糖尿病足感染局部特征与患者全身感染指标的相关性

 目的 探讨糖尿病足感染（DFI）局部特征（感染广度、感染深度、血供情况）与患者全身感染指标之间的关系。方法 回顾性纳入某院2016年1月—2019年5月内分泌科单侧、未经抗感染治疗的DFI患者，采集白细胞（WBC）、中性粒细胞（N）、C反应蛋白（CRP）作为全身感染指标，感染广度分为仅足趾累及、仅足体累及、足趾+跖趾关节累及、足趾+跖趾关节+足体累及，感染深度分为浅层感染（仅累及皮肤、皮下组织）、中层感染（累及肌肉、肌腱）、深层感染（累及骨、关节），血供情况根据患侧踝肱指数（ABI）分为正常（ABI≥0.9）、轻度缺血（0.4≤ABI<0.9）、重度缺血（ABI<0.4），采用多因素方差分析及组间比较进行统计分析。结果 DFI不同感染广度的患者WBC、N、CRP比较，差异均无统计学意义（均P>0.05），组间比较提示在感染广泛累及或十分局限时感染广度与患者WBC、N、CRP正相关。不同感染深度的患者WBC、N、CRP比较，差异有统计学意义（P值分别为0.012、0.010、0.003），组间比较提示感染深度与患者WBC、N、CRP正相关。DFI不同血供情况的患者WBC、N、CRP比较，差异有统计学意义（P值分别为0.003、0.003、0.001），组间多重比较提示糖尿病足缺血程度与患者WBC、N、CRP负相关。结论 DFI不同感染局部特征对患者全身感染指标有重要影响。糖尿病足的感染广度、感染深度与患者全身感染指标有一定的正相关性，与缺血有负相关性。

Correlation between local characteristics of diabetic foot infection and systemic infection indicators of patients

Objective To explore the correlation between local characteristics (infection width, infection depth, blood supply) of diabetic foot infection (DFI) and systemic infection indicators of patients. Methods Patients with unilateral DFI but without receiving anti-infective treatment in the department of endocrinology of a hospital from January 2016 to May 2019 were retrospectively included in analysis, white blood cell (WBC), neutrophil (N), C-reactive protein (CRP) were collected as indicators of systemic infection, according to the width of infection, infection was divided into toe involvement only, foot involvement only, toe+metatarsophalangeal joint involvement, and toe+metatarsophalangeal joint+foot involvement. According to the depth of infection, infection was divided into superficial infection (involving only skin and subcutaneous tissue), middle infection (involving muscles and tendons), and deep infection (involving bone and joint). According to the ankle brachial index (ABI) of the affected side, blood supply was divided into normal (ABI≥0.9), mild ischemia (0.4≤ABI<0.9) and severe ischemia (ABI<0.4), multivariate analysis of variance and group comparison were adopted for statistical analysis. Results There was no significant difference in patients’ WBC, N and CRP among different width of DFI (P>0.05), group comparison indicated that infection width was positively correlated with WBC, N and CRP when infection was widely involved or very limited. There were significant differences in WBC, N and CRP among different depth of infection (P=0.012, 0.010 and 0.003 respectively), group comparison indicated that infection depth was positively correlated with WBC, N and CRP. There were significant differences in WBC, N and CRP in DFI patients with different blood supply (P=0.003, 0.003 and 0.001 respectively), multiple groups comparisons suggested that degree of ischemia in diabetic foot was negatively correlated with WBC, N and CRP of patients. Conclusion Local characteristics of DFI have an important influence on the indicators of patients’ systemic infection. DFI width and depth is positively correlated with patients’ systemic infection indicators, but was negatively correlated with ischemia.