Moss S E, Klein R, Klein B E
Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, USA.
Arch Fam Med. 1996 Jul-Aug;5(7):391-8. doi: 10.1001/archfami.5.7.391.
To describe the 10-year cumulative incidence of and risk factors for lower-extremity amputations in diabetics.
Cohort study.
Primary care.
Population-based sample (N = 879) of younger-onset diabetic persons (in whom diabetes was diagnosed before 30 years of age and who were taking insulin) and a stratified random sample (N = 956) of older-onset diabetic persons (diagnosis at or after 30 years of age) participating in baseline, 4-year, and 10-year examinations.
Amputations of the lower extremities as reported by the participants.
The 10-year cumulative incidence of lower-extremity amputation was 5.4% in younger-onset and 7.3% in older-onset persons. Multivariate analyses were performed by logistic regression. In younger-onset persons, age (odds ratio [OR] for 10 years, 2.0; 95% confidence interval [CI], 1.5-2.8), history of ulcers (OR,4.8; 95% CI, 2.3-9.9), diastolic blood pressure (OR, 2.1 for 10 mm Hg; 95% CI, 1.5-3.0), glycosylated hemoglobin level (OR, 1.4 for 1%; 95% CI, 1.2-1.6), sex (OR, 5.2 for men; 95% CI, 2.2-12.3), and retinopathy (OR, 1.2 for 2 steps; 95% CI, 1.1-1.4) were significantly associated with incidence of lower-extremity amputation. In older-onset persons, history of ulcers (OR, 3.3; 95% CI, 1.6-6.8), glycosylated hemoglobin level (OR, 1.3 for 1%; 95% CI, 1.1-1.5), duration of diabetes (OR, 1.6 for 10 years; 95% CI, 1.1-2.5), sex (OR, 2.6 for men; 95% CI, 1.3-4.9), diastolic blood pressure (OR, 0.7 for 10 mm Hg; 95% CI, 0.5-1.0), and proteinuria (OR, 2.4; 95% CI, 1.0-5.7) were significantly associated with incidence of lower-extremity amputation.
These data show there are several risk factors for lower-extremity amputation with potential for modification and preventive strategies.
描述糖尿病患者下肢截肢的10年累积发病率及危险因素。
队列研究。
初级保健机构。
基于人群的年轻发病糖尿病患者样本（N = 879）（30岁之前诊断为糖尿病且正在使用胰岛素），以及参与基线、4年和10年检查的老年发病糖尿病患者分层随机样本（N = 956）（30岁及以后诊断）。
参与者报告的下肢截肢情况。
年轻发病患者下肢截肢的10年累积发病率为5.4%，老年发病患者为7.3%。通过逻辑回归进行多变量分析。在年轻发病患者中，年龄（10年的比值比[OR]为2.0；95%置信区间[CI]，1.5 - 2.8）、溃疡病史（OR，4.8；95% CI，2.3 - 9.9）、舒张压（每10 mmHg的OR为2.1；95% CI，1.5 - 3.0）、糖化血红蛋白水平（每1%的OR为1.4；95% CI，1.2 - 1.6）、性别（男性的OR为5.2；95% CI，2.2 - 12.3）以及视网膜病变（2期的OR为1.2；95% CI，1.1 - 1.4）与下肢截肢发病率显著相关。在老年发病患者中，溃疡病史（OR，3.3；95% CI，1.6 - 6.8）、糖化血红蛋白水平（每1%的OR为1.3；95% CI，1.1 - 1.5）、糖尿病病程（每10年的OR为1.6；95% CI，1.1 - 2.5）、性别（男性的OR为2.6；95% CI，1.3 - 4.9）、舒张压（每10 mmHg的OR为0.7；95% CI，0.5 - 1.0）以及蛋白尿（OR，2.4；95% CI，1.0 - 5.7）与下肢截肢发病率显著相关。
这些数据表明下肢截肢存在多种危险因素，有可能进行干预和采取预防策略。
