Hämäläinen H, Rönnemaa T, Halonen J P, Toikka T
Research and Development Centre, Social Insurance Institution, Turku, Finland.
J Intern Med. 1999 Jul;246(1):97-103. doi: 10.1046/j.1365-2796.1999.00523.x.
The aim of the study was to find factors predicting lower extremity amputation in patients with type 1 or type 2 diabetes mellitus through a 7-year follow-up period.
Follow-up study.
Altogether 733 diabetic patients. aged 10-79 years, were drawn from the national drug reimbursement register.
At baseline, the patients underwent a podiatric, circulatory and neurophysiological examination. Seven years later a follow-up study was performed based on clinical and register data. Patient data for those who died during the follow-up were collected from hospital records and death certificates. All amputations were recorded. The patients with amputation were compared with the other patients and also, in a case-control manner, by taking three nonamputated patients matched by sex, type of diabetes, and age for each patient with amputation.
The number of amputations was 25 in the sample. Compared with all patients without amputation, patients with amputation differed in altogether 24 variables concerning diabetes and its complications. Compared with the matched non-amputated patients, the amputated patients had longer duration of diabetes, lower ankle/brachial pressure index (ABI), more often history of retinopathy, nephropathy, and hypertension, more often visual handicap, elevated serum creatinine level, abnormal neurophysiological indices and electrophysiological findings. In the logistic regression analysis, vibration perception threshold, low ABI, history of retinopathy, visual handicap, and male sex were independently associated with lower extremity amputation.
Lower extremity amputations were strongly associated with retinopathy, nephropathy, and neuropathy. The presence of any of these complications should lead to intensified actions in order to prevent amputations. As far as arterial circulation is concerned, claudication or absent peripheral pulses were not good predictors of amputation, whereas low ABI, despite its known weaknesses, was a reliable indicator of future amputation.
本研究旨在通过7年的随访期，找出1型或2型糖尿病患者下肢截肢的预测因素。
随访研究。
共733例年龄在10 - 79岁的糖尿病患者，数据来自国家药品报销登记系统。
在基线时，患者接受了足病、循环和神经生理学检查。7年后，根据临床和登记数据进行随访研究。随访期间死亡患者的数据从医院记录和死亡证明中收集。记录所有截肢情况。将截肢患者与其他患者进行比较，并采用病例对照的方式，为每例截肢患者选取3名在性别、糖尿病类型和年龄上匹配的未截肢患者。
样本中的截肢患者有25例。与所有未截肢患者相比，截肢患者在24个与糖尿病及其并发症相关的变量上存在差异。与匹配的未截肢患者相比，截肢患者的糖尿病病程更长，踝臂压力指数（ABI）更低，视网膜病变、肾病和高血压病史更常见，视力障碍更常见，血清肌酐水平升高，神经生理学指标和电生理检查结果异常。在逻辑回归分析中，振动觉阈值、低ABI、视网膜病变病史、视力障碍和男性性别与下肢截肢独立相关。
下肢截肢与视网膜病变、肾病和神经病变密切相关。这些并发症中的任何一种出现都应促使采取强化措施以预防截肢。就动脉循环而言，间歇性跛行或外周脉搏消失并非截肢的良好预测指标，而低ABI尽管存在已知的局限性，但仍是未来截肢的可靠指标。
