A foot risk classification system to predict diabetic amputation in Pima Indians
A foot risk classification system to predict diabetic amputation in Pima Indians
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DOI：
10.2337/diacare.19.7.704
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发表时间：
1996-07-01
期刊：
影响因子：
16.2
通讯作者：
Greene, T
中科院分区：
文献类型：
--
作者：
Mayfield, JA;Reiber, GE;Greene, T
目的-量化各种危险因素对糖尿病患者截肢风险的贡献，并根据临床数据建立一个足部风险评分系统。研究设计和方法-进行了一项以人群为基础的病例对照研究。符合条件的受试者为：1）25-85岁，2）糖尿病患者，3）50%或以上的Pima或Tohono O 'odham印第安人，4）居住在吉拉河印第安社区，5）至少有一次国立卫生研究院的研究检查。病例组患者在1983年至1992年期间发生了下肢截肢事件;对照组受试者在1992年之前没有截肢。医疗记录进行了审查，以确定风险条件和健康状况的关键事件之前，导致截肢。结果-61人截肢，并与183名对照组进行了比较。男性比女性更容易截肢（比值比[OR] 6.5，95% CI 2.6-15），患有糖尿病眼、肾脏或心血管疾病的人比没有糖尿病眼、肾脏或心血管疾病的人更容易截肢（OR 4.6，95% CI 1.7-12）。截肢的风险与这些足部风险因素几乎同样相关。周围神经病变、周围血管疾病、骨畸形和足部溃疡病史。在控制了人口统计学差异和糖尿病严重程度后，截肢与一个loot风险因素的OR为2.1（95% CI 1.4-3.3），有两个风险因素，4.5（95% CI 2.9-6.9），有3或4个风险因素，9.7结论：男性、眼、心脏和肾脏的终末器官并发症以及血糖控制不良与较高的截肢率相关。周围神经病变、周围血管疾病、畸形和既往溃疡同样与下肢截肢风险增加相关。
OBJECTIVE - To quantify the contribution of various risk factors to the risk of amputation in diabetic patients and to develop a foot risk scoring system based on clinical data.RESEARCH DESIGN AND METHODS - A population-based case-control study was undertaken. Eligible subjects were 1) 25-85 years of age, 2) diabetic, 3) 50% or more Pima or Tohono O'odham Indian, 4) lived in the Gila River Indian Community, and 5) had had at least one National Institutes of Health research examination. Case patients had had an incident lower extremity amputation between 1983 and 1992; control subjects had no amputation by 1992. Medical records were reviewed to determine risk conditions and health status before the pivotal event that led to the amputation.RESULTS - Sixty-one people with amputations were identified and compared with 183 control subjects. Men were more likely to suffer amputation than women (odds ratio [OR] 6.5, 95% CI 2.6-15), and people with diabetic eye, renal, or cardiovascular disease were more likely to undergo amputation than those without (OR 4.6, 95% CI 1.7-12). The risk of amputation was almost equally associated with these foot risk factors. peripheral neuropathy, peripheral vascular disease, bony deformities, and a history of foot ulcers. After controlling for demographic differences and diabetes severity, the ORs for amputation with one loot risk factor was 2.1 (95% CI 1.4-3.3), with two risk factors, 4.5 (95% CI 2.9-6.9), and with three or four risk factors, 9.7 (95% CI 6.3-14.8).CONCLUSIONS - Male sex, end-organ complications of eye, heart, and kidney, and poor glucose control were associated with a higher amputation rate. Peripheral neuropathy, peripheral vascular disease, deformity, and a prior ulcer were similarly equally associated with an increased risk of lower extremity amputation.