Boyko E J, Ahroni J H, Smith D G, Davignon D
Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA.
Diabet Med. 1996 Nov;13(11):967-72. doi: 10.1002/(SICI)1096-9136(199611)13:11<967::AID-DIA266>3.0.CO;2-K.
The objective of this study was to evaluate the relationship between foot ulceration and short-term mortality in veterans of the American military services with diabetes mellitus. A total of 725 diabetic subjects participated in a prospective study of risk factors for lower extremity complications between 1990 and 1994. Mean follow-up was 691.8 days (+/-SD 339.9, range 28-1436 days). Subjects who died during follow-up (n = 72) had a similar mean duration of diabetes to those who survived (12.6 years vs 11.2), but their mean age was greater (65.9 years vs 63.2, p = 0.026). The relative risk (RR) of death was 2.39 (95% confidence interval (CI) 1.13 to 4.58) in the subjects who developed foot ulcer (n = 88) compared to those who did not. The risk of death for those with foot ulcer was 12.1 per 100 person-years of follow-up compared to 5.1 in those without foot ulcer. Cox regression analysis demonstrated a greater than two-fold increased risk of death in ulcerated subjects after adjustment for age; diabetes type, duration, and treatment; glycosylated hemoglobin level; history of lower extremity amputation; and cumulative pack years smoked. Higher ankle-arm index was significantly related to lower mortality risk, independent of foot ulcer occurrence. We conclude that foot ulcer and lower extremity vascular disease are related to a higher risk of death in diabetic subjects. The reasons for this excess mortality require further investigation.
本研究的目的是评估美国军队中患有糖尿病的退伍军人足部溃疡与短期死亡率之间的关系。共有725名糖尿病受试者参与了一项关于1990年至1994年间下肢并发症危险因素的前瞻性研究。平均随访时间为691.8天（±标准差339.9，范围28 - 1436天）。随访期间死亡的受试者（n = 72）糖尿病的平均病程与存活者相似（12.6年对11.2年），但他们的平均年龄更大（65.9岁对63.2岁，p = 0.026）。与未发生足部溃疡的受试者相比，发生足部溃疡的受试者（n = 88）死亡的相对风险（RR）为2.39（95%置信区间（CI）1.13至4.58）。足部溃疡患者每100人年随访的死亡风险为12.1，而无足部溃疡患者为5.1。Cox回归分析表明，在调整年龄、糖尿病类型、病程和治疗、糖化血红蛋白水平、下肢截肢史以及累积吸烟包年后，溃疡患者的死亡风险增加了两倍多。较高的踝臂指数与较低的死亡风险显著相关，与足部溃疡的发生无关。我们得出结论，足部溃疡和下肢血管疾病与糖尿病患者较高的死亡风险相关。这种额外死亡率的原因需要进一步研究。
