Department of Endocrinology, The Third Affiliated Hospital of Nanchang University (The First Hospital of Nanchang), Nanchang, Jiangxi, China.
Skin Res Technol. 2024 Jul;30(7):e13826. doi: 10.1111/srt.13826.
The aim of this study is to investigate the factors influencing the recurrence of diabetic foot ulcers (DFU) and provide guidance for reducing the recurrence rate.
A total of 211 patients diagnosed with DFU who were hospitalized and discharged from the hospital from October 2015 to January 2020 were included as the study cohort. Participants were divided into two groups according to whether the foot ulcer recurred during the 2-year follow-up period: a recurrence group (n = 84) and a non-recurrence group (n = 127). The following data were collected and analyzed for the two groups of patients: general information, foot information, laboratory indicators, diabetes comorbidities, and complications.
(1) The overall recurrence rate of diabetic foot ulcers (DFU) within 2 years was 39.8%, indicating a high recurrence rate. (2) Significant differences were observed between the two patient groups in terms of BMI, HbA1c, TBIL, CRP, financial situation, foot deformity, first ulcer on the sole of the foot, previous amputation history, Wagner grade of the first ulcer, osteomyelitis, DFU duration (>60 days), lower limb vascular reconstruction, peripheral arterial disease (PAD), and diabetic peripheral neuropathy (DPN) (t = 2.455; Z = -1.988, -3.731, -3.618; χ2 = 7.88, 5.004, 3.906, 17.178, 16.237, 5.007, 24.642, 4.782, 29.334, 10.253). No significant differences were found for the other indicators. (3) Logistic regression analysis revealed that TBIL (OR = 0.886, p = 0.036) was a protective factor against ulcer recurrence. In contrast, PAD, previous amputation history, DPN, and the first ulcer on the sole of the foot (OR = 3.987, 6.758, 4.681, 2.405; p < 0.05 or p < 0.01) were identified as risk factors for ulcer recurrence.
Early screening and preventive education targeting high-risk factors such as DPN, PAD and the initial ulcer location on the sole of the foot are essential to mitigate the high long-term recurrence rate of DFU. Furthermore, the protective role of TBIL in preventing ulcer recurrence underscores the importance of monitoring bilirubin levels as part of a comprehensive management strategy for DFU patients.
本研究旨在探讨影响糖尿病足溃疡（DFU）复发的因素，为降低复发率提供指导。
纳入 2015 年 10 月至 2020 年 1 月期间因 DFU 住院并出院的 211 例患者作为研究队列。根据 2 年随访期间足部溃疡是否复发，将参与者分为复发组（n=84）和未复发组（n=127）。收集并分析两组患者的一般信息、足部信息、实验室指标、糖尿病合并症和并发症。
（1）2 年内糖尿病足溃疡（DFU）的总体复发率为 39.8%，表明复发率较高。（2）两组患者在 BMI、HbA1c、TBIL、CRP、经济状况、足部畸形、足底首次溃疡、既往截肢史、首次溃疡 Wagner 分级、骨髓炎、DFU 病程（＞60 天）、下肢血管重建、外周动脉疾病（PAD）和糖尿病周围神经病变（DPN）方面存在显著差异（t=2.455；Z=-1.988，-3.731，-3.618；χ2=7.88，5.004，3.906，17.178，16.237，5.007，24.642，4.782，29.334，10.253）。其他指标无显著差异。（3）Logistic 回归分析显示，TBIL（OR=0.886，p=0.036）是溃疡复发的保护因素。相反，PAD、既往截肢史、DPN 和足底首次溃疡（OR=3.987，6.758，4.681，2.405；p＜0.05 或 p＜0.01）是溃疡复发的危险因素。
早期筛查和针对 DPN、PAD 和足底初始溃疡部位等高危因素的预防教育对于降低 DFU 的长期高复发率至关重要。此外，TBIL 在预防溃疡复发中的保护作用强调了监测胆红素水平作为 DFU 患者综合管理策略的重要性。
