New ulceration, new major amputation, and survival rates in diabetic subjects hospitalized for foot ulceration from 1990 to 1993 - A 6.5-year follow-up
New ulceration, new major amputation, and survival rates in diabetic subjects hospitalized for foot ulceration from 1990 to 1993 - A 6.5-year follow-up
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DOI：
10.2337/diacare.24.1.78
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发表时间：
2001-01-01
期刊：
影响因子：
16.2
通讯作者：
Morabito, A
中科院分区：
文献类型：
--
作者：
Faglia, E;Favales, F;Morabito, A
目的 - 评估 1) 新发溃疡、新大截肢以及 1990 至 1993 年间因足部溃疡住院的 115 名糖尿病受试者的生存率，平均随访时间为 6.5 年，以及 2) 与这些事件相关的人口和临床特征。 研究设计和方法 - 截至 12 月 31 日，对总共 115 名受试者（31 名女性和 84 名男性）进行了监测1998. 所有受试者均获得治疗鞋并接受 密集的教育。记录每位患者的新溃疡、新大截肢和再截肢事件以及死亡日期和原因的数据。然后评估这些事件的预后因素。 结果 - 平均随访时间为 78.3 +/- 15.3 个月（范围 60-106）。在此期间，同侧13次和对侧12次出现新的溃疡。在单变量分析中，所考虑的变量均与新溃疡没有显着相关。共有三处重大截肢：两处肢体先前已愈合，另一处为对侧肢体。在 115 名受试者中，有 51 名（44.3%）死亡：31 名女性中有 24 名女性（77.4%），84 名男性中有 27 名（32.1%）。缺血性心脏病是最常见的死亡原因（60.8%）。 1990年至1993年接受大截肢的27名受试者中有20名（74.1％）死亡，88名痊愈受试者中有31名（35.2％）死亡，差异显着（P <0.0001）。多变量分析显示踝臂指数 0.5（P = 0.005）、年龄（P = 0.003）和女性（P = 0.027）的独立作用。结论 - 我们相信，治疗鞋的使用和强化教育培训，包括家庭教育，有助于我们研究人群中新发溃疡和大截肢的规律发生率。缺血性心脏病作为死亡原因的高频率也许应该导致对因足部溃疡入院的糖尿病患者采取更积极的诊断和治疗态度。
OBJECTIVE - To evaluate 1) the new ulceration, the new major amputation, and the survival rates of 115 diabetic subjects hospitalized for foot ulceration from 1990 to 1993, with an average follow-up of 6.5 years, and 2) the demographic and clinical characteristics associated with these events.RESEARCH DESIGN AND METHODS - A total of 115 subjects, 31 women and 84 men, were monitored until 31 December 1998. All subjects were provided with therapeutic shoes and received intense education. Data concerning new ulceration, new major amputation, and reamputation events and the date and cause of death were recorded for each patient. The prognostic factors for these events were then evaluated.RESULTS - The average follow-up was 78.3 +/- 15.3 months (range 60-106). During this time, 13 homolateral and 12 contralateral episodes of new ulceration occurred. At univariate analysis none of the variables considered were significantly associated with the new ulceration. There were three major amputations: two of the limb previously healed and one of the contralateral limb. Of the 115 subjects, 51 (44.3%) died: 24 of the 31 women (77.4%) and 27 of the 84 men (32.1%). Ischemic cardiopathy was the most frequent cause of death (60.8%). Mortality concerned 20 of the 27 subjects (74.1%) undergoing major amputation from 1990 to 1993 and 31 of the 88 healed subjects (35.2%), with a significant difference (P < 0.0001). Multivariate analysis showed the independent role of the ankle-brachial index 0.5 (P = 0.005), age (P = 0.003), and female sex (P = 0.027).CONCLUSIONS - We believe that the use of therapeutic shoes and intense educational training, including the education of the family, have contributed to the law incidence of new ulceration and major amputation in our study population. The high frequency of ischemic cardiopathy as a cause of death should, perhaps, lead to a more aggressive diagnostic and therapeutic attitude toward this pathology in diabetic subjects admitted to hospitals for foot ulceration.