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龚洪平, 任妍, 查盼盼, 等. 初发与复发性糖尿病足溃疡临床特征分析[J]. 四川大学学报(医学版), 2022, 53(6): 969-975. DOI: 10.12182/20220860105
引用本文: 龚洪平, 任妍, 查盼盼, 等. 初发与复发性糖尿病足溃疡临床特征分析[J]. 四川大学学报(医学版), 2022, 53(6): 969-975. DOI: 10.12182/20220860105
GONG Hong-ping, REN Yan, ZHA Pan-pan, et al. Clinical Characteristics of Diabetic Patients with Initial and Recurrent Foot Ulcers[J]. Journal of Sichuan University (Medical Sciences), 2022, 53(6): 969-975. DOI: 10.12182/20220860105
Citation: GONG Hong-ping, REN Yan, ZHA Pan-pan, et al. Clinical Characteristics of Diabetic Patients with Initial and Recurrent Foot Ulcers[J]. Journal of Sichuan University (Medical Sciences), 2022, 53(6): 969-975. DOI: 10.12182/20220860105

初发与复发性糖尿病足溃疡临床特征分析

Clinical Characteristics of Diabetic Patients with Initial and Recurrent Foot Ulcers

  • 摘要:
      目的  分析四川大学华西医院住院糖尿病足溃疡(diabetic foot ulcer, DFU)患者的临床特征,探究足溃疡复发的危险因素。
      方法  回顾性分析2012年1月1日–2020年12月31日在四川大学华西医院住院的817例DFU患者的临床资料,按照既往是否发生足溃疡,分为初发组(502例)和复发组(315例)。比较两组患者临床特征的差异,采用多因素logistic回归分析足溃疡复发的危险因素。
      结果  初发和复发性DFU患者以神经缺血性足溃疡为主,均好发于第一足趾和第五足趾。与初发DFU患者相比,Wagner 3级和创面位于胼胝的复发性DFU患者更多(P<0.05),但足坏疽(Wagner 4~5级)的患者更少(P<0.05)。复发性DFU患者的糖化血红蛋白、血小板计数和纤维蛋白原水平更低(P<0.05),血尿酸和血肌酐水平更高(P<0.05);两组患者的血红蛋白、白细胞计数、估算肾小球滤过率、血沉和C-反应蛋白水平均无明显差异(P>0.05)。多因素logistic回归分析显示,男性(OR=1.555,95%CI:1.097~2.072,P=0.013)、糖尿病病程≥10年(OR=2.369,95%CI:1.473~3.810,P<0.001)、既往截肢史(OR=4.518,95%CI:2.386~8.553,P<0.001)、足部骨质疏松(OR=1.711,95%CI:1.065~2.751,P=0.027)、创面位于胼胝(OR=1.786,95%CI:1.058~3.012,P=0.030)和冠心病(OR=0.668,95%CI:0.453~0.987,P=0.043)与足溃疡复发相关。
      结论  男性、糖尿病病程超过10年、既往截肢史、足部骨质疏松和创面位于胼胝是DFU患者足溃疡复发的独立危险因素。因此,DFU患者即使足溃疡愈合,也应加强足部护理,降低足溃疡复发率。

     

    Abstract:
      Objective  To explore the risk factors for the recurrence of foot ulcers by analyzing clinical characteristics of the patients with diabetic foot ulcers (DFU) in West China Hospital, Sichuan University.
      Methods  A retrospective analysis was carried out with the clinical data of 817 DFU patients hospitalized at West China Hospital, Sichuan University between January 1, 2012 and December 31, 2020. The patients were divided into an initial ulceration group (502 cases) and a recurrent ulceration group (315 cases) according to their history of foot ulcers. The differences in clinical characteristics between the two groups were compared, and multivariate logistic regression analysis was conducted to identify the risk factors associated with the recurrence of foot ulcers.
      Results  Initial and recurrent DFU patients both had predominantly neuro-ischemic foot ulcers, and the most common sites of ulceration were the first and fifth toes in both groups. Compared with the initial DFU group, more patients in the recurrent group had foot ulcers of Wagner grade 3 and ulcerous wounds located on calluses (P<0.05), and fewer patients in the recurrent group suffered from foot gangrene (P<0.05). Patients with recurrent DFU had lower glycated hemoglobin, platelet counts, and fibrinogen levels (P<0.05), and higher serum uric acid and creatinine levels (P<0.05). Hemoglobin, white blood cell count, estimated glomerular filtration rate, erythrocyte sedimentation rate and C-reactive protein levels were not significantly different between the two groups (P>0.05). Multivariable logistic regression analysis showed that male sex (OR=1.555, 95% CI: 1.097-2.204, P=0.013), duration of diabetes≥10 years (OR=2.369, 95% CI: 1.473-3.810, P<0.001), history of amputation (OR=4.518, 95% CI: 2.386-8.553, P<0.001), foot osteoporosis (OR=1.711, 95% CI: 1.065 to 2.751, P=0.027), ulcerous wound located on foot callus (OR=1.786, 95% CI: 1.058-3.012, P=0.030), and coronary heart disease (OR=0.668, 95% CI:0.453-0.987, P=0.043) were significantly associated with the recurrence of foot ulcers.
      Conclusions  Male sex, duration of diabetes being over 10 years, history of previous amputation, foot osteoporosis, and ulcerous wounds located on foot callus are independent risk factors of recurrent foot ulcers in patients with DFU. Therefore, even after their foot ulcers have healed, special attention should be given to the care of foot for patients with DFU, which may reduce the recurrence of foot ulcers.

     

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