肾功能状态与糖尿病足溃疡患者预后的关系

Associationbetweenrenalfunctionandprognosisinpatientswithdiabeticfootulcer

摘要:

目的：探究糖尿病足溃疡（diabeticfootulcer，DFU）患者不同肾功能状态的临床特点及与预后的关系。方法：回顾性分析409例DFU患者。根据估算肾小球滤过率（estimatedglomerularfiltrationrate，eGFR）分为3组：肾功能正常组、肾功能轻度受损组及肾功能中重度受损组，比较各组临床特征、社会经济学状况、自我管理及预后；回归分析探讨肾功能状态与预后的关系。结果：与肾功能正常组相比，肾功能受损组患者年龄更大、糖尿病病程更长、自我管理更好、合并更多的大血管及微血管病变、有更低的血红蛋白及白蛋白水平，且到中重度肾功能受损时患者发生不良结局的比例更高（43.7%vs.26.8%，χ2＝8.567，P＝0.003）、死亡率更高（26.1%vs.8.3%，χ2＝16.587，P＝0.001）。单因素分析显示，eGFR与不良结局显著相关（OR=1.462，95%CI=1.132~1.874，P=0.004）。进一步在不同年龄段人群进行回归分析显示，在老年患者中，随着eGFR的下降，DFU患者预后越差（OR=1.614，95%CI=1.021~2.571，P=0.040），中青年患者中未见这一显著性关系。结论：随着肾功能的恶化，DFU患者更不易愈合、死亡率更高，尤其以老年患者为甚。

Abstract:

Objective：Toinvestigatetheclinicalcharacteristicsofpatientswithdiabeticfootulcers（DFUs）indifferentstatusofrenalfunction，andtoexploretheassociationbetweenrenalfunctionandprognosis.Methods：Atotalof409patientswithDFUswereretro－spectivelyanalyzed.Accordingtoestimatedglomerularfiltrationrate（eGFR），thepatientsweredividedintothreegroups：normalrenalfunctiongroup，mildrenaldysfunctiongroup，andmoderatetosevererenaldysfunctiongroup.Theclinicalcharacteristics，socio-eco－nomicstatus，self-management，andprognosiswerecomparedbetweenthethreegroups.Aregressionanalysiswasusedtoinvestigatetheassociationbetweenrenalfunctionandprognosisofpatients.Results：Comparedwiththenormalrenalfunctiongroup，therenaldysfunctiongroupshadolderageofpatients，longerdurationofdiabetes，betterself-management，moremicroangiopathyandmacroan－giopathy，andlowerlevelsofhaemoglobinandserumalbumin.Moreover，thepatientswithmoderatetosevererenaldysfunctionhadasignificantlyhigherproportionofindividualswtihadverseoutcomes（43.7%vs.26.8%，χ2=8.567，P=0.003）andasignificantlyhighermortalityrate（26.1%vs.8.3%，χ2=16.587，P=0.001）.UnivariateanalysisshowedasignificantassociationbetweeneGFRandadverseoutcomes（OR=1.462，95%CI=1.132-1.874，P=0.004）.FurtherregressionanalysisconductedindifferentagegroupsshowedthatthedeclineineGFRwasassociatedwithpooreroutcomesofDFUsinelderlypatients（OR=1.614，95%CI=1.021-2.571，P=0.040），butnotinyoungandmiddle-agedpatients.Conclusion：PatientswithDFUshavelongerulcerhealingtimeandhighmortalityratewiththedeteriorationofrenalfunction，especiallyinelderlypatients.