Lu Qingwei, Wang Jun, Wei Xiaolu, Wang Gang, Xu Yang
Department of Ulcers and Peripheral Vascular Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, People's Republic of China.
School of Integrated Traditional Chinese and Western Medicine, Binzhou Medical University, Yantai, 264003, People's Republic of China.
Diabetes Metab Syndr Obes. 2021 May 4;14:2019-2027. doi: 10.2147/DMSO.S307815. eCollection 2021.
The purpose of our study was to identify the new and the more specific risk factors for major amputation in patients with diabetic foot ulcer (DFU).
We used data from the Electronic Medical Record (EMR) database of our hospital from February 2014 to July 2020. Patients with DFU and amputation were included in the study. The logistic regression model was adjusted for demographic characteristics and related comorbidities between major and minor amputation groups.
Among 3654 patients with DFU, 363 (9.9%) were amputated. Patients with major versus minor amputation, in multivariable logistic regression models, major amputation independent factors included previous amputation history (odds ratio [OR] 2.31 [95% CI 1.17-4.53], = 0.02), smoking (2.58 [1.31-5.07], = 0.01), coronary artery disease (CAD) (2.67 [1.35-5.29], = 0.03), ankle brachial index (ABI) <0.4 (15.77 [7.51-33.13], < 0.01), Wagner 5 (5.50 [1.89-16.01], < 0.01), activated partial thromboplastin time (APTT) (1.23 [1.03-1.48], = 0.01), glycosylated hemoglobin A1c (HbA1c) (1.23 [1.03-1.48], = 0.03), hemoglobin (Hb) (0.98 [0.96-1.00], = 0.01), plasma albumin (ALB) (0.88 [0.81-0.95], < 0.01) and white blood cell (WBC) (1.10 [1.04-1.16], < 0.01).
Major amputation was associated with previous amputation history, smoking, CAD, Wagner 5, ABI <0.4, HbA1c, Hb, ALB, WBC, and APTT might be a new independent factor. In view of these factors, early prevention and guidance promptly orientated by multidisciplinary is of great significance to reduce the disability rate and economic burden.
我们研究的目的是确定糖尿病足溃疡（DFU）患者大截肢的新的和更具特异性的危险因素。
我们使用了我院2014年2月至2020年7月电子病历（EMR）数据库中的数据。纳入研究的患者为患有DFU且接受了截肢手术的患者。对大截肢组和小截肢组的人口统计学特征及相关合并症进行了逻辑回归模型调整。
在3654例DFU患者中，363例（9.9%）接受了截肢手术。在多变量逻辑回归模型中，大截肢组与小截肢组相比，大截肢的独立危险因素包括既往截肢史（比值比[OR]2.31[95%可信区间1.17 - 4.53]，P = 0.02）、吸烟（2.58[1.31 - 5.07]，P = 0.01）、冠状动脉疾病（CAD）（2.67[1.35 - 5.29]，P = 0.03）、踝肱指数（ABI）<0.4（15.77[7.51 - 33.13]，P < 0.01）、Wagner 5级（5.50[1.89 - 16.01]，P < 0.01）、活化部分凝血活酶时间（APTT）（1.23[1.03 - 1.48]，P = 0.01）、糖化血红蛋白A1c（HbA1c）（1.23[1.03 - 1.48]，P = 0.03）、血红蛋白（Hb）（0.98[0.96 - 1.00]，P = 0.01）、血浆白蛋白（ALB）（0.88[0.81 - 0.95]，P < 0.01）和白细胞（WBC）（1.10[1.04 - 1.16]，P < 0.01）。
大截肢与既往截肢史、吸烟、CAD、Wagner 5级、ABI <0.4、HbA1c、Hb、ALB、WBC有关，且APTT可能是一个新的独立因素。鉴于这些因素，早期预防并由多学科迅速进行指导对降低残疾率和经济负担具有重要意义。
