Nazim A
Katedra i Klinika Endokrynologii w Krakowie.
Pol Arch Med Wewn. 2001 Sep;106(3):829-38.
The aim of this study was to identify the incidence of lower extremity amputations (LEAs) in diabetics in Poland as background data for comparisons over time and with other communities. This was a cross-sectional study of the incidence of any non-traumatic and non-neoplastic LEAs in the population of Krakow region (1,239,703 inhabitants in its borders before 1.1.1999). It was calculated that for this population size it was sufficient to collect data for one year. The amputees had to be inhabitants of the Krakow region between 1.1.1996 and 31.12.1996. Data was collected from two sources: surgical wards and limb fitting centres. 290 non-traumatic and non-neoplastic LEAs were identified: 283 in the first source (hospital), of which 51 were found in the second (limb fitting centre) while 7 amputations were identified in the second source solely. 72.4% of LEAs were performed in males and this proportion tended to decrease with age, especially in diabetics. Mean age of the amputees was 64.7 years. Diabetics were significantly older (68.2 vs 61.5 years, p < 0.001). The number of amputations was growing with age reaching peak values between 65-74 years in diabetics and 55-64 in non-diabetics. 47.9% of LEAs were performed in diabetics. In 10.8% of cases diabetes was previously unknown. 88.7% of amputations were primary. The following amputation levels were identified: toe--15.5%, metatarsus--6.6%, ankle 1.0%, crus--20.0%, thigh--56.9%. In diabetics 21.6% of amputations were minor (metatarsus and below) comparing to 9.9% in non-diabetics. Incidence rates, calculated per 100,000/year and corrected using capture-recapture method, were as follows (95% confidence intervals in parentheses): 25.9 (10.2-41.6) in the whole population, 186.7 (125.3-248.1) in diabetics, 165.3 (110.5-220.0) primary in diabetics, and 14.4 (3.5-25.4) in non-diabetics. Comparing to data from the literature these were comparatively good results for diabetics of caucasian race. Like in other papers incidence rate in diabetics was almost 15 times higher than in non-diabetics, reaching 24 in females, which suggested that gender protection was reduced by diabetes. In an attempt to lower the rate of amputations several actions should be considered. They may include more active case finding, particularly by GPs, and more effective screening for a high risk diabetic foot.
本研究的目的是确定波兰糖尿病患者下肢截肢（LEA）的发生率，作为随时间推移以及与其他群体进行比较的背景数据。这是一项关于克拉科夫地区（1999年1月1日前边界内有1,239,703名居民）人群中任何非创伤性和非肿瘤性LEA发生率的横断面研究。经计算，对于该人口规模，收集一年的数据就足够了。截肢者必须是1996年1月1日至1996年12月31日期间克拉科夫地区的居民。数据从两个来源收集：外科病房和假肢装配中心。共识别出290例非创伤性和非肿瘤性LEA：第一个来源（医院）有283例，其中51例在第二个来源（假肢装配中心）被发现，而仅在第二个来源识别出7例截肢。72.4% 的LEA发生在男性中，且这一比例有随年龄下降的趋势，尤其是在糖尿病患者中。截肢者的平均年龄为64.7岁。糖尿病患者明显年龄更大（68.2岁对61.5岁，p < 0.001）。截肢数量随年龄增长，在糖尿病患者中65 - 74岁达到峰值，在非糖尿病患者中55 - 64岁达到峰值。47.9% 的LEA发生在糖尿病患者中。在10.8% 的病例中，糖尿病此前未被知晓。88.7% 的截肢是初次截肢。确定了以下截肢水平：脚趾——15.5%，跖骨——6.6%，脚踝1.0%，小腿——20.0%，大腿——56.9%。与非糖尿病患者相比，糖尿病患者中21.6% 的截肢为小截肢（跖骨及以下），而非糖尿病患者为9.9%。按每100,000/年计算并使用捕获 - 再捕获方法校正后的发病率如下（括号内为95% 置信区间）：整个人口中为25.9（10.2 - 41.6），糖尿病患者中为186.7（125.3 - 248.1），糖尿病患者初次截肢中为165.3（110.5 - 220.0），非糖尿病患者中为14.4（3.5 - 25.4）。与文献数据相比，对于白种糖尿病患者而言，这些是相对较好的结果。与其他论文一样，糖尿病患者的发病率几乎是非糖尿病患者的15倍，女性达到24，这表明糖尿病降低了性别保护作用。为降低截肢率，应考虑采取多项行动。这些行动可能包括更积极地发现病例，特别是由全科医生进行，以及对高危糖尿病足进行更有效的筛查。
