欢迎来到《四川大学学报(医学版)》

糖尿病足患者炎症标志物特征及其与足溃疡预后关系

Characteristics of Inflammatory Markers in Diabetic Foot Patients and Their Relationship With Prognosis of Diabetic Foot Ulcers

  • 摘要:
      目的  探究糖尿病足患者基线炎症标志物特征及其与足溃疡预后的关系。
      方法  通过医院电子病历系统收集2016年以来在四川大学华西医院住院的495例糖尿病足患者的临床资料,分析炎症标志物特征及与足溃疡预后的关系。
      结果  Wagner 4级患者白细胞计数(white blood cell count, WBC)、红细胞沉降率(erythrocyte sedimentation rate, ESR)、C反应蛋白(C-reactive protein, CRP)、降钙素原(procalcitonin, PCT)和白细胞介素6(interleukin-6, IL-6)水平均高于Wagner 0-3级患者,中性粒细胞百分率(neutrophil percentage, NE%)在Wagner 4级高于Wagner 0-1级,Wagner 3级高于Wagner 0级。NE%、CRP、PCT和IL-6水平与糖尿病足严重程度呈正相关,比值比(odds ratio, OR)及95%可信区间(confidence interval, CI)分别为1.038 (1.019~1.056)、1.019(1.012~1.026)、8.225(2.015~33.576)和1.017(1.008~1.025);以Wagner 0级为参照,高WBC者病情更易进展至Wagner 2-4级,OR(95%CI)值分别为1.260(1.096~1.447)、1.188(1.041~1.356)和1.301(1.137~1.490);高ESR者病情进展至Wagner 3-4级的风险更高,OR(95%CI)值为1.030(1.006~1.054)和1.045(1.019~1.071)。入院前接受抗生素治疗的患者ESR(P=0.008)、CRP(P=0.039)和IL-6(P=0.033)的水平低于未接受治疗者。痊愈组WBC、NE%、ESR、PCT和IL-6水平低于无效组。NE%和IL-6水平越高,足溃疡患者预后越差,OR(95%CI)值分别为1.030(1.010~1.051)和1.008(1.002~1.013)。
      结论  随着基线炎症标志物水平的升高,糖尿病足溃疡的严重程度增加;基线NE%和IL-6水平升高,预示患者预后不良。该研究提示应该尽早评估糖尿病足溃疡感染状况并给予规范化抗生素治疗,以改善疾病预后。

     

    Abstract:
      Objective  To explore the characteristics of baseline inflammatory markers in diabetic foot patients and their relationship with the prognosis of diabetic foot ulcers.
      Methods  The clinical data of diabetic foot patients (n=495) admitted to West China Hospital, Sichuan University since 2016 were retrospectively collected through the hospital electronic medical record system to analyze the characteristics of inflammatory markers and their relationship with the prognosis of diabetic foot ulcers.
      Results  White blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) levels were significantly higher in patients defined as grade 4 on the Wagner Scale than those in patients defined as grade 0-3 on the Wagner Scale. Neutrophil percentage (NE%) was higher in Wagner grade-4 patients than those in Wagner grade-0 and grade-1 patients and higher in Wagner grade-3 patients than those in Wagner grade-0 patients. NE%, CRP, PCT, and IL-6 levels were positively correlated with the severity of diabetic foot, with the respective odds ratio (OR) at 95% confidence interval (CI) being 1.038 (1.019-1.056), 1.019 (1.012-1.026), 8.225 (2.015-33.576), and 1.017 (1.008-1.025). Using Wagner grade-0 patients as the reference, patients with higher WBC were more likely to progress to Wagner grade 2, 3, and 4, with the respective OR (95% CI) values being 1.260 (1.096-1.447), 1.188 (1.041-1.356), and 1.301 (1.137-1.490); patients with higher ESR were more likely to progress to Wagner grade 3 and 4, with the respective OR (95% CI) values being 1.030 (1.006-1.054) and 1.045 (1.019-1.071). Baseline ESR (P=0.008), CRP (P=0.039), and IL-6 (P=0.033) levels were lower in patients who had received antibiotics prior to their admission than those in patients who had not received antibiotics before admission. The levels of WBC, NE%, ESR, PCT, and IL-6 were lower in the full recovery group than those in the group of patients who did not respond to treatment. The higher the levels of NE% and IL-6, the worse the prognosis of diabetic foot ulcers became, with the respective OR (95% CI) values being 1.030 (1.010-1.051) and 1.008 (1.002-1.013).
      Conclusion  The severity of diabetic foot ulcers increased with the rise in baseline levels of inflammatory markers. Elevated baseline NE% and IL-6 levels suggest a poor prognosis. Our findings suggest that early assessment of diabetic foot infection and standardized antibiotic therapy should be implemented to improve the prognosis.

     

/

返回文章
返回