·糖尿病足病与下肢血管病·

　　【摘要】 目的 探讨糖尿病足溃疡(DFU)发生的危险因素，分析糖尿病周围神经(DPN)和糖尿病血管病变(PAD)与DFU的相互作用。 方法 选取T2DM患者278例，按其是否合并DFU分成糖尿病足溃疡组(DFU,102例)和非糖尿病足溃疡组(NDFU,176例)，回顾性分析两组生化特征和并发症情况.采用Logistic回归分析DFU发生的危险因素，并通过相对超额危险度比(RERI)，归因比(AP)和相互作用指数(S)评价DPN与PAD的相加相互作用。 结果 与NDFU组比较，DFU组HbA1c和纤维蛋白原(FIB)水平,DR、DPN和PAD发生率均升高，血红蛋白(Hb)、血白蛋白(Alb)、TC和LDL-C降低(P<0.05)。Logistic回归分析显示，DFU相关影响因素有:HbA1c、DPN、PAD、Hb、Alb和FIB(OR分别为: 1.41、3.66、3.00、0.98、0.79和2.51)。DPN和PAD对DFU的相加相互作用指标RERI、AP和S分别为3.45(95%CI ：1.22~8.56)、0.29(95%CI ：0.02~0.58)和1.45(95%CI ：1.03~4.96)。 结论 血糖控制欠佳、合并DPN和PAD、营养不良及FIB代谢失衡是DFU发生的主要危险因素。DPN和PAD对DFU存在相加相互作用，同时患有DPN和PAD增加DFU的患病风险。

　　【关键词】糖尿病，2型;糖尿病足溃疡;周围神经病变;周围血管病变;相互作用

The association and interaction of diabetic peripheral neuropathy and peripheral arterial disease with diabetic foot ulcers ZHU Ping, REN meng, XU Gang, et al. Department of Endocrinology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou 510220, China

Corresponding author: RAN Jian-min, E-mail: sumszc@126.com

　　【Abstract】 Objective To explore the possible risk factors for foot ulcerations in patients with type 2 diabetes mellitus, and to evaluate the effect and interaction of diabetic peripheral neuropathy (DPN) and arterial diseases (PAD) on diabetic foot ulcer. Methods Diabetic complications and clinical data were surveyed retrospectively in 278 patients who were divided into groups of diabetic foot (n=102) and non-diabetic foot (n=176). Risk factors for foot ulcerations in patients with type 2 diabetes mellitus were analyzed by a stepwise logistic regression model. Relative excess risk of interaction (RERI), attributable proportion (AP) of interaction and synergy index (S) were used to evaluate the additive interaction of diabetic peripheral neuropathy and peripheral vascular diseases. Results Compared with non-diabetic foot ulcer group, the patients with diabetic foot ulcers had significantly higher levels of HbA1c,TC ,LDL-C and fibrinogen, lower level of Hb,serum albumin,and higher incidence rate of retinopathy, peripheral neuropathy, and vascular disease(P<0.05). Multiple logistic regression analysis indicated that the risk factors for developing foot ulcers were HbA1c (OR：1.41), DPN (OR：3.66), PAD (OR：3.00), Hb (OR：0.98), serum Alb (OR：0.79) and FIB (OR：2.51). The OR(95% CI) of the additive interaction indexes RERI, AP and S between DPN and PAD on DFU development were 3.45 (1.22~8.56), 0.29 (0.02~0.58) and 1.45 (1.03~4.96) respectively. Conclusion Peripheral neuropathy, diabetic vascular disease, poor glycaemic control, FIB imbalance, and malnutrition are the major independent risk factors for diabetic foot ulceration. There is additive interaction between neuropathy and vascular diseases on diabetic foot.

　　【Key Words】 Diabetes，type 2;Diabetic foot ulcers; Peripheral neuropathy; Peripheral arterial diseases; Interaction