Abstract: Objective To analyze risk factors for amputation using information on diabetic foot（DF） at community clinics for early detection of high-risk DF at the grassroots levels and early specialist treatment. develop cost-effective and extendible method for early detection and treatment, this study evaluated risk factors for diabetic foot （DF） amputation using easily accessed data from community medical centers. Methods A total of 403 DF patients admitted to First People′s Hospital of Kashi Prefecture between Jan 2018 and Jan 2021 were enrolled. They were divided into amputation and non-amputation group according to treatment and prognosis. Multivariate cox regression and K-M method were performed to analyze the factors influencing （major） amputation. Results The significant differences were showed on duration of diabetes mellitus （DM）, DF surgery history, blood glucose management, smoking, fever, Wagner grade, ankle brachial index （ABI）, hemoglobin （HB） between two groups （P<0.05）. The multivariate cox regression showed that DM>10 years （HR=2.439, 95%CI： 1.180-5.050, P=0.016）, DF surgery history （HR=2.403, 95%CI： 1.540-3.745, P<0.001）, uncontrolled blood glucose （HR=1.879, 95%CI： 1.259-2.898, P=0.002）, smoking （HR=1.644, 95%CI：1.085-2.487, P=0.019）, Wagner grade 3~5 （HR=1.980, 95%CI： 1.314-2.985）, P=0.001] and hypo-HB （HR=1.027, 95%CI： 1.011-1.044, P=0.001） were risk factors of amputation. Additionally, DM>18years （HR=2.544, 95%CI： 1.055-7.874, P=0.037） and DF surgery history （HR=2.525, 95%CI： 1.757-4.608, P=0.034） were risk factors of major amputation. Conclusion DF patients from community medical centers with long DM duration, DF surgery history, uncontrolled blood glucose, smoking, Wagner grade 3-5, hypo-HB and ABI<0.9 should be given more attention to prevent probable amputation.

Key words: diabetic foot, amputation, major amputation, risk factors

摘要： 目的 利用社区（乡村）医务所可获取的糖尿病足（DF）疾病信息,分析截肢结局的危险因素,以便早发现基层高危DF并及早专科治疗。方法 回顾性研究2018年1月至2021年1月期间收治于喀什地区第一人民医院的403例DF患者,分析截肢组与非截肢组临床信息,通过Cox比例风险模型分析截肢风险,确定DF截肢危险因素。结果 病程、既往DF手术史、血糖控制情况、吸烟、Wagner分级、踝肱指数（ABI）和发热等在两组间差异有统计学意义（P<0.05）。多因素Cox回归结果显示,糖尿病超过10年（HR=2.439, 95%CI：1.180-5.050,P=0.016）、DF手术史（HR=2.403,95%CI：1.540-3.745,P<0.001）、血糖控制差（HR=1.879,95%CI：1.259-2.898,P=0.002）、吸烟（HR=1.644,95%CI：1.085-2.487,P=0.019）、Wagner 3-5级（HR=1.980,95%CI：1.314-2.985,P=0.001）以及低血红蛋白（HR=1.027,95%CI：1.011-1.044,P=0.001）是截肢的危险因素;糖尿病超过18年（HR=2.544,95%CI：1.055-7.874,P=0.037）、DF手术史（HR=2.525,95%CI：1.757-4.608,P=0.034）是DF大截肢的危险因素。结论 根据本研究建立的Cox比例风险模型,DF手术史、糖尿病病程、血糖控制情况、吸烟、Wagner分级、ABI及血红蛋白等廉价、易获取指标,可作为DF截肢的预警指标,可在基层、社区医疗机构采纳。

关键词: 糖尿病足, 截肢, 大截肢, 危险因素