Moss S E, Klein R, Klein B E
Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, USA.
Diabetes Care. 1999 Jun;22(6):951-9. doi: 10.2337/diacare.22.6.951.
To estimate the cumulative 14-year incidence of lower-extremity amputations (LEAs) and evaluate risk factors for LEA.
Study subjects consisted of population-based cohorts of younger-onset (diagnosed before age 30 years and taking insulin, n = 906) and older-onset (diagnosed after age 30 years, n = 984) individuals with diabetes. Subjects participated in baseline (1980-1982), 4-year, 10-year, and 14-year examinations or interviews. LEAs were determined by history.
The cumulative 14-year incidence of LEA was 7.2% in younger- and 9.9% in older-onset patients. In multivariable analyses based on the discrete linear logistic model, LEA in the younger-onset group was more likely for males (odds ratio [OR] 5.21 [95% CI 2.50-10.88]), older age (OR for 10 years 1.71 [1.30-2.24]), higher glycosylated hemoglobin (OR for 1% 1.39 [1.22-1.59]), higher diastolic blood pressure (OR for 10 mmHg 1.58 [1.20-2.07]), history of ulcers of the feet (3.19 [1.71-5.95]), and more severe retinopathy (OR for one step 1.16 [1.08-1.24]). In younger-onset patients aged > or = 18, pack-years smoked (OR for 10 years 1.20 [1.03-1.41]) was also associated with LEAs, and daily aspirin use was inversely associated (OR 0.11 [0.01-0.83]). In the older-onset group, LEA was more likely for men (2.66 [1.49, 4.76]) and if the subject had higher glycosylated hemoglobin (OR for 1% 1.25 [1.09-1.43]), higher pulse pressure (OR for 10 mmHg 1.19 [1.04-1.37]), history of ulcers (3.56 [1.84-6.89]), and more severe retinopathy (OR for one step 1.07 [1.00-1.13]).
There are several risk factors for LEA with potential for modification and preventive strategies.
评估下肢截肢（LEA）的14年累积发病率，并评估LEA的危险因素。
研究对象包括以人群为基础的糖尿病发病年龄较小（30岁之前确诊且使用胰岛素，n = 906）和发病年龄较大（30岁之后确诊，n = 984）的队列人群。研究对象参与了基线（1980 - 1982年）、4年、10年和14年的检查或访谈。LEA通过病史确定。
发病年龄较小的患者LEA的14年累积发病率为7.2%，发病年龄较大的患者为9.9%。在基于离散线性逻辑模型的多变量分析中，发病年龄较小的组中，男性发生LEA的可能性更大（优势比[OR] 5.21 [95%可信区间2.50 - 10.88]）、年龄较大（10年时的OR为1.71 [1.30 - 2.24]）、糖化血红蛋白水平较高（1%时的OR为1.39 [1.22 - 1.59]）、舒张压较高（10 mmHg时的OR为1.58 [1.20 - 2.07]）、足部溃疡病史（3.19 [1.71 - 5.95]）以及视网膜病变更严重（每增加一级的OR为1.16 [1.08 - 1.24]）。在年龄≥18岁的发病年龄较小的患者中，吸烟包年数（10年时的OR为1.20 [1.03 - 1.41]）也与LEA相关，而每日服用阿司匹林则与之呈负相关（OR 0.11 [0.01 - 0.83]）。在发病年龄较大的组中，男性发生LEA的可能性更大（2.66 [1.49, 4.76]），且如果受试者糖化血红蛋白水平较高（1%时的OR为1.25 [1.09 - 1.43]）、脉压较高（10 mmHg时的OR为1.19 [1.04 - 1.37]）、有溃疡病史（3.56 [1.84 - 6.89]）以及视网膜病变更严重（每增加一级的OR为1.07 [1.00 - 1.13]）。
LEA存在多种危险因素，具有进行干预和预防策略的可能性。
