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目的分析Wagner 3级以下的糖尿病足溃疡的预后及其影响因素。方法回顾性分析150例Wagner 3级以下的糖尿病足溃疡患者的年龄、病程、吸烟及慢性并发症等病史,进行血液生化、尿微量白蛋白、踝肱动脉压指数(ABI)、下肢血管超声等检查。部分患者进行下肢血管造影检查。对于足溃疡进行Wagner分级和美国德州大学分级分期;足溃疡严重程度评分方法参考DUSS法。对所有的溃疡分别进行治疗后4周和最终的面积计算。按照患者治疗实施情况分为标准治疗、部分标准治疗和基本治疗3组。分析不同的足溃疡分类分期、治疗后4周溃疡面积变化、治疗方法和其他因素与溃疡预后的关系。结果全部患者平均HbA_1c为(8.21±2.08)%,52%的患者ABI<0.9,47.3%的患者血浆白蛋白<35g/L,16.6%的患者血浆白蛋白<30g/L。84%的患者尿微量白蛋白>30mg/g。治疗后4周足溃疡愈合率和足溃疡治疗的最终疗效与DUSS评分、Wagner分级、美国德州大学分级和分期有关,足溃疡预后差的患者见于DUSS分值3～4分、Wagner 3级和德州大学分类为3、4级和分期为C、D期的患者。多元回归分析提示,血红蛋白、血浆白蛋白、溃疡面积、溃疡位置、治疗方法、第4周溃疡面积变化等因素中,影响最终治疗结果因素是血红蛋白和血浆白蛋白。结论 DUSS评分、Wagner分级和德州大学分类分级的方法都能预示糖尿病足溃疡的预后。血红蛋白和血浆白蛋白是影响足溃疡预后的重要因素。
Objective To analyze the prognosis of Wagner grade 3 diabetic foot ulcer and its influencing factors. Methods A retrospective analysis of 150 cases of Wagner grade 3 diabetic foot ulcer patients age, course of disease, smoking and chronic complications such as history of blood biochemistry, urinary albumin, ankle brachial artery pressure index (ABI), lower extremity vascular ultrasound an examination. Some patients underwent lower extremity angiography. The Wagner classification of foot ulcers and the grading and staging of the United States University of Texas; foot ulcer severity score method reference DUSS method. All ulcers were treated for 4 weeks and the final area was calculated. In accordance with the implementation of patient treatment is divided into standard treatment, some standard treatment and basic treatment of three groups. Analysis of different stages of foot ulcer classification, ulcer area changes 4 weeks after treatment, treatment and other factors and prognosis of the ulcer. Results The mean HbA 1c in all patients was (8.21 ± 2.08)%, the ABI <0.9 in 47% of patients, the plasma albumin in 35.7% of patients, and the plasma albumin of 30% in 16.6% of patients. 84% of patients urinary albumin> 30mg / g. The final curative effect of foot ulcer healing and foot ulcer healing 4 weeks after treatment was related to DUSS score, Wagner grade, grade and staging of the University of Texas, and patients with poor prognosis of foot ulcer were found in DUSS scores of 3 to 4, Wagner grade 3 and Texas The university is classified as grade 3, 4, and patients with stage C and D. Multivariate regression analysis showed that hemoglobin, plasma albumin, ulcer area, ulcer location, treatment, ulcer area changes at the fourth week and other factors, the final treatment outcome factors are hemoglobin and plasma albumin. Conclusion DUSS score, Wagner grade and the classification of the University of Texas classification method can predict the prognosis of diabetic foot ulcer. Hemoglobin and plasma albumin are important prognostic factors for foot ulcers.