Sohn Min-Woong, Lee Todd A, Stuck Rodney M, Frykberg Robert G, Budiman-Mak Elly
Center for Management of Complex Chronic Care, Hines VA Hospital, Hines, Illinois, USA.
Diabetes Care. 2009 May;32(5):816-21. doi: 10.2337/dc08-1695. Epub 2009 Feb 5.
The purpose of this study was to compare mortality risks of patients with Charcot arthropathy with those of patients with diabetic foot ulcer and those of patients with diabetes alone (no ulcer or Charcot arthropathy).
A retrospective cohort of 1,050 patients with incident Charcot arthropathy in 2003 in a large health care system was compared with patients with foot ulcer and those with diabetes alone. Mortality was determined during a 5-year follow-up period. Patients with Charcot arthropathy were matched to individuals in the other two groups using propensity score matching based on patient age, sex, race, marital status, diabetes duration, and diabetes control.
During follow-up, 28.0% of the sample died; 18.8% with diabetes alone and 37.0% with foot ulcer died compared with 28.3% with Charcot arthropathy. Multivariable Cox regression shows that, compared with Charcot arthropathy, foot ulcer was associated with 35% higher mortality risk (hazard ratio 1.35 [95% CI 1.18-1.54]) and diabetes alone with 23% lower risk (0.77 [0.66-0.90]). Of the patients with Charcot arthropathy, 63% experienced foot ulceration before or after the onset of the Charcot arthropathy. Stratified analyses suggest that Charcot arthropathy is associated with a significantly increased mortality risk independent of foot ulcer and other comorbidities.
Charcot arthropathy was significantly associated with higher mortality risk than diabetes alone and with lower risk than foot ulcer. Patients with foot ulcers tended to have a higher prevalence of peripheral vascular disease and macrovascular diseases than patients with Charcot arthropathy. This finding may explain the difference in mortality risks between the two groups.
本研究旨在比较夏科氏关节病患者与糖尿病足溃疡患者以及单纯糖尿病患者（无溃疡或夏科氏关节病）的死亡风险。
对2003年在一个大型医疗保健系统中首次发生夏科氏关节病的1050例患者的回顾性队列进行研究，并与足溃疡患者和单纯糖尿病患者进行比较。在5年随访期内确定死亡率。采用倾向评分匹配法，根据患者年龄、性别、种族、婚姻状况、糖尿病病程和糖尿病控制情况，将夏科氏关节病患者与其他两组个体进行匹配。
随访期间，样本中有28.0%死亡；单纯糖尿病患者死亡率为18.8%，足溃疡患者死亡率为37.0%，而夏科氏关节病患者死亡率为28.3%。多变量Cox回归分析显示，与夏科氏关节病相比，足溃疡患者的死亡风险高35%（风险比1.35 [95%置信区间1.18 - 1.54]），单纯糖尿病患者的死亡风险低23%（0.77 [0.66 - 0.90]）。在夏科氏关节病患者中，63%在夏科氏关节病发病之前或之后出现足部溃疡。分层分析表明，独立于足部溃疡和其他合并症，夏科氏关节病与死亡风险显著增加相关。
夏科氏关节病与单纯糖尿病相比，死亡风险显著更高；与足溃疡相比，死亡风险更低。与夏科氏关节病患者相比，足溃疡患者外周血管疾病和大血管疾病的患病率往往更高。这一发现可能解释了两组之间死亡风险的差异。
