糖尿病足溃疡、血管问题 可预测死亡


  【24drs.com】研究者于纽奥良举办的美国糖尿病协会第76届科学会议中报告指出,下肢血管并发症与足部溃疡可显著预测糖尿病患的死亡率。
  
  发表此篇研究的西雅图华盛顿大学Edward Boyko医师表示,糖尿病增加了外围动脉疾病、神经病变和足部溃疡的风险,这些并发症都与死亡率增加有关。但是,这些下肢并发症和死亡率之间是否有独立关联则未知,也不知道它们是否可预测长期死亡。
  
  Boyko医师解释,我们的目标是要进行这个研究,采用退伍军人全国健康照护资料,在研究门诊中,前瞻追踪1,456名糖尿病男性退伍军人。他的团队使用多变项Cox回归模式估计死亡率之风险比,在追踪的13,038人-年中,发生1,103例死亡。
  
  在开始时与追踪期,评估研究对象的糖尿病特征、HbA1c、生活型态、视力、足部特征、足部单股尼龙纤维敏感度、44°时的足背经皮血氧饱和度、曾发生与突发的足部溃疡及截肢、踝肱指数、估计肾丝球过滤速率、血清白蛋白值。多变项分析中,死亡率与截肢、神经病变、跛行无关。
  
  会议主席、华盛顿特区乔治城大学医院的Paul Kim医师表示,这些患者不会死于截肢,心脏疾患比较可能引起死亡。
  
  Kim医师强调,医师能越早确认高风险患者越好。
  
  下肢问题相当常见,重点在于,我们在这些问题加剧、复杂化与快速恶化之前就确定它们。
  
  资料来源:http://www.24drs.com/
  
  Native link:Diabetic Foot Ulcers, Vascular Problems Predict Death

Diabetic Foot Ulcers, Vascular Problems Predict Death

By Allison Shelley
Medscape Medical News

Lower limb vascular complications and foot ulcers significantly predict mortality in patients with diabetes, researchers reported at the American Diabetes Association 76th Scientific Sessions in New Orleans.

Diabetes increases the risk for peripheral arterial disease, neuropathy, and foot ulcer, and all of these complications have been associated with an increase in mortality, said presenter Edward Boyko, MD, from the University of Washington in Seattle. But whether there is an independent association between these lower limb complications and mortality is not known, nor is whether they predict death in the long term.

His team used multivariable Cox regression models to estimate hazard ratios for mortality. During 13,038 person-years of follow-up, 1103 deaths occurred.

At baseline and follow-up, study participants were assessed for features of diabetes, HbA1c, lifestyle, vision, foot characteristics, foot monofilament insensitivity, dorsal foot transcutaneous oximetry at 44°, previous and incident foot ulcer and amputation, ankle-brachial index, estimated glomerular filtration rate, and serum albumin level.

On multivariable analysis, mortality was not associated with amputation, neuropathy, or claudication, as previously reported by Medscape Medical News.

"These patients won't die from an amputation," said session chair Paul Kim, MD, from Georgetown University Hospital in Washington, DC.

"It's heart disease that will be the more likely cause of death," he told Medscape Medical News.

The earlier physicians identify high-risk patients, the better, Dr Kim stressed.

"Lower limb problems are very common. It's important that we identify them early before these cases escalate and get very complicated, very quickly."

Dr Boyko and Dr Kim have disclosed no relevant financial relationships.

American Diabetes Association (ADA) 76th Scientific Sessions:Presented June 11, 2016.

    
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