Shojaiefard Abolfazl, Khorgami Zhamak, Larijani Bagher
Department of Surgery and Endocrinology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Int J Diabetes Dev Ctries. 2008 Apr;28(2):32-7. doi: 10.4103/0973-3930.43096.
Diabetic foot (DF) is the main cause of nontraumatic lower extremity amputation. Early recognition and management of risk factors for foot complications may prevent amputations and other adverse outcomes.
At our hospital we have a protocol for the management of patients hospitalized because of DF. We collected clinical and laboratory data, details of diabetes complications, and history of comorbidities in 146 patients who were admitted for management of DF to determine the risk factors of amputation (major or minor) in these patients. We divided these patients into two groups, those whose treatment included amputation and those who were treated conservatively and carried out a comparative analysis of the variables in the two groups.
Major amputation was performed in 5.5% of the patients and minor amputation in 22.6%. Those who required amputation presented a significantly higher (P < 0.05) incidence of nephropathy, history of previous amputation, ischemic diabetic foot and first fasting blood glucose (FBG) > 200 mg/dl after admission. Multivariable-adjusted odds ratios in stepwise logistic regression model was 2.64 for nephropathy (95%CI: 1.06 to 6.60; P = 0.03); 3.03 for ischemic diabetic foot (95%CI: 1.28 to 7.18; P = 0.01); and 3.01 for first FBG > 200 after admission (95%CI: 1.32 to 6.83; P= 0.01).
Nephropathy, ischemic diabetic foot, and first FBG > 200 mg/dl are independent predictors of limb amputation in patients hospitalized for DF lesions. In addition to early detection and treatment of foot lesions, early management of risk factors is also important.
糖尿病足（DF）是非创伤性下肢截肢的主要原因。早期识别和处理足部并发症的危险因素可预防截肢及其他不良后果。
在我院，我们有一套针对因糖尿病足住院患者的管理方案。我们收集了146例因糖尿病足入院接受治疗患者的临床和实验室数据、糖尿病并发症细节以及合并症病史，以确定这些患者截肢（大截肢或小截肢）的危险因素。我们将这些患者分为两组，一组治疗包括截肢，另一组接受保守治疗，并对两组变量进行比较分析。
5.5%的患者接受了大截肢，22.6%的患者接受了小截肢。需要截肢的患者肾病发生率、既往截肢史、缺血性糖尿病足以及入院后首次空腹血糖（FBG）>200mg/dl的发生率显著更高（P<0.05）。逐步逻辑回归模型中的多变量调整比值比，肾病为2.64（95%CI：1.06至6.60；P = 0.03）；缺血性糖尿病足为3.03（95%CI：1.28至7.18；P = 0.01）；入院后首次FBG>200为3.01（95%CI：1.32至6.83；P = 0.01）。
肾病、缺血性糖尿病足以及入院后首次FBG>200mg/dl是因糖尿病足病变住院患者肢体截肢的独立预测因素。除了早期检测和治疗足部病变外，早期管理危险因素也很重要。
