Faglia Ezio, Clerici Giacomo, Clerissi Jacques, Gabrielli Livio, Losa Sergio, Mantero Manuela, Caminiti Maurizio, Curci Vincenzo, Quarantiello Antonella, Lupattelli Tommaso, Morabito Alberto
Diabetology Center, Diabetic Foot Center, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, Sesto San Giovanni, Milano, Italy.
Diabetes Care. 2009 May;32(5):822-7. doi: 10.2337/dc08-1223. Epub 2009 Feb 17.
To evaluate the long-term prognosis of critical limb ischemia (CLI) in diabetic patients.
A total of 564 consecutive diabetic patients were hospitalized for CLI from January 1999 to December 2003; 554 were followed until December 2007.
The mean follow-up was 5.93 +/- 1.28 years. Peripheral angioplasty (PTA) was performed in 420 (74.5%) and bypass graft (BPG) in 117 (20.6%) patients. Neither PTA nor BPG were possible in 27 (4.9%) patients. Major amputations were performed in 74 (13.4%) patients: 34 (8.2%) in PTA, 24 (21.1%) in BPG, and 16 (59.2%) in a group that received no revascularization. Restenosis occurred in 94 patients, bypass failures in 36 patients, and recurrent ulcers in 71 patients. CLI was observed in the contralateral limb of 225 (39.9%) patients; of these, 15 (6.7%) required major amputations (rate in contralateral compared with initial limb, P = 0.007). At total of 276 (49.82%) patients died. The Cox model showed significant hazard ratios (HRs) for mortality with age (1.05 for 1 year [95% CI 1.03-1.07]), unfeasible revascularization (3.06 [1.40-6.70]), dialysis (3.00 [1.63-5.53]), cardiac disease history (1.37 [1.05-1.79]), and impaired ejection fraction (1.08 for 1% point [1.05-1.09]).
Diabetic patients with CLI have high risks of amputation and death. In a dedicated diabetic foot center, the major amputation, ulcer recurrence, and major contralateral limb amputation rates were low. Coronary artery disease (CAD) is the leading cause of death, and in patients with CAD history the impaired ejection fraction is the major independent prognostic factor.
评估糖尿病患者下肢严重缺血（CLI）的长期预后。
1999年1月至2003年12月期间，共有564例连续性糖尿病患者因CLI住院治疗；其中554例随访至2007年12月。
平均随访时间为5.93±1.28年。420例（74.5%）患者接受了外周血管成形术（PTA），117例（20.6%）患者接受了旁路移植术（BPG）。27例（4.9%）患者既无法进行PTA也无法进行BPG。74例（13.4%）患者接受了大截肢手术：PTA组34例（8.2%），BPG组24例（21.1%），未接受血运重建的患者组16例（59.2%）。94例患者发生再狭窄，36例患者旁路移植失败，71例患者出现复发性溃疡。225例（39.9%）患者对侧肢体出现CLI；其中15例（6.7%）需要进行大截肢手术（对侧肢体与初始肢体的截肢率相比，P = 0.007）。共有276例（49.82%）患者死亡。Cox模型显示，年龄（每增加1岁，风险比[HR]为1.05[95%置信区间1.03 - 1.07]）、无法进行血运重建（3.06[1.40 - 6.70]）、透析（3.00[1.63 - 5.53]）、有心脏病史（1.37[1.05 - 1.79]）以及射血分数降低（每降低1个百分点，HR为1.08[1.05 - 1.09]）与死亡率的HR值具有显著性。
CLI糖尿病患者截肢和死亡风险较高。在专门的糖尿病足中心，大截肢、溃疡复发和对侧肢体大截肢率较低。冠状动脉疾病（CAD）是主要死因，在有CAD病史的患者中，射血分数降低是主要的独立预后因素。
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