Apelqvist J, Larsson J, Agardh C D
Department of Internal Medicine, University Hospital, Lund, Sweden.
J Intern Med. 1993 Jun;233(6):485-91. doi: 10.1111/j.1365-2796.1993.tb01003.x.
To evaluate the recurrence of foot ulcers as well as the cumulative amputation and mortality rates in diabetic patients with previous foot ulcers.
A prospective study of consecutively presenting diabetic patients admitted to the Department of Internal Medicine because of foot ulcer with a median follow-up of 4 years.
A multidisciplinary foot-care team.
Five-hundred-and-fifty-eight consecutive diabetic patients with foot ulcers treated between 1 July 1983 and 31 December 1990 were followed to final outcome. Out of these patients, 468 healed either primarily (n = 345) or after minor or major amputations (n = 123) and 90 died before healing had occurred. Those 468 patients who healed were included in this prospective study from the time of healing.
Patients were followed according to a standardized protocol with registration of foot lesions, amputation, morbidity and mortality. Clinical examination was performed twice yearly.
After 1, 3 and 5 years of observation 34%, 61% and 70% of the patients, respectively, had developed a new foot ulcer. The recurrence rate of foot lesions was slightly higher among patients who previously had had an amputation (P < 0.05, P < 0.01 and non-significant, respectively). Among patients with previous primary healing the cumulative amputation rates were 3%, 10% and 12% after 1, 3 and 5 years of follow-up compared with 13%, 35% and 48% among those who previously healed after amputation, irrespective of previous amputation level (P < 0.001 at all time-points). All amputations except three were initiated by a foot ulcer deteriorating to deep infection or progressive gangrene. The long-term survival ratio was lower among patients healed after previous amputation (80%, 59%, 27%) compared with patients with previously primary healing (92%, 73%, 58%) after 1, 3 and 5 years of observation, respectively (P < 0.001, P < 0.01 and P < 0.001 respectively). The mortality rate was twice as high among primarily healed and four times as high among patients with amputation compared to an age- and sex-matched Swedish population.
These findings stress the need for life-long surveillance of the diabetic foot at risk and the necessity of preventive foot care among diabetic patients with previous foot lesions, and particularly among those who had had a previous amputation.
评估既往有足部溃疡的糖尿病患者足部溃疡的复发情况以及累积截肢率和死亡率。
一项对因足部溃疡入住内科的连续就诊糖尿病患者进行的前瞻性研究，中位随访时间为4年。
一个多学科足部护理团队。
对1983年7月1日至1990年12月31日期间连续治疗的558例糖尿病足部溃疡患者进行随访直至最终结局。在这些患者中，468例患者溃疡初步愈合（n = 345）或在进行小截肢或大截肢后愈合（n = 123），90例患者在溃疡愈合前死亡。这468例愈合的患者从愈合时起被纳入这项前瞻性研究。
按照标准化方案对患者进行随访，记录足部病变、截肢、发病率和死亡率。每年进行两次临床检查。
在观察1年、3年和5年后，分别有34%、61%和70%的患者出现了新的足部溃疡。既往有截肢史的患者足部病变复发率略高（分别为P < 0.05、P < 0.01和无统计学意义）。在既往初步愈合的患者中，随访1年、3年和5年后的累积截肢率分别为3%、10%和12%，而既往截肢后愈合的患者累积截肢率分别为13%、35%和48%，与既往截肢水平无关（在所有时间点P < 0.001）。除3例截肢外，所有截肢均由足部溃疡恶化为深部感染或进行性坏疽引起。与既往初步愈合的患者相比，既往截肢后愈合的患者在观察1年、3年和5年后的长期生存率较低（分别为80%、59%、27%）（分别为92%、73%、58%）（分别为P < 0.001、P < 0.01和P < 0.001）。与年龄和性别匹配的瑞典人群相比，初步愈合患者的死亡率高出两倍，截肢患者的死亡率高出四倍。
这些发现强调了对有风险的糖尿病足进行终身监测的必要性，以及对既往有足部病变的糖尿病患者，尤其是既往有截肢史的患者进行预防性足部护理的必要性。
