Mortality in patients with diabetic neuropathic osteoarthropathy (Charcot foot)
Mortality in patients with diabetic neuropathic osteoarthropathy (Charcot foot)
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DOI：
10.1111/j.1464-5491.2004.01215.x
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发表时间：
2004-11-01
影响因子：
3.5
通讯作者：
Jeffcoate, W
中科院分区：
文献类型：
--
作者：
Gazis, A;Pound, N;Jeffcoate, W
目的确定由单一专科单位管理的夏科特神经病理性骨关节病患者的死亡率，并将结果与对照人群进行比较。方法对1982年以来在诺丁汉城市医院糖尿病足专科门诊维护的所有夏科特足病患者进行回顾性分析。将存活率和截肢发生率(大和小)与非复杂神经性溃疡的对照人群进行比较。对照组在性别、年龄(+/-2岁)、疾病类型、病程(+/-2年)和转诊年份(+/-3年)方面进行配对。结果共确诊夏科足病47例(女性21例，男性26例)，其中1型糖尿病18例(38.3%)。平均发病年龄和病程分别为59.2±13.4岁和16.2±11.2年，而对照组分别为59.7±12.6岁和16.3±11.2年。夏科特患者中有21人(44.7%)在平均间隔3.7+/-2.8年后死亡。相比之下，控制组在平均3.1+/-2.7年后有16人(34.0%)。幸存者的平均随访期为4.7+/-4.9年(夏科特)和5.3+/-3.9年(对照组)。共有11名Charcot患者(23.4%)在指状病变一侧进行了重大截肢，而对照组为5例(10.6%)。两组差异无统计学意义(P>；0.05，卡方检验)。结论本组夏科足病患者病死率高于预期。然而，夏科特患者和无并发症的神经性溃疡患者之间并无差异。可能是神经病变，而不是夏科特骨关节病，这与糖尿病死亡率的增加独立相关。任何此类关联背后的机制尚不清楚。有必要进行一项正式的、前瞻性的多中心研究，以调查夏科特骨关节病患者的预期寿命和心血管风险。
Objective To determine the mortality of a population of patients diagnosed with Charcot neuropathic osteoarthropathy managed by a single specialist unit and to compare the results with a control population.Methods We have undertaken a retrospective analysis of all cases of Charcot foot on the comprehensive database which has been maintained at the specialist diabetic foot clinic at the City Hospital, Nottingham since 1982. Survival and the incidence of amputation (major and minor) was compared with a control population referred with uncomplicated neuropathic ulceration. Controls were individually matched for gender, age (+/-2 years), disease type, disease duration (+/-2 years) and year of referral (+/-3 years).Results Forty-seven cases (21 female, 26 male) of Charcot foot were identified, of whom 18 (38.3%) had Type 1 diabetes. Mean age and disease duration at presentation were 59.2 +/- 13.4 SD and 16.2 +/- 11.2 years, compared with 59.7 +/- 12.6 and 16.3 +/- 11.2 years, respectively, in the controls. Twenty-one (44.7%) of those with Charcot had died, after a mean interval of 3.7 +/- 2.8 years. This compared with 16 (34.0%) after a mean 3.1 +/- 2.7 years in the control group. Mean duration of follow-up in the survivors was 4.7 +/- 4.9 years (Charcot) and 5.3 +/- 3.9 years (controls). A total of 11 (23.4%) Charcot patients had had a major amputation on the side of the index lesion, compared with five (10.6%) controls. There was no difference between the two groups (P > 0.05, Chi-square).Conclusions The mortality in this group of patients with Charcot foot was higher than expected. Nevertheless, there was no difference between those with Charcot and those with uncomplicated neuropathic ulceration. It is possible that it is neuropathy, rather than Charcot osteoarthropathy, which is independently associated with increased mortality in diabetes. The mechanism underlying any such association is not known. There is a need for a formal, prospective, multicentre study to investigate the life expectancy and cardiovascular risk of those with Charcot osteoarthropathy.