| Background:Diabetic foot ulcer(DFU)has become one of the serious complications in diabetic patients,characterized by high morbidity,high mortality and disability rate,difficult treatment,heavy economic burden and high recurrence rate.Patients with a history of foot ulcers have a 13-fold greater risk of developing foot ulcers again and a 2.0-10.5 times greater risk of amputation than those without a history of foot ulcers.Diabetic foot ulcer causes great pain to the patients,affects the mental state of the patients and reduces their quality of life.It is urgent to strengthen the screening of high-risk foot,observe the clinical characteristics of patients with diabetic foot ulcer,analyze the risk factors of patients with major amputation,and give effective early clinical prevention and treatment and intervention measures.Objective:To observe the clinical characteristics of diabetic foot ulcer patients and the distribution of TCM syndrome types,and to discuss and analyze the independent risk factors of major amputation in DFU patients,so as to provide guidance for the early prevention and treatment of integrated traditional Chinese and western medicine.Methods:This study was a prospective cohort study,to collect case data of patients with diabetic foot ulcer who were admitted to the peripheral vascular department of dongzhimen hospital from January 2019 to December 2019 and met the inclusion criteria.It includes the patient’s general information,previous medical history,local characteristics,TCM syndromes,laboratory examination and pathogen examination,etc.They were all registered on the scale.Case data were managed by double-input data,and SPSS23.0 statistical software was used for statistics.The case data were divided into the case group(the major amputation group)and the control group(the non-major amputation group)according to whether or not major amputation was performed,t-test or non-parametric test was used for comparison between counting data sets,and chi-square test was used for comparison between metering data sets.Multi-factor logistic regression analysis was carried out for the observation indexes with statistical significance in single factor analysis.Results:1.There were 151 patients with diabetic foot ulcer,including 100 males and 51 females,with an average age of 66.11±9.91 years,an average duration of diabetes of 17.14±9.05 years,and an average ulcer area of 19.79±33.66cm2.2.DFU patients with disease,past history,local distribution characteristics:peripheral arterial disease(96.09%),diabetic peripheral neuropathy(80.13%),hypertension(72.19%),ischemic heart disease(54.97%),smoking(49.67%),and renal insufficiency(19.21%),diabetic retinopathy(10.60%),dialysis(3.97%),history of major amputation(3.31%).The local features of 151 patients with diabetic foot ulcer were mostly the bone involvement of ulcer(50.99%)and the reduction of ankle brachial index(ABI)(76.82%).3.Results of laboratory examination in 151 patients:white blood cell count(WBC)M=7.69,c-reactive protein(CRP)M=15.36,fasting blood glucose(FBG)M=7.94,glycosylated hemoglobin(HbAlc)M=7.70,and fibrinogen content(FIB)M=4.38 all increased,while albumin(ALB)M=34.20 decreased.4.Among the 151 patients with diabetic foot ulcer,blood stasis syndrome(30%)was the most,damp-heat with exuberance of virulence syndrome(28%),deficiency of qi and blood syndrome(26%),yin-damage by heat toxin syndrome(16%)was the least.There were differences in depth grade and infection degree grade among 151 patients with diabetic foot ulcer with different TCM syndromes(2=28.10,P<0.05).Patients with grade 1 ulcer depth were more inclined to blood stasis syndrome,patients with grade 2 ulcer depth were more inclined to deficiency syndrome of qi and blood,and patients with grade 3 ulcer depth were more inclined to yin-damage by heat toxin syndrome.Patients with grade 1-2 infection degree tended to have blood stasis syndrome,patients with grade 3 infection degree tended to have damp-heat with exuberance of virulence syndrome and yin-damage by heat toxin syndrome,and patients with grade 4 infection degree tended to have damp-heat with exuberance of virulence syndrome.The main syndromes of 13 patients with major amputation were damp-heat with exuberance of virulence syndrome(69%)and blood stasis syndrome(23%).The infection grade of 13 patients with diabetic foot ulcer with different TCM syndromes was different(2=57.85,P=0.021).5.There were 13 patients in the maj or amputation group and 138 patients in the non-maj or amputation group.Single-factor analysis of case data of the two groups was conducted,and the risk factors with statistical significance(P<0.05)included:age,ulcer area,ulcer recurrence,ulcer bone involvement,resting pain,heel ulcer,multidrug-resistant bacterial infection,previous history of major amputation,WBC,HGB,PLT,NE%,CRP,FIB,and D-D.Multivariate Logistic regression analysis showed that the independent risk factors for major amputation in patients with diabetic foot ulcer were:Ulcer recurrence(OR=5.178,P=0.010),resting pain(OR=5.257,P=0.020),ulcer bone involvement(OR=6.286,P=0.031),ulcer area(OR=1.042,P<0.01),WBC(OR=1.381,P<0.01),CRP(OR=1.021,P<0.01),PLT(OR=1.010,P<0.01),FIB(OR=0.033,P=1.317).HGB(OR=0.902,P=0.006)was a protective factor for large amputation of diabetic foot ulcer.Conclusion:Patients with diabetic foot ulcer are mostly male,elderly and have a long course of diabetes.When diabetic patients are accompanied by peripheral artery disease,diabetic peripheral neuropathy,previous history of hypertension,ischemic heart disease and smoking,the risk of developing foot ulcer will be greatly increased.According to the results of laboratory examination,WBC and CRP are related to infection and inflammatory response,FIB is related to coagulation function,and HbAlc and FBG reflect the condition of blood glucose control,indicating that most patients with diabetic foot ulcer have the manifestations of infection,hypercoagulability,poor blood glucose control,low protein and malnutrition.Local characteristics reflect that patients with diabetic foot ulcer are often accompanied by ischemia and the degree of ulcer is deep.The most common syndrome type of DFU patients was blood stasis,there were significant differences between different TCM syndromes and the degree of foot infection and the grade of ulcer depth,the higher the degree of infection and the deeper the ulcer in patients with diabetic foot ulcer,the greater the possibility of dampness-heat and heat-poison in TCM syndrome differentiation.The independent risk factors for major amputation in patients with diabetic foot ulcer were:ulcer recurrence,resting pain,ulcer bone involvement,ulcer area,WBC,CRP,PLT,and FIB.HGB is a protective factor for large amputation of diabetic foot ulcer. |
