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Diabetes Care：警惕！年轻糖尿病患者足部溃疡甚至截肢风险增加！

2021-03-15 MedSci原创 MedSci原创

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糖尿病相关足部溃疡（DFU）是糖尿病常见且代价最高昂的并发症。

糖尿病相关足部溃疡（DFU）是糖尿病常见且代价最高昂的并发症。DFU常能导致感染、截肢甚至过早死亡。DFU的5年死亡率和直接护理费用几乎与癌症相当，而且85%的非创伤性下肢截肢(LEA)之前都有足部溃疡。有证据表明，美国约1000万糖尿病患者中，有1/5的住院是因足部疾病引起，且2/3的LEA为糖尿病患者。

DFU发病率在不同国家间差异很大，从1.5％到10％不等。在弗里曼特尔糖尿病研究第一阶段(FDS1)中，基于社区的2型糖尿病患者DFU的基线患病率为1.2%。而15年后，在同一地理区域进行的FDS第二阶段(FDS2)中，DFU的基线患病率为1.5%。其它相关研究报道的DFU发生率也有很大差异，从0.6%/年到7.2%/年不等，但很少有数据描述发生率的时间变化。

为了确定近几十年来，2型糖尿病患者因DFU而住院的发生率，并同时反映糖尿病其他慢性并发症的趋势，来自澳大利亚多个机构的专家对FDS1与FDS2的参与者进行了全面的随访和评估。结果发表在最新的《糖尿病护理》（Diabetes Care）杂志上。

研究人员对基于社区的FDS1（1296名参与者，平均年龄64.0岁，48.6%男性，1993-1996年招募）和FDS2（1509名参与者，平均年龄65.4岁，51.8%男性，2008-2011年招募）的2型糖尿病参与者进行跟踪调查，包括入院到首次因DFU住院/伴有DFU、死亡或5年随访。计算了FDS2与FDS1的总体和10年年龄组的事故率比（IRRs）和事故率差异（IRD）。Cox比例危险模型确定了组合队列中首次DFU住院的独立预测因素。

在为期5879人年的随访中，FDS1的DFU住院率为1.9（0.9-3.3）/1000人年；在6 915人年的随访中，FDS2为4.5（3.0-6.4）/1000人年。粗IRR为2.40（1.17-5.28），IRD为2.6（0.7-4.5）/1000人年。

在FDS2参与者中，IR最高的为31-40岁组，数值为23.6/1000人年。进一步分析显示，糖尿病诊断时的年龄、HbA1c、胰岛素的使用、身高、ln（尿白蛋白/肌酐）、足背动脉消失、既往外周血管重建和外周感觉神经病变（PSN）是DFU事件住院的独立预测因素。

在FDS各期之间，尤其是在年轻的参与者中，2型糖尿病的DFU住院事件增加，并且在基线时有PSN、外周动脉疾病和血糖控制不理想的人风险更高。

 

参考文献：

Temporal Trends in Incident  Hospitalization for DiabetesRelated Foot Ulcer in Type 2 Diabetes: The Fremantle Diabetes Study. Diabetes Care 2021;44:722–730. https://doi.org/10.2337/dc20-1743

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    2021-07-06 木头人513

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    2021-06-26 ms9608593228839890

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    #糖尿病患者#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1902555, encodeId=dd0a19025554c, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Tue Jul 06 09:26:53 CST 2021, time=2021-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1639729, encodeId=81081639e2967, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Sat Jun 26 20:26:53 CST 2021, time=2021-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761590, encodeId=6d991e61590e3, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Sat May 22 07:26:53 CST 2021, time=2021-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1388215, encodeId=8f5d1388215aa, content=<a href='/topic/show?id=e51454180b6' target=_blank style='color:#2F92EE;'>#截肢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54180, encryptionId=e51454180b6, topicName=截肢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c1292500019, createdName=124984edm22暂无昵称, createdTime=Wed Mar 17 01:26:53 CST 2021, time=2021-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475050, encodeId=69ea14e5050c4, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Wed Mar 17 01:26:53 CST 2021, time=2021-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043539, encodeId=6f4c104353994, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Mon Mar 15 13:26:53 CST 2021, time=2021-03-15, status=1, ipAttribution=)]
    2021-03-15 misszhang

    谢谢MedSci提供最新的资讯

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