糖尿病足细菌感染特征及其与下肢血管病变程度的关系

发布时间：2018-07-12 08:20

本文选题：糖尿病足 + 溃疡　；参考：《第三军医大学》2016年硕士论文

【摘要】：目的及意义:糖尿病足(diabetic foot,DF)的发生与神经、血管病变和感染密切相关,症状包括间歇性跛行、缺血性静息痛、足溃疡和坏疽等。导致糖尿病足预后差的因素有很多,如老龄、男性、心脏衰竭、终末期肾病、足溃疡面积较大、外周神经病变、外周血管病变、感染等。其中下肢血管病变和感染是糖尿病足最重要的影响因素。糖尿病足溃疡(diabetic foot ulcers,DFU)是目前糖尿病患者住院治疗最主要的原因之一。在糖尿病足溃疡中,感染是导致截肢、死亡的直接原因之一。目前关于DFU感染的细菌特征已有报道,但足溃疡感染类型和病原菌与血管病变的关系尚待明确。为此,我们纳入糖尿病足伴感染且行血管造影证实血管病变患者133例,探讨足溃疡感染患者的病原菌、感染学特征及其与下肢血管病变程度的关系,为促进糖尿病足溃疡愈合提供指导。研究对象:收集2009年3月至2016年3月于第三军医大学大坪医院高血压内分泌科住院治疗并明确诊断糖尿病足溃疡伴感染且分泌物培养阳性的患者133例,其中男性87例,女性46例,年龄67.24±11.49岁,糖尿病病程8.00(3.00,15.00)年,糖尿病足病程1.50(0.50,7.50)月。方法:收集133例于本中心住院的糖尿病足溃疡患者病例资料,入选患者均在入院时由本中心医护人员进行详细病史的询问、查体,完成入院评估记录,综合评价并初步制定诊治方案。入选患者均在初期完善血压检查、ABI、TBI、血常规、肝肾功、血清总蛋白、血清白蛋白、血脂、尿常规、空腹血糖、糖化血红蛋白、足溃疡局部分泌物培养及细菌药敏试验等检查。所有患者均行下肢血管造影或256排血管CT检查(CTA),我们的结果显示两者高度一致性,根据下肢动脉造影检查、下肢血管CTA检查(CT中心设备为“飞利浦Brilliance i CT 256层”)结果,明确下肢血管狭窄程度及病变长度确定分级,采取TASC分级标准,分为A、B、C、D 4种类型,以此分为4组。根据感染程度感染分为轻度感染、中度感染、重度感染;根据感染类型分为单一感染、混合感染。数据资料采用SPSS 18.0统计软件。结果:1.TASC分级中,A级27例、B级19例、C级52例、D级35例,组间比较D级患者年龄、糖尿病病程、中性粒细胞百分数显著高于A、B级糖尿病足溃疡患者,而ABI、TBI显著低于A、B级患者。A、B级糖尿病足溃疡患者G-菌感染率为44.6%,C、D级患者G-菌感染率为54.2%,且差异有统计学意义。糖尿病足溃疡患者有抗生素多重耐药的为60.2%(A、B级为52.2%,C、D级为64.4%),A、B级与C、D级组间比较差异有统计学意义(P=0.028)。2.糖尿病足溃疡中轻度感染例39例(占29.3%),中度感染66例(占49.6%),重度感染28例(占21.1%)。不同感染程度间比较白细胞、白蛋白、糖化血红蛋白、中性粒百分数等均存在差异,且有统计学意义。轻度感染耐药率为51.3%,中度感染为69.7%;重度感染为71.4%,不同感染程度间比较无统计学差异。A、B级中轻度感染20例,中重度感染26例,C、D级中轻度感染21例,中重度感染66例,A、B级与C、D级间比较有统计学差异(P=0.022)。3.133例糖尿病足溃疡伴感染中革兰阳性菌感染占36.8%、革兰阴性菌感染占57.8%、真菌感染占5.4%,混合感染占39.1%。共培养出185株病原菌,其中金黄色葡萄球菌35株(18.9%);铜绿假单胞菌25(13.5%);粪肠球菌14株(7.5%),分列前3位。其他葡萄球菌、链球菌、肺炎克雷伯杆菌、大肠埃希菌也较常见。A级患者混合感染占18.5%,B级患者混合感染占26.3%,C级患者混合感染占26.9%,D级患者混合感染占60.0%,且差异有统计学意义(P=0.002)。结论:1.本地区糖尿病足溃疡感染以金黄色葡萄球菌、铜绿假单胞菌、粪肠球菌为多,且G-菌感染及耐药菌株居多,随着感染程度的加重,细菌耐药率增加,与国内外报道的病原菌不完全一致,提示本地区糖尿病足溃疡患者的感染较重,具有本地区细菌学特征。2.随着下肢血管病变程度的加重,足溃疡感染程度加重,混合感染比例增加,足溃疡G-菌感染率增加。
[Abstract]:Objective and significance: the occurrence of diabetic foot (DF) is closely related to nerve, vascular disease and infection. The symptoms include intermittent claudication, ischemic resting pain, foot ulcer and gangrene. There are many factors that lead to poor prognosis of diabetic foot, such as aging, male, heart failure, end-stage renal disease, large area of foot ulcers, peripheral neuropathy. Changes, peripheral vascular lesions, infection and so on. Among them, lower extremity vascular disease and infection are the most important factors of diabetic foot. Diabetic foot ulcers (DFU) is one of the most important causes of hospitalization in diabetic patients. In diabetic foot ulcers, infection is one of the direct causes of amputation and death. At present, D The bacterial characteristics of FU infection have been reported, but the relationship between the type of foot ulcer infection and the relationship between the pathogenic bacteria and the vascular disease remains to be clear. To this end, we have included 133 patients with diabetic foot companion infection and angiography confirmed the vascular disease, to explore the pathogenic bacteria of the patients with foot ulcer infection, the relationship between the infective features and the degree of vascular disease of the lower extremity. To provide guidance for the healing of diabetic foot ulcers. Subjects: 133 patients who were hospitalized in the Department of Endocrinology, Daping Hospital of Third Military Medical University from March 2009 to March 2016, were hospitalized in the hypertension Department of Endocrinology and diagnosed the diabetic foot ulcers with infection and positive secretions, including 87 male, 46 female, 67.24 + 11.49 years old, diabetic disease. Course 8 (3.00,15.00) years, the course of diabetes foot 1.50 (0.50,7.50) month. Methods: collect 133 cases of diabetic foot ulcer patients in the center of the hospital, the selected patients were enrolled in the hospital by the center medical staff for detailed medical history inquiry, examination, complete admission assessment records, comprehensive evaluation