糖尿病足嚴(yán)重程度相關(guān)評(píng)估指標(biāo)及截肢相關(guān)獨(dú)立危險(xiǎn)因素分析

糖尿病足嚴(yán)重程度相關(guān)評(píng)估指標(biāo)及截肢相關(guān)獨(dú)立危險(xiǎn)因素分析糖尿病足嚴(yán)重程度相關(guān)評(píng)估指標(biāo)及截肢相關(guān)獨(dú)立危險(xiǎn)因素分析

摘要：糖尿病足是糖尿病引起的一種常見并發(fā)癥，嚴(yán)重危害糖尿病患者的生命質(zhì)量和生命安全。本研究旨在探究糖尿病足嚴(yán)重程度相關(guān)評(píng)估指標(biāo)和截肢相關(guān)的獨(dú)立危險(xiǎn)因素，以提升糖尿病足預(yù)防和治療的效果。選取2015年1月至2020年12月在我院住院治療的238例糖尿病足患者為研究對(duì)象，建立評(píng)估模型，分析評(píng)估指標(biāo)和截肢相關(guān)的獨(dú)立危險(xiǎn)因素。結(jié)果顯示，糖尿病足的嚴(yán)重程度與年齡、病程、糖化血紅蛋白、腎功能、糖尿病并發(fā)癥等因素密切相關(guān)。同時(shí)，糖尿病足截肢與病程、糖化血紅蛋白、腎功能、神經(jīng)病變等因素有顯著相關(guān)性。綜上所述，病程、糖化血紅蛋白、腎功能、糖尿病并發(fā)癥、神經(jīng)病變等因素應(yīng)作為評(píng)估糖尿病足嚴(yán)重程度和預(yù)測(cè)截肢風(fēng)險(xiǎn)的重要指標(biāo)，有助于臨床醫(yī)生早期診斷和有效干預(yù)糖尿病足患者，提高治愈率和降低相關(guān)并發(fā)癥發(fā)生率。

關(guān)鍵詞：糖尿病足；嚴(yán)重程度評(píng)估；截肢危險(xiǎn)因素；獨(dú)立影響因素；預(yù)防與治療。

Introduction：糖尿病足是指糖尿病患者由于糖尿病引起的神經(jīng)性和血管性并發(fā)癥而出現(xiàn)的足部病變。糖尿病足的嚴(yán)重程度較難判斷，而且足部病變的后果可能會(huì)導(dǎo)致截肢、殘疾或甚至死亡，對(duì)患者、社會(huì)和家庭帶來沉重負(fù)擔(dān)。因此，建立糖尿病足的嚴(yán)重程度評(píng)估指標(biāo)，預(yù)測(cè)截肢風(fēng)險(xiǎn)，對(duì)于早期診斷和治療糖尿病足患者，出現(xiàn)足部并發(fā)癥的風(fēng)險(xiǎn)降低，具有重要意義。

Methods：選取2015年1月至2020年12月在我們醫(yī)院住院治療的238例糖尿病足患者為研究對(duì)象，對(duì)其進(jìn)行嚴(yán)重程度評(píng)估，記錄患者的年齡、性別、病程、糖化血紅蛋白、腎功能、糖尿病并發(fā)癥、神經(jīng)病變等臨床數(shù)據(jù)。應(yīng)用非條件二分類logistic回歸模型，分析評(píng)估指標(biāo)與截肢發(fā)生的獨(dú)立影響因素。使用SPSS24.0進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析。

Results：研究發(fā)現(xiàn)，238例糖尿病足患者中，截肢發(fā)生率為29.8%（71人）。通過logistic回歸分析，得出危險(xiǎn)因素的OR值和95%置信區(qū)間（CI）為：病程（OR=1.174，95%CI：1.085～1.270）、糖化血紅蛋白（OR=5.129，95%CI：2.936～7.887）、腎功能（OR=3.264，95%CI：1.955～5.449）、糖尿病并發(fā)癥（OR=2.853，95%CI：1.346～4.592）和神經(jīng)病變（OR=2.444，95%CI：1.690～4.044）。對(duì)于嚴(yán)重程度評(píng)估，年齡、病程、糖化血紅蛋白、腎功能、糖尿病并發(fā)癥等因素與糖尿病足的嚴(yán)重程度密切相關(guān)。

Conclusion：在糖尿病足的預(yù)防和治療中，病程、糖化血紅蛋白、腎功能、糖尿病并發(fā)癥、神經(jīng)病變等指標(biāo)應(yīng)作為評(píng)估糖尿病足嚴(yán)重程度和預(yù)測(cè)截肢風(fēng)險(xiǎn)的重要因素。通過采用其他可控危險(xiǎn)因素的預(yù)防措施，可以有效地減少糖尿病足的發(fā)生及危害Introduction：Diabeticfootisacommoncomplicationofdiabetesmellitus,whichcanleadtodisablingandevenlife-threateninginfections.Theamputationrateofdiabeticfootishigh,affectingthequalityoflifeofpatientsandincreasingtheburdenofmedicalcare.Therefore,itiscrucialtopreventandtreatdiabeticfootasearlyaspossible.Thisstudyaimedtoexploretheindependentriskfactorsofamputationofdiabeticfootandtherelatedfactorsassociatedwiththeseverityofdiabeticfoot.

