Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study
Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study
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DOI：
10.1007/s00125-008-1226-2
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发表时间：
2009-03-01
期刊：
影响因子：
8.2
通讯作者：
Apelqvist, J.
中科院分区：
文献类型：
--
作者：
Gershater, M. A.;Londahl, M.;Apelqvist, J.
我们试图确定在多学科系统中治疗的糖尿病患者足部溃疡的短期预后相关因素，直到愈合。连续出现糖尿病和最严重足部溃疡（Wagner 1-5级，踝关节以下）的患者（n = 2511）进行前瞻性随访，并根据标准化方案进行治疗，直至治愈或死亡。因中途退出的患者为31例。其余2480例患者的特征为：1465例男性，年龄68 +/- 15岁（18-96岁），1型糖尿病18%，2型糖尿病82%，胰岛素治疗62%。存活患者无大截肢的治愈率为90.6% （n = 1867）。65% （n = 1617）初步愈合，9% （n = 250）为小截肢，8%为大截肢；17% （n = 420）未愈合死亡。在2,060例存活患者中，1,007例为神经缺血（48.8%）。在多元回归分析中，初次愈合与合并症、糖尿病病程、周围血管病变程度和溃疡类型有关。在神经性溃疡中，深足感染、溃疡部位和合并症与截肢有关。神经缺血性溃疡截肢与合并症、周围血管病变及溃疡类型有关。年龄、性别、糖尿病病程、神经病变、畸形、溃疡病程或溃疡部位对截肢概率无明显影响。糖尿病足溃疡患者患有多器官疾病。与结果相关的因素也相应复杂。
We sought to identify factors related to short-term outcome of foot ulcers in patients with diabetes treated in a multidisciplinary system until healing was achieved.Consecutively presenting patients with diabetes and worst foot ulcer (Wagner grade 1-5, below ankle) (n = 2,511) were prospectively followed and treated according to a standardised protocol until healing was achieved or until death. The number of patients lost to dropout was 31. The characteristics of the remaining 2,480 patients were: 1,465 men, age 68 +/- 15 years (range 18-96), type 1 diabetes 18%, type 2 diabetes 82% and insulin-treated 62%.The healing rate without major amputation in surviving patients was 90.6% (n = 1,867). Sixty-five per cent (n = 1,617) were healed primarily, 9% (n = 250) after minor amputation and 8% after major amputation; 17% (n = 420) died unhealed. Out of 2,060 surviving patients, 1,007 were neuroischaemic (48.8%). In a multiple regression analysis, primary healing was related to co-morbidity, duration of diabetes, extent of peripheral vascular disease and type of ulcer. In neuropathic ulcers, deep foot infection, site of ulcer and co-morbidity were related to amputation. Amputation in neuroischaemic ulcers was related to co-morbidity, peripheral vascular disease and type of ulcer. Age, sex, duration of diabetes, neuropathy, deformity and duration of ulcer or site of ulcer did not have an evident influence on probability of amputation.Patients with diabetic foot ulcer suffer from multi-organ disease. Factors related to outcome are correspondingly complex.