Is neuropathic ulceration the key to understanding increased mortality due to ischaemic heart disease in diabetic foot ulcer patients? A population approach using a proportionate model
Is neuropathic ulceration the key to understanding increased mortality due to ischaemic heart disease in diabetic foot ulcer patients? A population approach using a proportionate model
复制标题
DOI：
10.1177/147323000203000602
复制
发表时间：
2002-11-01
影响因子：
1.6
通讯作者：
Edmonds, ME
中科院分区：
文献类型：
--
作者：
Chammas, NK;Hill, RLR;Edmonds, ME
缺血性心脏病（IHD）是糖尿病足溃疡患者和非溃疡糖尿病患者的最常见死因，然而糖尿病足溃疡患者的死亡率是非溃疡患者的两倍以上。由于死亡率增加的原因尚不清楚，我们绘制了缺血性心脏病（IHD）死亡率。242例糖尿病足溃疡患者和121例对照组（非溃疡性糖尿病患者）的其他死因（即IHDn：OCDn）与年龄的关系。糖尿病足溃疡患者的IHDn：OCDn比值从40岁开始上升到1.0以上，而对照组从70岁开始上升，表明IHD导致的死亡率差异性增加。一个涉及神经性和神经缺血性糖尿病足溃疡患者IHDn：OCDn比值总和的人群模型计算出，与非溃疡性糖尿病患者相比，总体死亡率增加1.8。该模型预测，死于IHD的神经性糖尿病足溃疡患者减少25%将消除死亡率增加，表明神经性溃疡而不是缺血性溃疡定义了糖尿病足溃疡患者死亡率增加的原因。
ischaemic heart disease (IHD) is the commonest cause of death in diabetic foot ulcer patients and non-ulcerated diabetic patients, yet the mortality rate of diabetic foot ulcer patients is over twice that of non-ulcerated patients. As the cause of this increased mortality is not understood, we plotted the ratio of deaths due to ischaemic heart disease (IHD.) to other causes of death (i.e. IHDn:OCDn) against age for 242 diabetic foot ulcer patients and 121 controls (non-ulcerated diabetic patients). The IHDn:OCDn ratio rose above 1.0 from age 40 years onwards for diabetic foot ulcer patients, but from age 70 years onwards for controls, demonstrating differentially increased mortalities due to IHD. A population model involving summation of IHDn:OCDn ratios for neuropathic and neuroischaemic diabetic foot ulcer patients calculated an overall increased mortality rate of 1.8 compared with that of non-ulcerated diabetics. The model predicted that a 25% reduction in neuropathic diabetic foot ulcer patients dying from IHD would eliminate the increased mortality, demonstrating that neuropathic rather than ischaemic ulceration defines the cause of increased mortality among diabetic foot ulcer patients.