Yammine Kaissar, Hayek Fady, Assi Chahine
Department of Orthopedic Surgery, School of Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, Beirut, Lebanon.
Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.
Wound Repair Regen. 2021 May;29(3):432-442. doi: 10.1111/wrr.12902. Epub 2021 Feb 16.
Anemia was found to be prevalent in patients with diabetes mellitus. Higher rates of anemia were reported in patients having diabetic foot ulcers (DFU). With the presence of an altered microcirculation, the potential negative effects of anemia might impede ulcer healing leading to higher rates of amputation and mortality. Medline, Embase, Scopus, CINAHL, Cochrane Library, and Google Scholar, were searched for from inception to locate relevant papers reporting any association between anemia and diabetic foot ulcers. The meta-analysis included 15 studies with 2895 patients. The weighted prevalence anemia rates of the total, mild-to-moderate DFU, and severe DFU groups were as follows: 69.7%, 49.5%, and 73%, respectively. For the hemoglobin level outcome, the same samples yielded the following pooled means: 11.00 ± 1.13, 12.08 ± 0.8, and 10.57 ± 0.68 g/dl. Individual studies showed association between low levels of hemoglobin and higher rates of non-healing ulcer, amputation, and mortality. This review demonstrated (a) a clear association between the presence of anemia and diabetic foot ulcers, (b) a clear association between the severity of anemia and the severity of DFUs, and (c) that anemia could be a predictor of amputation and mortality. Whether anemia is a predictor of adverse outcomes or an independent risk factor is to be further investigated.
研究发现，贫血在糖尿病患者中普遍存在。据报道，患有糖尿病足溃疡（DFU）的患者贫血发生率更高。由于微循环改变，贫血的潜在负面影响可能会阻碍溃疡愈合，导致截肢率和死亡率升高。检索了Medline、Embase、Scopus、CINAHL、Cochrane图书馆和谷歌学术数据库，从创刊号开始查找报告贫血与糖尿病足溃疡之间任何关联的相关论文。荟萃分析纳入了15项研究，涉及2895名患者。总组、轻度至中度DFU组和重度DFU组的加权贫血患病率如下：分别为69.7%、49.5%和73%。对于血红蛋白水平结果，相同样本得出的合并均值如下：11.00±1.13、12.08±0.8和10.57±0.68g/dl。个别研究表明，低血红蛋白水平与溃疡不愈合、截肢和死亡率升高之间存在关联。本综述表明：（a）贫血与糖尿病足溃疡之间存在明确关联；（b）贫血严重程度与DFU严重程度之间存在明确关联；（c）贫血可能是截肢和死亡的预测指标。贫血是不良结局的预测指标还是独立危险因素有待进一步研究。
