Nelson R G, Gohdes D M, Everhart J E, Hartner J A, Zwemer F L, Pettitt D J, Knowler W C
Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona.
Diabetes Care. 1988 Jan;11(1):8-16. doi: 10.2337/diacare.11.1.8.
The incidence of lower-extremity amputations was estimated in the Pima Indians of the Gila River Indian Community in Arizona, a population with a high prevalence of non-insulin-dependent diabetes mellitus (NIDDM). Between 1972 and 1984, from a study population of 4399 subjects, lower-extremity amputations were performed on 84 patients, 80 (95%) of whom had NIDDM. Among diabetic subjects, the incidence rate of first lower-extremity amputations was higher in men than in women. Rates increased significantly with increasing duration of diabetes. Presence of medial arterial calcification, retinopathy, or nephropathy; absence of patellar tendon reflexes; impaired great toe vibration-perception threshold; and degree of fasting and 2-h postload hyperglycemia were significant risk factors for amputations. Serum cholesterol concentration, blood pressure, age, and absence of Achilles tendon reflexes were not predictive of amputations. The death rate was greater in diabetic amputees than in diabetic nonamputees of similar age, sex, and duration of diabetes, and a significant increase in cardiovascular deaths was observed in diabetic subjects with amputations. The incidence rate of lower-extremity amputations in diabetic Pima Indians is higher than that reported in other diabetic populations. This may reflect differences in risk or a more complete case ascertainment than was possible in previous studies. If the latter is true, the rate of amputations in diabetic individuals may be higher than has been previously appreciated.
在亚利桑那州吉拉河印第安社区的皮马印第安人中，估计了下肢截肢的发生率。该人群中非胰岛素依赖型糖尿病（NIDDM）的患病率很高。1972年至1984年期间，在4399名研究对象中，有84名患者接受了下肢截肢手术，其中80名（95%）患有NIDDM。在糖尿病患者中，男性首次下肢截肢的发生率高于女性。发生率随糖尿病病程的延长而显著增加。内侧动脉钙化、视网膜病变或肾病的存在；髌腱反射缺失；大脚趾振动感觉阈值受损；以及空腹和餐后2小时高血糖程度是截肢的重要危险因素。血清胆固醇浓度、血压、年龄和跟腱反射缺失并不能预测截肢情况。糖尿病截肢患者的死亡率高于年龄、性别和糖尿病病程相似的非截肢糖尿病患者，并且在有截肢手术的糖尿病患者中观察到心血管死亡显著增加。糖尿病皮马印第安人下肢截肢的发生率高于其他糖尿病群体的报告发生率。这可能反映了风险差异或比以往研究更完整的病例确定情况。如果后者属实，糖尿病个体的截肢率可能比以前认为的要高。