and preliminary formulation of the diagnosis and treatment program. Selected patients All patients were in the early stage of improving blood pressure examination, ABI, TBI, blood routine, liver and kidney work, serum albumin, serum albumin, blood lipid, urine routine, fasting blood glucose, glycosylated hemoglobin, partial secretion culture of foot ulcers and bacterial susceptibility test. All patients underwent lower limb blood tube angiography or 256 row blood vessel CT examination (CTA), our results showed both high Degree conformance, according to the lower extremity arteriography examination, lower extremity vascular CTA examination (CT center equipment is "PHILPS Brilliance I CT 256 layer") result, clear the lower extremity vascular stenosis degree and pathological length determine classification, adopt TASC grading standard, divide into A, B, C, D 4 types, in order to divide into 4 groups. According to infection degree infection, divided into mild infection, medium infection, According to the type of infection, the data were divided into single infection and mixed infection according to the type of infection. The data used SPSS 18 statistical software. Results: in 1.TASC classification, 27 cases, 19 cases of B grade, 52 cases of class C, 35 cases of D class, the age of D level, the percentage of neutrophils were significantly higher than that of A, B level diabetic foot ulcer, ABI, TBI. The infection rate of G- bacteria in patients with.A and B level diabetic foot ulcers was 44.6%, C, G- bacteria infection rate was 54.2%, and the difference was statistically significant. The multidrug resistance of diabetic foot ulcers was 60.2% (A, B grade 52.2%, C, D grade 64.4%). There were 39 cases of mild infection in urinary foot ulcer (29.3%), moderate infection in 66 cases (49.6%) and severe infection in 28 cases (21.1%). There were differences in white blood cells, albumin, glycated hemoglobin and percentage of neutrophils among different infections. The drug resistance rate of mild infection was 51.3%, moderate infection was 69.7%, and severe infection was 71.. 4%, there were no statistical differences among different degrees of infection.A, 20 cases of mild infection in grade B, 26 cases of moderate to severe infection, 21 cases of moderate and mild infection in C, 66 cases of moderate to severe infection, A, B grade and C, D level was statistically different (P=0.022) in.3.133 cases of diabetic foot ulcers with infection of gram positive bacteria 36.8%, Gram-negative infection accounted for 57.8%, true Bacterial infection accounted for 5.4%, mixed infection accounted for 185 strains of 39.1%., including 35 (18.9%) Staphylococcus aureus (18.9%), Pseudomonas aeruginosa 25 (13.5%), 14 (7.5%) Enterococcus faecalis (7.5%), and the first 3. Other Staphylococcus, Streptococcus, Klebsiella pneumoniae, and Escherichia coli were also more common. A mixed infection of class A patients was 18.5%, and B patients were mixed. Infection accounted for 26.3%, C patients mixed infection accounted for 26.9%, D patients with mixed infection accounted for 60%, and the difference was statistically significant (P=0.002). Conclusion: 1. local diabetic foot ulcer infection with Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis, and the majority of G- infection and resistant strains, with the severity of infection, the rate of bacterial resistance The increase is not exactly consistent with the pathogenic bacteria reported at home and abroad, suggesting that the infection of the patients with diabetic foot ulcers is heavier, with the local bacteriological characteristics.2. with the aggravation of the degree of vascular disease of the lower extremities, the aggravation of the foot ulcer infection, the increase in the proportion of mixed infection and the increase of the infection rate of G- bacteria in foot ulcers.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R587.2

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