Fei Yang-fan, Wang Chun, Chen Da-wei, Li Yong-heng, Lin Shuang, Liu Guan-jian, Ran Xing-wu
Division of Endocrinology & Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu 610041, China.
Zhonghua Yi Xue Za Zhi. 2012 Jun 26;92(24):1686-9.
To evaluate the incidence and risk factors of lower extremity amputation among inpatients with diabetic foot.
For this retrospective study, a total of 685 inpatients with diabetic foot (Wagner grade 1-5) admitted at a multi-disciplinary Diabetic Foot Care Center, West China Hospital, Sichuan University during January 1, 2005 and June 30, 2011. The data of each patient including clinical information, laboratory results and final outcome were collected and analyzed. They were divided into non-amputated and amputated groups. And the latter included minor and major amputation groups according to amputation site.
The overall amputation rate was 11.4% in diabetic foot inpatients. The incidences of minor amputation and major amputation were 5.4% and 6.0% respectively. 17.9% of amputated patients experienced a second amputation. The amputated patients had a longer hospitalized stay, higher counts of white blood cells and neutrophils, greater HbA1c and lower serum levels of hemoglobin and albumin than the non-amputation patients (P < 0.05). The prevalence of diabetic peripheral neuropathy was significantly higher in the amputation group than that in the non-amputation group (P < 0.05). However, no difference existed between the minor and major amputation groups (P > 0.05). Ankle brachial index (ABI) in the amputation group was significantly lower than that in the non-amputation group (0.41 ± 0.25 vs 0.91 ± 0.36, P < 0.01). Minor and major amputation inpatients had similar ABI (0.43 ± 0.24 vs 0.39 ± 0.26, P = 0.087). Ordinal regression showed that HbA1c (P = 0.015), ABI (P = 0.016), history of amputation (P < 0.01) and Wagner grade of diabetic foot (P < 0.01) were the independent risk factors of amputation.
Diabetic foot inpatients have a higher rate of lower extremity amputation. The risk factors of amputation include HbA1c, ABI, history of amputation and Wagner grade of diabetic foot. And diabetic peripheral neuropathy, ischemia of lower limbs (especially peripheral arterial diseases below knees), infection and nutritional state are closely associated with amputation of diabetic foot inpatients.
评估糖尿病足住院患者下肢截肢的发生率及危险因素。
本回顾性研究纳入了2005年1月1日至2011年6月30日期间在四川大学华西医院多学科糖尿病足护理中心收治的685例糖尿病足患者（Wagner分级1 - 5级）。收集并分析每位患者的临床信息、实验室检查结果及最终结局等数据。将患者分为非截肢组和截肢组，后者根据截肢部位分为小截肢组和大截肢组。
糖尿病足住院患者的总体截肢率为11.4%。小截肢和大截肢的发生率分别为5.4%和6.0%。17.9%的截肢患者经历了二次截肢。与非截肢患者相比，截肢患者的住院时间更长，白细胞和中性粒细胞计数更高，糖化血红蛋白水平更高，血清血红蛋白和白蛋白水平更低（P < 0.05）。截肢组糖尿病周围神经病变的患病率显著高于非截肢组（P < 0.05）。然而，小截肢组和大截肢组之间无差异（P > 0.05）。截肢组的踝肱指数（ABI）显著低于非截肢组（0.41±0.25 vs 0.91±0.36，P < 0.01）。小截肢和大截肢住院患者的ABI相似（0.43±0.24 vs 0.39±0.26，P = 0.087）。有序回归分析显示，糖化血红蛋白（P = 0.015）、ABI（P = 0.016）、截肢史（P < 0.01）和糖尿病足Wagner分级（P < 0.01）是截肢的独立危险因素。
糖尿病足住院患者下肢截肢率较高。截肢的危险因素包括糖化血红蛋白、ABI、截肢史和糖尿病足Wagner分级。糖尿病周围神经病变、下肢缺血（尤其是膝以下周围动脉疾病）、感染和营养状况与糖尿病足住院患者的截肢密切相关。
