Vella Lourdes, Formosa Cynthia
J Am Podiatr Med Assoc. 2017 May;107(3):180-191. doi: 10.7547/15-070.
We sought to determine patient and ulcer characteristics that predict wound healing in patients living with diabetes.
A prospective observational study was conducted on 99 patients presenting with diabetic foot ulceration. Patient and ulcer characteristics were recorded. Patients were followed up for a maximum of 1 year.
After 1 year of follow-up, ulcer characteristics were more predictive of ulcer healing than were patient characteristics. Seventy-seven percent of ulcers had healed and 23% had not healed. Independent predictors of nonhealing were ulcer stage (P = .003), presence of biofilm (P = .020), and ulcer depth (P = .028). Although this study demonstrated that the baseline hemoglobin A reading at the start of the study was not a significant predictor of foot ulcer outcome (P = .603, resolved versus amputated), on further statistical analyses, when hemoglobin A was compared with the time taken for complete ulcer healing (n = 77), it proved to be significant (P = .009).
The factors influencing healing are ulcer stage, presence of biofilm, and ulcer depth. These findings have important implications for clinical practice, especially in an outpatient setting. Prediction of outcome may be helpful for health-care professionals in individualizing and optimizing clinical assessment and management of patients. Identification of determinants of outcome could result in improved health outcomes, improved quality of life, and fewer diabetes-related foot complications.
我们试图确定可预测糖尿病患者伤口愈合的患者及溃疡特征。
对99例糖尿病足溃疡患者进行了一项前瞻性观察研究。记录患者及溃疡特征。对患者进行了最长1年的随访。
随访1年后，溃疡特征比患者特征更能预测溃疡愈合。77%的溃疡已愈合，23%未愈合。溃疡未愈合的独立预测因素为溃疡分期（P = 0.003）、生物膜的存在（P = 0.020）和溃疡深度（P = 0.028）。虽然本研究表明研究开始时的基线糖化血红蛋白读数不是足部溃疡结局的显著预测因素（P = 0.603，愈合与截肢），但在进一步的统计分析中，当将糖化血红蛋白与溃疡完全愈合所需时间进行比较时（n = 77），结果显示具有显著性（P = 0.009）。
影响愈合的因素为溃疡分期、生物膜的存在和溃疡深度。这些发现对临床实践具有重要意义，尤其是在门诊环境中。结局预测可能有助于医护人员对患者进行个体化和优化临床评估及管理。确定结局的决定因素可改善健康结局、提高生活质量并减少糖尿病相关的足部并发症。
