0.038).

Conclusions

These data confirm PSN as an important risk factor for foot ulceration but, in contrast to some other studies, peripheral arterial disease was also a major independent contributor. Associations between hospitalisation for foot ulcer and both retinopathy and raised pulse pressure suggest a role for local microvascular dysfunction, while alcohol may have non-neuropathic toxic effects on skin/subcutaneous structures. The multifactorial nature of foot ulceration complicating type 2 diabetes may have implications for its management.     

The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study

Summary Foot ulceration results in substantial morbidity amongst diabetic patients. We have studied prospectively the relationship between high foot pressures and foot ulceration using an optical pedobarograph. A series of 86 diabetic patients, mean age 53.3 (range 17–77) years, mean duration of diabetes 17.1 (range 1–36) years, were followed-up for a mean period of 30 (range 15–34) months. Clinical neuropathy was present in 58 (67%) patients at baseline examination. Mean peak foot pressure was higher at the follow-up compared to baseline (13.5 kg·cm^–2±7.1 SD vs 11.2±5.4, p<0.001) with abnormally high foot pressures (>12.3) being present in 55 patients at follow-up and 43 at the baseline visit (p=NS). Plantar foot ulcers developed in 21 feet of 15 patients (17%), all of whom had abnormally high pressures at baseline; neuropathy was present in 14 patients at baseline. Non-plantar ulcers occurred in 8 (9%) patients. Thus, plantar ulceration occurred in 35% of diabetic patients with high foot pressures but in none of those with normal pressures. We have shown for the first time in a prospective study that high plantar foot pressures in diabetic patients are strongly predictive of subsequent plantar ulceration, especially in the presence of neuropathy.