| Part 1.Risk factors for type 2 diabetic foot diseaseObjective To explore type 2 diabetes diabetic foot occurrence, risk factors for development.Methods PLA 306 Hospital, Department of Endocrinology, June 2009- June 2014 treated 662 cases of type 2 diabetes mellitus(T2DM) with diabetic foot(DF), 215 cases of non-foot disease T2DM(NDF), a total of 877 cases of patients analyzed retrospectively, Set into a set of NDF patients, the patients Wagner1 ~ 2 level set to DF minor group 253 examples, set Wagner3 ~ 5 level to DF serious group in 409 cases.Comparison of clinical data between the groups: gender, age, systolic blood pressure,diastolic blood pressure, diabetes, peripheral vascular disease(PAD), peripheral neuropathy(DPN), nephropathy(DN), retinopathy(DR), hypoglycemic therapy,amputation case, the number of days in hospital; biochemical indicators: white blood cell count(WBC), hemoglobin(Hb), glycated hemoglobin(Hb A1c), serum total protein(TP), serum albumin(Alb), blood urea nitrogen(BUN), creatinine(Cr), uric acid(UA),triglycerides(TC), cholesterol(TG), high density lipoprotein(HDL-C), low density lipoprotein(LDL-C), fasting plasma glucose(FPG), 2-hour postprandial blood glucose(PPG), urinary protein creatinine ratio(UACR), estimate the glomerular filtration rate(e GFR). DF and analyze risk factors.Results The clinical data analysis: Compared with the NDF group, DF group age larger,longer duration of diabetes, PAD, DPN, DN, DR incidence of elevated blood glucose using insulin more frequently, the difference was significant, P < 0.05; DF serious group compare with DF minor group, the amputation rate is higher, the higher level of the incision, wound healing lower grades,the difference was significant, P <0.05;biochemical indicators of analysis: group compared with the NDF, DF group PPG, TP,Alb, UA, TC, e GFR decline, the difference was statistically significant, P <0.05;compared with the NDF group, WBC, Cr, UACR rise, the difference was statistically significant, P <0.05; between DF group Hb, TP, Alb, UA difference was statistically significant, P <0.05; Hb A1 c, BUN, TG, HDL-C, LDL-C, FPG was no difference among the three groups statistically significant, P> 0.05. Related items row step wise regression analysis showed that age, gender, age, PAD, DPN, WBC, Hb, UACR, UA, Alb for DF occurrence, have an important impact on the development.Conclusion Age, gender, PAD, DPN, WBC, Hb, UACR, UA, Alb for DF occurrence,have an important impact on the development.Part 2.Clinical studies of kidney lesion in different Wagner classification of Type 2 diabetic footObjective To investigate the severity of diabetic foot disease of kidney lesion, to study the relationship of diabetic foot between kidney disease, and improve clinical practice for treatment of diabetic foot disease.Methods We studied retrospectively 622 cases of type 2 diabetes mellitus patients with diabetic foot disease and 215 cases of non-foot disease to PLA 306 Hospital of Endocrinology, June 2009- June 2014, The non-foot disease, Wagner1 level, 2, 3 were divided into a group, Wagner4 level and 5 into one group, UACR, e GFR as an indicator of varying degrees of foot disease analysis of kidney lesion status.The data were analyzed by SPSS19.0 software.Results diabetic foot disease compared with non-foot group,UACRwere increased,[(78.00)vs(10.60)mg/g],e GFR were decreased [(100.91±44.98) vs(114.27±35.88)ml/min·1.73m2]; Wagner3 level compared with Wagner2 level, microalbuminuria(UACR 30 ~ 300 mg / g)incidence were significantly elevated, [39.2%(67/171)vs49.7%(87/175),χ2=3.885], grade Wagner4 ~ 5 compared with Wagner3 stage renal insufficiency(e GFR<60ml / min·1.73m2) significantly increased the incidence,[23.5%( 24/220) vs 11.0%(43/183),χ2=11.421], all P<0.05; macroalbuminuria(UACR ≥300mg / g), renal insufficiency occurred in Wagner3 level rate of less than 2, but increased again at the level Wagner4~5.Conclusion The more serious of diabetic foot disease,the more severe kidney lesion,MAU prompts kidney lesion more sensitive then GFR, Wagner3 level is a turning point of the deterioration of kidney lesion and clinical treatment,when the patient is in Wagner3 level should strengthen efforts to renal function tests and treatment. |
