糖尿病足截肢术预后影响因素分析及预后能力评估

doi:10.13418/j.issn.1001-165x.2020.04.022

摘要/Abstract

摘要： 目的　探索相关实验室指标对糖尿病足截肢术预后的影响，评估对其不良预后的预测价值。方法　回顾性选取2016年1月到2018年3月于本院行糖尿病足截肢术且完成术后随访1年的69例患者资料，将随访期间发生病情恶化的患者定义为不良预后组，病情无恶化、伤口愈合良好者为预后良好组，绘制Kaplan-Meier生存曲线观察1年预后不良率；单因素及多因素分析筛选导致不良预后的独立影响因素；ROC曲线评价其对糖尿病足截肢术后发生不良事件的预测能力；在预后良好组内依据清创次数进行亚分组，筛选影响截肢术前清创次数的独立危险因素。结果　单因素分析提示糖尿病足截肢术不良预后组其血清白蛋白（ALB）、中性粒细胞/淋巴细胞比值（NLR）、C反应蛋白（CRP）、血沉（ESR）及D-二聚体（D-dimer）相比预后良好组有统计学差异（P<0.05），多因素分析显示D-dimer、CRP及NLR为影响重症糖尿病足截肢术预后的独立危险因素。生存曲线提示1年不良预后率为40.6%。ROC三者联合诊断的曲线下面积为0.902，高于D-dimer，Delong检验显示其与D-二聚体有统计学差异（P<0.05）。在预后良好组内，CRP是影响截肢术前清创次数的独立危险因素（P<0.05）。结论　D-dimer、CRP、NLR及三者联合诊断对糖尿病足截肢术预后均有较好的预测能力，其联合诊断效率高于D-dimer，但不优于CRP或NLR；CRP为预后良好组内影响截肢术前的独立危险因素。

关键词: 糖尿病足截肢术, 　预后分析, 　D-二聚体, 　C反应蛋白, 　粒淋比

Abstract: Objective　To explore the influence of different laboratory indexes for different prognosis of diabetic foot amputation and evaluate its predictive value for poor prognosis.　Methods 　The clinical data of 69 patients with diabetic foot amputation at the Second Xiangya Hospital of Central South University from January 2016 to March 2018 were retrospectively collected. All the patients were followed up for 1 year. The patients were classified into a poor prognosis group (patients with exacerbation) and a favorable prognosis group (patients with on exacerbation and good wound healing). Kaplan-Meier survival curve was drawn to observe the one-year poor prognosis rate. Univariate and multivariate analysis were used to screen out the independent influencing factors that lead to poor prognosis. The predictive ability of the adverse reactions after diabetic foot amputation was calculated and evaluated by the ROC curve. In the prognostic group, patients were sub-grouped according to the number of debridement to screen out the independent risk factors that affecting the number of debridement before amputation surgery.　Results　Univariate analysis showed that for diabetic foot amputation, D-dimer、CRP、ESR、NLR、ALB of the poor prognosis group have better statistical difference than that of the favorable prognosis group (P<0.05). Multivariate analysis showed D-dimer、CRP and NLR were the independent factors that influencing the prognosis of diabetic foot amputation. Kaplan-Meier survival curve showed that one-year poor prognosis rate was 40.6%. Area under the curve of the combined diagnosis of D-dimer, CRP and NLR was 0.902, which was higher than that of D-dimer or CRP or NLR. Delong test showed there were statistical difference between the area under the curve and D-dimer (P<0.05). CRP was the independent risk factor that affecting the number of debridement before amputation in the favorable prognosis group (P<0.05).　Conclusions　D-dimer, CRP, NLR and the combined diagnosis of the three have favorable predictive ability for the prognosis of diabetic foot amputation. The efficiency of the combined diagnosis was higher than that of D-dimer, but not significantly better than that of CRP and NLR. CRP was the independent risk factor that affecting the number of debridement before amputation in the favorable prognosis group.

Key words: Diabetic foot amputation, 　Prognosis analysis, 　D-dimer, 　CRP, 　NLR

中图分类号:

R687.5

曹志远, 何爱咏, 肖波. 糖尿病足截肢术预后影响因素分析及预后能力评估[J]. 中国临床解剖学杂志, 2020, 38(4): 481-485.

CAO Zhi-yuan, HE Ai-yong, XIAO Bo. Analysis of factors influencing the prognosis of diabetic foot amputation and evaluation of prognosis ability[J]. Chinese Journal of Clinical Anatomy, 2020, 38(4): 481-485.

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