Xu B, Yang C Z, Wu S B, Zhang D, Wang L N, Xiao L, Chen Y, Wang C R, Tong A, Zhou X F, Li X H, Guan X H
Department of Endocrinology, Air Force General Hospital of PLA, Beijing 100142, China.
Zhonghua Nei Ke Za Zhi. 2017 Jan 1;56(1):24-28. doi: 10.3760/cma.j.issn.0578-1426.2017.01.007.
To explore the risk factors for lower extremity amputation in patients with diabetic foot. The clinical data of 1 771 patients with diabetic foot at the Air Force General Hospital of PLA from November 2001 to April 2015 were retrospectively analyzed. The patients were divided into the non-amputation and amputation groups. Within the amputation group, subjects were further divided into the minor and major amputation subgroups. Binary logistic regression analyses were used to assess the association between risk factors and lower extremity amputation. Among 1 771 patients with diabetic foot, 323 of them (18.24%) were in the amputation group (major amputation: 41; minor amputation: 282) and 1 448 (81.76%) in the non-amputation group. Compared with non-amputation patients, those in the amputation group had a longer hospital stay and higher estimated glomerular filtration rate(eGFR)levels. Fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), C-reaction protein (CRP), ESR, ferritin, fibrinogen and WBC levels of the amputation group were higher, while hemoglobin albumin, transferrin, TC, TG, HDL-C and LDL-C were lower than those of the non-amputation group (all <0.05). The proportion of hypertension(52.48% vs 59.98%), peripheral vascular disease (PAD)(68.11% vs 25.04%), and coronary heart disease(21.33% vs 28.71%)were different between the amputation and non-amputation groups (all <0.05). Multivariable logistic regression analyses showed that Wagner's grade, PAD and CRP were the independent risk factors associated with lower extremity amputation in hospitalized patients with diabetic foot. Wagner's grade, ischemia of lower limbs and infection are closely associated with amputation of diabetic foot patients.
探讨糖尿病足患者下肢截肢的危险因素。回顾性分析2001年11月至2015年4月解放军空军总医院1771例糖尿病足患者的临床资料。将患者分为非截肢组和截肢组。在截肢组中，受试者进一步分为小截肢亚组和大截肢亚组。采用二元逻辑回归分析评估危险因素与下肢截肢之间的关联。1771例糖尿病足患者中，323例（18.24%）在截肢组（大截肢：41例；小截肢：282例），1448例（81.76%）在非截肢组。与非截肢患者相比，截肢组患者住院时间更长，估计肾小球滤过率（eGFR）水平更高。截肢组的空腹血糖（FPG）、糖化血红蛋白（HbA1c）、C反应蛋白（CRP）、血沉（ESR）、铁蛋白、纤维蛋白原和白细胞水平较高，而血红蛋白、白蛋白、转铁蛋白、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）低于非截肢组（均P<0.05）。截肢组与非截肢组之间高血压（52.48%对59.98%）、外周血管疾病（PAD）（68.11%对25.04%）和冠心病（21.33%对28.71%）的比例不同（均P<0.05）。多变量逻辑回归分析显示，Wagner分级、PAD和CRP是糖尿病足住院患者下肢截肢的独立危险因素。Wagner分级、下肢缺血和感染与糖尿病足患者的截肢密切相关。