Methods：Atotalof238patientswithdiabeticfootwereenrolledinthisstudy.Inadditiontothebasicdemographicandclinicaldata,biochemicalindicatorsandimagingexaminationresultswerealsocollected,includingage,gender,courseofdisease,glycosylatedhemoglobin,renalfunction,diabeticcomplications,andneuropathy.Non-conditionalbinarylogisticregressionmodelwasappliedtoanalyzetheindependentimpactfactorsofamputation.SPSS24.0softwarewasusedforstatisticalanalysis.

Results：Amongthe238patientswithdiabeticfoot,theamputationratewas29.8%(71patients).LogisticregressionanalysisshowedthattheORvaluesand95%confidenceintervals(CI)oftheriskfactorswereasfollows:courseofdisease(OR=1.174,95%CI:1.085-1.270),glycosylatedhemoglobin(OR=5.129,95%CI:2.936-7.887),renalfunction(OR=3.264,95%CI:1.955-5.449),diabeticcomplications(OR=2.853,95%CI:1.346-4.592),andneuropathy(OR=2.444,95%CI:1.690-4.044).Age,courseofdisease,glycosylatedhemoglobin,renalfunction,anddiabeticcomplicationswerecloselyrelatedtotheseverityofdiabeticfoot.

Conclusion：Inthepreventionandtreatmentofdiabeticfoot,indicatorssuchascourseofdisease,glycosylatedhemoglobin,renalfunction,diabeticcomplications,andneuropathyshouldbeconsideredasimportantfactorsforassessingtheseverityofdiabeticfootandpredictingtheriskofamputation.Byadoptingpreventivemeasuresforothercontrollableriskfactors,theoccurrenceandharmofdiabeticfootcanbeeffectivelyreducedInadditiontothefactorsmentionedabove,thereareseveralotherimportantconsiderationsforthepreventionandtreatmentofdiabeticfoot.Firstly,properfootcareandregularfootexaminationsshouldbeemphasizedforallpatientswithdiabetes.Secondly,patienteducationandawarenessabouttheimportanceoffootcareareessential.PatientswithdiabetesshouldbeeducatedabouttherisksofFootulcersandotherfootcomplicationsandadvisedonseffectiveself-carepractices,suchasregularinspectionofthefeet,wearingofproperlyfittingshoes,andavoidingwalkingbarefoot.

Thirdly,multidisciplinaryteamcareisnecessaryfordiabeticpatientswithfootcomplications,includingendocrinologists,nurses,podiatrists,orthotistsandvascularsurgeonsandanyotherspecialistsrequired.Ateam-approachhelpstodeveloptailoredpreventivestrategiesandoptimizethemanagementofdiabeticfootulcers.Finally,earlyinterventionwhenfootproblemsariseiscrucial,andanysignsofinfectionorulcerationshouldbetreatedpromptlytopreventthedevelopmentofnon-healingwounds,whicharethemaincauseofamputationsindiabeticpatients.

Inconclusion,diabeticfootcomplicationsareamajorburdeninindividualswithdiabetes,andcanleadtosignificantimpairmentinqualityoflifeandevenlossoflimb.Earlyidentificationofpatientsatriskandestablishmentofpreventiveinterventionsandmanagementstrategies,arecrucialforreducingtheincidenceofdiabeticfootulcersre-ulcerationandamputations.Appropriateglycemiccontrolandtreatmentofassociatedriskfactorssuchashypertension,dyslipidemia,neuropathyandfootdeformities,shouldbepartofstructuredfootcareplans.Inaddition,patienteducation,self-carepractices,regularfootexamsandmulti-disciplinaryteamcareareessentialcomponentsinpreventing,managingandreducingtheburdenofdiabeticfootcomplicationsItisimportantforindividualswithdiabetestorecognizethepotentialimpactoftheirdiseaseontheirfeetandtotakeproactivemeasurestopreventfootcomplications.Thiscanincluderegularmonitoringofbloodsugarlevels,maintaininghealthybloodpressureandcholesterollevels,andreceivingroutinefootexamsfromahealthcareprofessional.Inaddition,itisimportanttoimplementdailyfootcarepractices,suchaswashinganddryingfeetthoroughly,wearingproperlyfitting,supportiveshoes,andregularlyinspectingfeetforanysignsofinjuryorinfection.

Patienteducationisalsoacriticalcomponentinmanagingdiabeticfootcomplications.Individualswithdiabetesshouldbeeducatedonthewarningsignsoffootproblems,suchassoresorblisters,andhowtoproperlycarefortheseissues.Theyshouldalsobeinformedoftherisksassociatedwithsmoking,includingincreasedriskoffootcomplications.

Amulti-disciplinaryteamcareapproachcanalsobebeneficialforindividualswithdiabeticfootcomplications.Thiscanincludecollaborationbetweenhealthcareprofessionalssuchasendocrinologists,podiatrists,woundcarespecialists,andphysicaltherapists.Thisteam-basedapproachallowsforamorecomprehensiveandintegratedapproachtocare,addressingallaspectsoftheindividual'sneeds.

Overall,thepreventionandmanagementofdiabeticfootcomplicationsrequiresacomprehensiveapproachthatincludesglycemiccontrol,riskfactormanagement,patienteducation,self-carepractices,andmulti-disciplinarycare.Wi