Meloni Marco, Izzo Valentina, Giurato Laura, Cervelli Valerio, Gandini Roberto, Uccioli Luigi
Department of Systems Medicine, University of Tor Vergata, Rome, Italy.
Plastic Surgery, Department of Plastic and Reconstructive Surgery, University of Tor Vergata, Rome, Italy.
J Clin Transl Endocrinol. 2018 Mar 2;11:31-35. doi: 10.1016/j.jcte.2018.01.002. eCollection 2018 Mar.
To establish the role of heart failure (HF) and dialysis (D) in the prognosis of diabetic patients with critical limb ischemia and foot ulcers (FUs).
Consecutive diabetic patients with ischemic FUs who referred to our Diabetic Foot Centre were prospectively included. All patients underwent a preset limb salvage protocol including peripheral revascularization. According to the presence of HF and D, they were divided in four groups: group 1 without HF and without D defined as ischemic foot (IF); group 2 with HF and without D defined as heart ischemic foot (H-IF); group 3 without HF and with D defined as renal ischemic foot (R-IF); group 4 with HF and with dialysis defined as heart-renal foot (HR-IF). Survival with limb salvage, survival with major amputation and death were reported after 1 year of follow-up.
136 patient have been included: 66 with IF, 26 with H-IF, 24 with R-IF and 20 with HR-IF. The mean age was 68,9 ± 9,7 years, the diabetes duration 20,7 ± 11,6 years, the mean HbA1c 62,7 ± 22,3 mmol/mol. 103/136 (75,7%) survived with limb salvage, 10/136 (7,4%) survived with major amputation, 23/136 (16,9%) died. The outcomes for group IF patients, H-IF, R-IF and HR-IF were respectively: survival with limb salvage (92,4%, 61,5%, 79,2% and 35%), survival with major amputation (6,1%, 7,7%, 8,3% and 10%), death (1,5%, 30,8%, 12,5% and 55%) χ = 0.0001. Heart failure was an independent predictor of death.
The presence of heart failure and dialysis in diabetic patients with ischemic foot ulcers was associated to high risk of amputation and mortality.
确定心力衰竭（HF）和透析（D）在糖尿病严重肢体缺血和足部溃疡（FU）患者预后中的作用。
前瞻性纳入转诊至我院糖尿病足中心的连续性糖尿病缺血性足部溃疡患者。所有患者均接受预设的保肢方案，包括外周血管重建。根据是否存在HF和D，将患者分为四组：1组无HF且无D，定义为缺血性足（IF）；2组有HF且无D，定义为心脏缺血性足（H-IF）；3组无HF且有D，定义为肾脏缺血性足（R-IF）；4组有HF且有透析，定义为心肾足（HR-IF）。随访1年后报告保肢生存、大截肢生存和死亡情况。
共纳入136例患者：66例为IF，26例为H-IF，24例为R-IF，20例为HR-IF。平均年龄为68.9±9.7岁，糖尿病病程为20.7±11.6年，平均糖化血红蛋白为62.7±22.3 mmol/mol。103/136（75.7%）例患者保肢存活，10/136（7.4%）例患者大截肢存活，23/136（16.9%）例患者死亡。IF组、H-IF组、R-IF组和HR-IF组的结果分别为：保肢存活（92.4%、61.5%、79.2%和35%），大截肢存活（6.1%、7.7%…此处原文有误，应为7.7%、8.3%和10%），死亡（1.5%、30.8%、12.5%和55%）χ²=0.0001。心力衰竭是死亡的独立预测因素。
糖尿病缺血性足部溃疡患者中存在心力衰竭和透析与截肢和死亡的高风险相关。 （注：原文中“10/136 (7,4%) survived with major amputation”中“7,4%”表述有误，应为“7.7%”，翻译时按正确内容翻译）
