糖尿病患者血糖波动幅度对糖尿病足的影响

目的探讨糖尿病足（DF）发生、发展的高危因素，特别是血糖波动对DF的影响。方法将192例非糖尿病足（NDF）和575例DF患者纳入研究，575例DF患者又分为DF累及到肌腱或深部的皮下组织（Wagner1～2级）组、累及骨组织（Wagner3级）组以及坏疽（Wagner4～5级）组。回顾性分析研究对象一般因素、生化指标、血糖水平的标准差（SDBG）、空腹血糖的变异系数（CV-FPG）、日内最大血糖波动幅度（LAGE）。再根据是否截肢将575例DF患者分为DF截肢组及DF非截肢组，比较各组有关血糖波动指标的差别。结果DF组较NDF组年龄、病程、血肌酐（sCr）、血尿酸（UA）、血清超敏C反应蛋白（hsCRP）、尿Alb／Cr、SDBG、CV-FPG、LAGE升高，血清总蛋白、血清白蛋白、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL．C）降低，其中hsCRP、SDBG、CV-FPG在各组间差异均有统计学意义（P〈0．05）。DF截肢组与NDF组相比，SDBG、CV-FPG、LAGE增高（P〈O．05），其中SDBG在DF截肢组与DF非截肢组差异亦有统计学意义（P〈O．05）。Logistic回归分析显示hsCRP、尿Alb／Cr、血清白蛋白、SDBG、CV-FPG是影响糖尿病足的独立危险因素；SDBG是DF截肢的独立危险因素。结论hsCRP、尿Alb／Cr、血清白蛋白、SDBG、CV-FPG可能与糖尿病足病的发生发展密切相关。

Influence of blood glucose fluctuation on diabetic foot in patients with diabetes mellitus

Objective To identify the risk factors for the occurrence and development of diabetic foot（DF） in patients with type 2 diabetes mellitus, and to study the influence of blood glucose fluctuation on DF. Methods Clinical data of 192 patients with non-DF and 575 patients with DF were analyzed. According to the severity of DF, 575 DF patients were further divided into Wagner 1-2, Wagner 3, and Wagner 4-5 subgroups. According to whether amputation was performed or not, 575 patients with DF were further divided into DF with amputation and without amputation groups. The analysis factors included biochemical indicators, standard of blood glucose （SDBG）, coefficient of variation（CV） of fasting plasma glucose（CV-FPG）, large amplitude of glycemic excursions（LAGE）. Results Compared with NDF group, the age, diabetic course, serum creatinine, blood uric acid, hyper-sensitivity C reaction protein（hsCRP）, Alb/Cr, SDBG, CV-FPG, and LAGE were higher, and total protein, serum albumin, total cholesterol, triglyceride and low density lipoprotein cholesterol were lower in DF group. The difference was statistically significant in hsCRP, SDBG, CV-FPG between the two groups（P 〈 0.05）. Compared with NDF group, the DF with amputation group had significantly increased SDBG, CV-FPG and LAGE（P 〈 0.05）. Among which, SDBG was also significantly different between DF with amputation and without amputation groups（P 〈 0.05）. Logistic regression analysis showed that hsCRP, Alb/Cr, serum albumin, SDBG and CV-FPG were the independent risk factors for diabetic foot; and that SDBG was the independent risk factor for amputation in DF patients. Conclusion The fluctuations in hsCRP, Alb/Cr, serum albumin, SDBG, CV-FPG are closely related to the development of DF.