A prospective study of risk factors for diabetic foot ulcer - The Seattle diabetic foot study
A prospective study of risk factors for diabetic foot ulcer - The Seattle diabetic foot study
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DOI：
10.2337/diacare.22.7.1036
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发表时间：
1999-07-01
期刊：
影响因子：
16.2
通讯作者：
Smith, DG
中科院分区：
文献类型：
--
作者：
Boyko, EJ;Ahroni, JH;Smith, DG
目的：很少有关于糖尿病足溃疡危险因素的前瞻性研究，这些研究考虑了多种潜在病因的独立作用。我们前瞻性地研究了糖尿病特征、足部畸形、行为因素和神经血管功能对749名糖尿病退伍军人1,483条小腿足部溃疡风险的影响。研究设计和方法-符合条件的受试者包括所有在普通内科诊所登记的糖尿病患者，其中83%同意参与。基线评估包括病史和下肢体检，感觉神经和自主神经病变的测试，以及足部大血管和微血管血流的测量。受试者因服用>的足部全层皮肤缺陷的发生而接受跟踪调查；结果：经逐步COX回归分析，以下因素与足部溃疡风险独立相关：足部对5.07单丝不敏感(相对风险[95%CI])2.2(1.5-3.1)，既往截肢2.8(1.8-4.3)或足部溃疡病史1.6(1.2-2.3)，胰岛素用量1.6(1.1-2.2)，夏科畸形3.5(1.2-9.9)，经皮足背压增加15 mm Hg 0.8(0.7~0.9)，体重增加20 kg 1.2(1.1~1.4)，踝臂指数增加0.3(0.7~1.0)，视力下降1.9(1.4~2.6)，立位血压下降1.2(1.1~1.5)。在某些亚组中，锤子/爪趾畸形和激光光凝史与较高的溃疡风险相关。在多因素模型中，糖尿病病程和类型、种族、吸烟状况、糖尿病教育、关节活动度、拇指血压和其他足部畸形与愚人溃疡风险无关。结论：某些足部畸形、皮肤氧合和足部血流减少、视力差、体重增加以及感觉和自主神经病变都独立影响足部溃疡风险，从而为糖尿病足部溃疡的多因素病因提供支持。
OBJECTIVE - Little prospective research exists on risk factors for diabetic foot ulcer that considers the independent effects of multiple potential etiologic agents. We prospectively studied the effects of diabetes characteristics, foot deformity, behavioral factors, and neurovascular function on foot ulcer risk among 749 diabetic veterans with 1,483 lower limbs.RESEARCH DESIGN AND METHODS - Eligible subjects included all diabetic enrollees of a general internal medicine clinic without fool ulcer, of whom 83% agreed to participate. Baseline assessment included history and lower-limb physical examination, tests for sensory and autonomic neuropathy, and measurements of macro- and microvascular perfusion in the foot. Subjects were followed for the occurrence of a full thickness skin defect on the foot that took >14 days to heal, with a mean follow-up of 3.7 years.RESULTS - Using stepwise Cox regression analysis, the following factors were independently related to foot ulcer risk: foot insensitivity to the 5.07 monofilament (relative risk [95% CI]) 2.2 (1.5-3.1), past history of amputation 2.8 (1.8-4.3) or foot ulcer 1.6 (1.2-2.3), insulin use 1.6 (1.1-2.2), Charcot deformity 3.5 (1.2-9.9), 15 mmHg higher dorsal foot transcutaneous Po-2 0.8 (0.7-0.9), 20 kg higher body weight 1.2 (1.1-1.4), 0.3 higher ankle-arm index 0.8 (0.7-1.0), poor vision 1.9 (1.4-2.6), and 13 mmHg orthostatic blood pressure fall 1.2 (1.1-1.5). Higher ulcer risk was associated with hammer/claw toe deformity and history of laser photocoagulation in certain subgroups. Unrelated to fool ulcer risk in multivariate models were diabetes duration and type, race, smoking status, diabetes education,joint mobility hallux blood pressure, and other foot deformities.CONCLUSIONS - Certain foot deformities, reduced skin oxygenation and foot perfusion, poor vision, greater body mass, and both sensory and autonomic neuropathy independently influence foot ulcer risk, thereby providing support For a multifactorial etiology For diabetic foot ulceration.