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糖尿病足感染截肢（趾）相关危险因素分析

刘倩1,王鹏华1,张达1,孙茜1,杨蔚1,褚月颉1,李代清2   

  1. 1. 天津医科大学代谢病医院
    2. 卫生部及天津市激素与发育重点实验室，天津医科大学代谢病医院
  • 收稿日期:2012-05-08 修回日期:2012-10-19 出版日期:2013-02-15 发布日期:2013-02-15
  • 通讯作者: 李代清

The risk factors related to lower extremity amputations in the patients suffered from severe infective diabetic foot ulcers

  • Received:2012-05-08 Revised:2012-10-19 Published:2013-02-15 Online:2013-02-15
  • Contact: Dai-Qing LI

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摘要：

目的 研究除感染因素外影响感染程度的糖尿病足溃疡患者行大（小）截肢（趾）的因素。方法 选取PEDIS感染分级3～4级的糖尿病足病已愈合的患者1 076例，分未手术愈合组(A组，48例)、小截肢（趾）愈合组（B 组，162例）、大截肢愈合组（C组，70例）。测量并比较各组患者生化指标和SAD评分，采用多因素Logistic回归分析影响小截肢（趾）和大截肢的因素。结果 患者的血小板水平、血尿酸水平与SAD评分中的动脉病变是其行小截肢（趾）手术的影响因素。而患者的血小板水平、血尿酸水平、血浆纤维蛋白原水平、Charlson评分和患者SAD评分中的动脉病变程度与溃疡深度是其行大截肢手术的影响因素。结论 血小板计数、血尿酸与血浆纤维蛋白原水平、合并症 Charlson评分及患者的下肢动脉病变程度和溃疡深度可以预测感染程度较重糖尿病足患者截肢（趾）的危险性。

关键词: 截肢（趾）, 糖尿病足, 溃疡, 感染

Abstract:

[Abstract] Objective  To analyze risk factors of lower extremity amputations in patients with severe infective diabetic foot ulcers. Methods  The total of 1 076 patients with diabetic foot ulcers was included in this study. All patients with severe diabetic foot infections were selected (PEDIS grade 3-4) by PEDIS infection classification，and divided into three groups including non-amputation group (group A，n=48),healing after minor amputations (group B，n =162) and administered amputations above ankle-level (group C, n=70). The biochemical indicators and SAD score were measured and compared in groups of patients. The multiple Logistic regression analysis was used to observe the factors affect small amputation (toe) and amputation. Results  The multivariate analysis showed that platelet count, serum uric acid and the degree of peripheral vascular diseases (SAD score) were independent predictors of minor amputations in the patients with severe infections. Besides the above factors，the plasma fibrinogen and the depth of ulcer (scored by SAD) were the factors related to the risk of major amputation. Conclusion  It was found that the platelet count, serum uric acid, plasma fibrinogen, the Charlson score, the degree of peripheral vascular diseases and the depth of ulcer can predict the amputation-risk in diabetic foot patients with severe infections.

Key words: amputation, diabetic foot, ulcer, wound infection