2型糖尿病患者下肢截肢的相关因素分析

目的：了解患有2型糖尿病的患者发生下肢截肢的相关因素。方法收集了北京市某三甲医院于2009年5月到2014年12月因发生糖尿病足部并发症的214例住院的2型糖尿病患者为研究对象，其中截肢组66例，非截肢组148例，对两组资料进行单因素分析，并做多元逐步Logistic回归分析。结果本研究中2型糖尿病下肢截肢的发生率高达30.84％。单因素分析显示截肢组患者的三酰甘油（TG）、总胆固醇（TC）、 C反应蛋白（CRP）、体质指数（BMI）、病程、住院时间、住院总花费均高于未截肢组（P＜0.05）；截肢组患者的红细胞计数（RBC）、血红蛋白（Hb）、高密度脂蛋白胆固醇（HDL－C）、尿酸（UA）以及血清白蛋白（Alb）等均低于未截肢组（P＜0.05）；截肢组和未截肢组患者是否服用抗血小板药物、患者是否有糖尿病足史、下肢截肢史、周围神经病变（ DPN）、周围血管病变（ PAD）、糖尿病肾病（ DN）以及患者的Wagnar分级差异均有统计学意义（ P＜0.05）。多元逐步Logistic分析结果表明患者糖尿病足史、 DPN、 PAD、 CRP、糖尿病病程、 Wagnar分级是发生下肢截肢的独立危险因素，而抗血小板药物、 Hb、 TC是发生下肢截肢的独立保护因素。结论2型糖尿病尤其是合并足部并发症的患者下肢截肢的患病率很高，而预防糖尿病患者下肢截肢的重点在于糖尿病足神经病变、血管病变的早期筛查，合理使用抗血小板药以及对有足溃疡患者加强感染治疗和营养支持，以减少糖尿病足下肢截肢的发生。

Analysis of the risk factors for Lower-Extremity Amputation in type 2 diabetes patients

Objective To investigate the risk factors for Lower?Extremity Amputations ( LEA) in type 2 diabetes patients. Methods Patients, who were hospitalized in a Top?Three hospital in Beijing from May 2009 to Decem?ber 2014 with Type 2 diabetes mellitus were divided into non?LEA group(148 cases), LEA group(66 cases). To analyses the data the single factor analysis and stepwise Logistic regression analysis were used.Results The inci?dence of type 2 diabetes LEA was up to 30.84%. Univariate analysis showed that:the LEA group's triglyceride (TG), total cholesterol(TC), C?reactive protein (CRP), duration of hospital stay, the total cost of hospitaliza?tion, body mass index (BMI) were higher than the non?LEA group (P<0.05).The LEA group’s erythrocytes ( RBC ) , hemoglobin ( Hb ) , high density lipoprotein cholesterol ( HDL?C ) , uric acid ( UA ) , serum albumin (Alb)were lower than non?LEA group (P<0.05).The two groups whether taking anti?platelet drugs,the history of diabetic foot,the history of LEA, peripheral neuropathy ( DPN) , peripheral vascular disease ( PAD) , diabet?ic nephropathy (DN), hyperlipidemia, Wagnar grade differences were statistically significance(P<0.05).Step?wise Logistic regression analysis showed that the history of diabetic foot, peripheral neuropathy, peripheral vas?cular disease, C?reactive protein, duration of diabetes, Wagnar rating were independent risk factors for LEA, and anti?platelet drugs, hemoglobin, total cholesterol were independent protective factors for LEA. Conclusion The prevalence of LEA is high in diabetic foot patients. We should focus on the prevention of diabetic foot, dia?betic foot neuropathy, vascular disease screening, rational use of antiplatelet drugs, for patients with foot ulcers we have to strengthen the treatment of infections and nutritional support to reduce diabetic foot amputation oc?curred.