Peters Edgar J G, Lavery Lawrence A, Armstrong David G
Department of Internal Medicine, Haga Hospital, Leyenburg, The Hague, The Netherlands.
J Diabetes Complications. 2005 Mar-Apr;19(2):107-12. doi: 10.1016/j.jdiacomp.2004.06.002.
Although literature is scarce, it is a common belief that patients with lower social background are more prone to diabetic complications. The purpose of this study was to identify local, systemic, and psychosocial risk factors that can lead to severe foot infections and subsequent amputations.
This study was set up as a case-control study. We enrolled 112 persons with diabetes, in an approximately 1:1 case to control ratio. Cases were defined as patients admitted to the hospital with a severe foot infection, possibly necessitating a lower extremity amputation; controls were patients admitted for nonemergent medical or surgical cause. Study participants received a physical examination and interview to evaluate exposure variables, including demographic data, general medical, surgical, diabetes, and diabetes-related complication history. Socioeconomic status was quantified with the Duncan socioeconomic impact and Siegel prestige score. The patient's knowledge of foot care was evaluated as well. The risks for severe foot infection of social, economical, and physical risk factors were compared in a stepwise logistic regression analysis.
The following variables were significant factors for severe foot infection: history of previous amputation [odds ratio (OR)=19.9, P=.01], peripheral vascular disease (OR=5.5, P=.007), and peripheral neuropathy, as measured with vibratory perception threshold (OR 3.4, P=.044). Social and economic factors were not significant in this model.
These data suggest that physical risk factors are important in foot infection and that the additional risk of socioeconomic status or knowledge of foot care is limited in this population.
尽管相关文献较少，但人们普遍认为社会背景较低的患者更容易出现糖尿病并发症。本研究的目的是确定可能导致严重足部感染及后续截肢的局部、全身和社会心理风险因素。
本研究为病例对照研究。我们以约1:1的病例对照比例招募了112名糖尿病患者。病例定义为因严重足部感染入院、可能需要进行下肢截肢的患者；对照为因非紧急医疗或手术原因入院的患者。研究参与者接受了体格检查和访谈，以评估暴露变量，包括人口统计学数据、一般医疗、手术、糖尿病及糖尿病相关并发症病史。用邓肯社会经济影响和西格尔声望评分对社会经济地位进行量化。同时也评估了患者的足部护理知识。在逐步逻辑回归分析中比较了社会、经济和身体风险因素导致严重足部感染的风险。
以下变量是严重足部感染的重要因素：既往截肢史[比值比（OR）=19.9，P = 0.01]、外周血管疾病（OR = 5.5，P = 0.007）以及用振动觉阈值测量的外周神经病变（OR = 3.4，P = 0.044）。在该模型中，社会和经济因素不显著。
这些数据表明身体风险因素在足部感染中很重要，并且在该人群中社会经济地位或足部护理知识的额外风险有限。
