Bartos V, Jirkovská A, Koznarová R
Centrum diabetologie IKEM, Praha.
Cas Lek Cesk. 1997 Sep 10;136(17):527-9.
The risk of tissue damage of the foot in diabetic subjects is due to a combination of arterial insufficiency and peripheral neuropathy. The probable development of diabetic foot with possible subsequent amputation is greater in uraemic diabetics. The objective of the presented work was to assess the incidence and risk of diabetic foot in diabetic patients where on account of renal failure transplantation of the kidney was performed.
In a retrospective study in 1983-1992 for a period of 6 months to 7 years a group of 64 diabetics was investigated (37 men and 27 women), mean age 42.8 years, range 29-58 years where on account of diabetic nephropathy renal (n = 49, 76.6%) or renal and pancreatic transplantation (n = 15, 23.4%) was performed. At the time of transplantation 53 patients (82.8%) suffered from peripheral neuropathy, 24 (37.5%) from angiopathy of the lower extremities. During the follow up period 22 patients (34.4%) developed ulcerations of the skin of the lower extremities, incl. 15 patients (23.4%) with a local and 4 (6.3%) with a phlegmonous infection. In 10 patients (15.6%) amputation had to be performed.
Ulceration of the foot in diabetics cannot be prevented by transplantation of the kidney or transplantation of the kidney and pancreas. Ulceration of the foot is at present an important contraindication for transplantation.
糖尿病患者足部组织损伤的风险是由动脉供血不足和周围神经病变共同引起的。尿毒症糖尿病患者发生糖尿病足并可能随后截肢的可能性更大。本研究的目的是评估因肾衰竭而接受肾脏移植的糖尿病患者中糖尿病足的发生率和风险。
在一项回顾性研究中，于1983年至1992年对一组64例糖尿病患者进行了为期6个月至7年的调查（37例男性和27例女性），平均年龄42.8岁，年龄范围29至58岁，这些患者因糖尿病肾病接受了肾脏移植（n = 49，76.6%）或肾脏和胰腺移植（n = 15，23.4%）。移植时，53例患者（82.8%）患有周围神经病变，24例（37.5%）患有下肢血管病变。在随访期间，22例患者（34.4%）出现下肢皮肤溃疡，其中15例患者（23.4%）有局部感染，4例（6.3%）有蜂窝织炎感染。10例患者（15.6%）不得不接受截肢手术。
肾脏移植或肾脏和胰腺移植无法预防糖尿病患者足部溃疡。目前，足部溃疡是移植的重要禁忌证。
