ADA 2013：许樟荣教授认为中国近半非创伤性截肢由糖尿病足所致

    2013年第73届美国糖尿病协会科学年会(ADA2013)于6月21日~25日在美国芝加哥隆重举办。在ADA2013年会上，解放军306医院许樟荣教授发表一篇会议摘要“中国中心城市医院糖尿病截肢和非糖尿病非创伤性截肢患者的临床特点及医疗费用”发表在会议摘要上，研究指出中国42.2%的非创伤性截肢是由糖尿病足导致的。糖尿病截肢患者具有高龄、高血糖、高血压、小截肢率高、住院时间长、医疗费用高等特点。
　　目标：分析中国中心城市医院糖尿病截肢患者和非糖尿病非创伤性截肢的截肢平面及转归、临床特点及医疗费用。
　　方法：对全国19家综合医院2010年全年的截肢数据进行回顾性分析。总纳入419例截肢患者，分为糖尿病截肢组和非糖尿病截肢组。
　　结果：糖尿病患者占所有截肢患者的27.3%，占非创伤性截肢的41.5%。与非创伤性截肢者相比，糖尿病截肢者具有高龄(65.4±11.6 vs 50.1±20.4岁，p=0.000)，收缩压  (136.7±19.7 vs 128.0±19.2mmHg，p=0.000)和空腹血糖水平(8.3±3.7 vs 5.6±1.9mmol/L  p=0.000)较高，甘油三酯(TG) (1.3±0.7 vs 1.5±1.0 mmol/L p=0.028)和高密度脂蛋白(HDL-C)(1.0±0.4 vs 1.2±0.4 mmol/L p=0.000)水平较低的特点。糖尿病足患者的小截肢率为55.7%，比非糖尿病足者(18.3%)更高(x2=63.450 p=0.000)。两组的住院时间(33.5 vs 22.0天)和医疗费用(36392 vs 25337元)具有明显的差别。
　　结论：42.2%的非创伤性截肢是由糖尿病足导致的。糖尿病截肢患者年龄更高，且血糖和血压水平较高，TG和HDL-C较低,大多数需要小截肢,住院时间延长，医疗费用增多。

【研究摘要】

Clinical Characteristics and Medical Costs in the Patients with Diabetic  Amputation and the Non-Diabetic Patients with Non-Traumatic Amputation in China  Central Urban Hospitals

Zhangrong Xu MD Diabetes Centre
OBJECTIVE: To analyze the clinical characteristics amputation level final  outcome of amputation and medical cost between the diabetic amputation and  nontraumatic amputation in China central urban hospitals.

METHOD: The amputation data in the year 2010 from the 19 central municipal  general hospitals located in the different big cities in China were  retrospectively analyzed according to the standardized protocol including  clinical characteristics level and prognosis of the amputation and medical cost  in the hospitals. The patients were divided into diabetic amputation group and  non-traumatic amputation group. A total of 419 amputation patients were  recruited.

RESULTS: 27.3 % of the all amputated patients or 41.5% of the non-traumatic  patients were diabetic patients. Compared with non-traumatic amputation patients  with diabetic amputation were older (65.4±11.6 vs 50.1±20.4 yrs p=0.000) with  higher systolic blood pressure (136.7±19.7 vs 128.0±19.2mmHg p=0.000) and  fasting blood glucose level (8.3±3.7 vs 5.6±1.9mmol/L p=0.000) lower  triglycerides (1.3±0.7 vs 1.5±1.0 mmol/L p=0.028) and high density lipoprotein  cholesterol (HDL-C) (1.0±0.4 vs 1.2±0.4 mmol/L p= 0.000) level. Minor amputation  was more common in the patients with diabetic foot disease (55.7%) than those  with nontraumatic foot disease (18.3%) (x2=63.450 p =0.000). There were  significant differences in days of hospital stay (33.5 vs 22.0 d) and medical  cost (36392 vs 25337 Yuan RMB) between the two groups.

CONCLUSION: The 42.2% of non-tramatic amputation were caused by diabetic  foot diseases The patients with diabetic amputation were older with higher blood  glucose blood pressure and lower TG and HDL-C level. Most of them required minor  amputation. Their hospital stay was longer with significantly higher medical  costs.