重症糖尿病足及糖尿病足截肢影响因素分析

背景　糖尿病足发病率高、危害大，应加强对糖尿病足不良预后危险因素的认识以提高疾病防控能力。目的　分析糖尿病足患者的病例特点，探讨重症糖尿病足及糖尿病足截肢的影响因素。方法　选取2012年3月—2017年3月锦州市中心医院内分泌科住院的糖尿病足患者175例，回顾性收集患者的一般资料、实验室检查结果、糖尿病并发症及合并症，根据糖尿病足Wagner分级标准分为轻型组和重型组，根据截肢与否分为截肢组和非截肢组。采用多因素Logistic回归分析重症糖尿病足及糖尿病足截肢的影响因素。结果　重型组患者吸烟率高于轻型组，糖尿病病程长于轻型组，体质指数（BMI）、空腹C肽、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、血清清蛋白（Alb）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、红细胞计数（RBC）、血红蛋白（Hb）水平低于轻型组，同型半胱氨酸（Hcy）、白细胞计数（WBC）、血小板计数（PLT）、糖尿病肾病、下肢动脉硬化闭塞症患病率及小截肢率高于轻型组（P<0.05）。多因素Logistic回归分析结果显示，Alb〔OR=0.754，95%CI（0.650，0.874）〕、PLT〔OR=1.006，95%CI（1.000，1.011）〕、Hcy〔OR=1.702，95%CI（1.376，2.106）〕与重症糖尿病足发生有回归关系（P<0.05）。截肢组吸烟率高于非截肢组，BMI、Alb、Hb水平低于非截肢组，WBC、PLT、脑梗死患病率高于非截肢组（P<0.05）。多因素Logistic回归分析结果显示，BMI〔OR=0.833，95%CI（0.723，0.960）〕、Alb〔OR=0.921，95%CI（0.872，0.974）〕与糖尿病足截肢发生有回归关系（P<0.05）。结论　PLT升高、高同型半胱氨酸血症是发生重症糖尿病足的危险因素，血清Alb为重症糖尿病足的保护因素；BMI及血清Alb为糖尿病足截肢的保护因素。

Analysis of Factors Affecting Severe Diabetic Foot and Consequent Amputation

Background　The incidence of diabetic foot （DF） disease is high，and DF causes great harm.Awareness of the risk factors for poor prognosis in DF should be improved to aid in disease prevention and control.Objective　To analyze the characteristics of patients with DF and to explore the factors influencing severe DF and DF amputation.Methods　A total of 175 DF patients admitted to the Department of Endocrinology at Jinzhou Central Hospital between March 2012 and March 2017 were selected for this study.General patient data，laboratory test results，and diabetic complications were retrospectively collected.According to the Wagner grading standard of DF，the patients were divided into a light group and a severe group.According to amputation conditions，they were also divided into an amputation group and a non-amputation group.Multivariate Logistic regression analysis was performed to analyze the factors influencing severe DF and DF amputation.Results　The smoking rate in the severe group was higher than that in the light group.The duration of diabetes in the severe group was longer than that in the light group，and the BMI in the severe group was lower than that in the light group.The fasting C-peptide，triglyceride （TG），total cholesterol （TC），low-density lipoprotein cholesterol （LDL-C），serum albumin （Alb），alanine aminotransferase （ALT），aspartate aminotransferase （AST），red blood cell count （RBC），and hemoglobin （Hb） in the severe group were lower than those in the light group，but the homocysteine （Hcy），white blood cell count （WBC），and platelet count （PLT） in the severe group were higher than those in the light group.The incidence of diabetic nephropathy，arteriosclerosis obliterans of lower extremities，and minor amputation in the severe group were higher in the severe group than in the light group （P<0.05）.The multivariate Logistic regression analysis showed that Alb 〔OR=0.754，95%CI（0.650，0.874）〕，PLT 〔OR=1.006，95%CI（1.000，1.011）〕，and Hcy 〔OR=1.702，95%CI（1.376，2.106）〕 were associated with severe DF.In the amputation group，the smoking rate was higher，whereas the BMI was lower，than those in the non-amputation group.The levels of Alb and Hb in the amputation group were lower to those in the non-amputation group.The levels of WBC and PLT in the amputation group were higher than those in the non-amputation group.The incidence of cerebral infarction in the amputation group was higher than that in the non-amputation group （P<0.05）.The multivariate Logistic regression analysis results showed that BMI 〔OR=0.833，95%CI（0.723，0.960）〕 and Alb 〔OR=0.921，95%CI（0.872，0.974）〕 were associated with DF amputation.Conclusion　Elevated PLT and hyperhomocystinemia are risk factors for severe DF.Serum Alb is a protective factor for severe DF，and BMI and serum Alb are protective factors for DF amputation.