糖尿病足病不同程度感染患者临床特点分析

目的:回顾性分析不同程度感染的糖尿病足病患者的临床特点及重度感染的危险因素,为临床预防和治疗糖尿病足病提供对策。方法:选取2017年1月1日2018年12月31日于我科住院的新诊断的糖尿病足病患者258例,以Wagner分级为分类依据,将127例Wagner分级2~3级患者定义为轻度感染组,131例Wagner分级4~5级患者定义为重度感染组,比较两组患者的临床资料差异性,并分析糖尿病足病患者重度感染的独立危险因素。结果:临床资料方面,重度感染组患者糖尿病病程、糖尿病足病程[(19.12±3.12)y、(58.48±4.93)d]明显长于轻度感染组[(15.56±2.94)y、(41.37±5.87)d],差异有统计学意义;重度感染组患者合并糖尿病视网膜病变、糖尿病肾病、高血压病、冠心病、慢性心力衰竭患者比例(74.05%、58.02%、73.28%、93.89%、94.66%、67.94%)高于轻度感染组(44.09%、37.80%、61.42%、72.44%、93.70%、52.76%),差异有统计学意义(P<0.05)。在感染指标方面,重度感染组白细胞计数、中性粒细胞百分比、C反应蛋白、降钙素原、转铁蛋白[(12.35±2.03)×10^9、(83.21±7.31)%、(96.28±21.04)mg/L、(1.56±0.42)ng/mL、(387.16±49.27)g/L]明显高于轻度感染组([6.78±1.56)×10^9、(68.58±5.36)%、(38.76±11.68)mg/L、(0.97±0.12)ng/mL、(235.87±37.29)g/L],差异有统计学意义。理化指标方面,重度感染组红细胞计数、血红蛋白、糖化血红蛋白、总蛋白(TP)、白蛋白(ALB)、高密度脂蛋白(HDL-C)、尿酸(UA)、踝肱指数(ABI)与轻度感染组比较差异有统计学意义。多因素Logistic回归分析示,糖尿病足病时间长、伴有糖尿病肾病、低蛋白血症(<30 g/L)、高糖化血红蛋白(>7.5%)、低ABI(<0.6)是糖尿病足病患者发生重度感染的独立危险因素(P<0.05)。结论:糖尿病足病时间长、伴有糖尿病肾病、低蛋白血症、高糖化血红蛋白、低ABI是糖尿病足病患者发生重度感染的独立危险因素。

Analysis of Clinical Characteristics of Different Degrees of Infection in Patients with Diabetic Foot Disease

Objective To retrospectively analyze the clinical characteristics of diabetic foot disease patientswith different degrees of infection and risk factors of severe infection, and then provide countermeasures forclinical prevention and treatment of diabetic foot disease. Methods The clinical data of newly diagnoseddiabetic foot patients hospitalized in our department from Jan. 1, 2017 to Dec. 31, 2018 were collected. Accordingto the Wagner classification, the patients of Wagner classification 2–3 were defined as mild infection and thepatients of Wagner classification 4–5 were defined as severe infection. The differences of clinical data betweenthe two groups were compared and the independent risk factors of severe infection in diabetic foot patients wereanalyzed. Results The duration of diabetes mellitus and diabetic foot in severe infection group [(19.12 ±3.12)y, (58.48 ±4.93) d] was significantly longer than that in mild infection group [(15.56 ±2.94) y, (41.37±5.87)d, P < 0.05]. The proportions of patients with diabetic retinopathy, diabetic nephropathy, hypertension, coronaryheart disease and chronic heart failure (74.05%, 58.02%, 73.28%, 93.89%, 94.66%, 67.94%) in severe infectiongroup were higher than those in mild infection group (44.09%, 37.80%, 61.42%, 72.44%, 93.70%, 52.76%).The difference was statistically significant (P<0.05).In terms of infection indicators, the white blood cellcount, percentage of neutrophils, C-reactive protein,procalcitonin, transferrin [(12.35±2.03)×10^9 ,(83.21±7.31)%, (96.28±21.04) mg/L, (1.56±0.42) ng/mL, (387.16±49.27) g/L] in severe infection groupwere significantly higher than those in mild infection group [(6.78±1.56)×10^9, (68.58 ±5.36)%, (38.76±11.68)mg/L, (0.97±0.12) ng/mL, (235.87±37.29) g/L, P <0.05]. The differences were statistically significant. Interms of physical and chemical indexes, the erythrocyte count, hemoglobin, glycosylated hemoglobin, total protein(TP), albumin (ALB), high density lipoprotein (HDL-C), uric acid (UA), ankle-brachial index (ABI) in severeinfection group were significantly different from those in mild infection group (P < 0.05). Multivariate logisticregression analysis showed that the time of diabetic foot disease, diabetic nephropathy, hypoproteinemia (< 30 g/L),hyperglycated hemoglobin (>7.5%), and low ABI (<0.6) were independent risk factors for severe infectionin diabetic foot patients (P <0.05). Conclusion The time of diabetic foot disease, diabetic nephropathy,hypoproteinemia, hyperglycated hemoglobin, and low ABI were independent risk factors for severe infection indiabetic foot patients.