糖尿病足中医辨证分型相关影响因素及与Wagner分级的相关性研究

发布时间：2018-01-02 05:17

本文关键词：糖尿病足中医辨证分型相关影响因素及与Wagner分级的相关性研究　出处：《山东中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:探讨糖尿病足中医辨证分型的影响因素及与Wagner分级的相关性研究,重型糖尿病足、截趾/肢的危险因素。方法:选取2012-2016年于山东省立医院内分泌科住院的糖尿病足患者,其中符合纳入标准的270例,对其资料进行回顾性分析。用二分类Logistic回归分析确定发生重型糖尿病足和截趾/肢的危险因素。结果:(1)270例糖尿病足患者中,男女比例为:1.4:1,91.5%的患者年龄≥51岁,87.4%的患者糖尿病病程5年,91.1%的患者糖化血红蛋白(Hb A1c)6.5%。(2)糖尿病足患者多并发糖尿病周围神经病变,烧/烫伤(54.7%)是足部溃疡最常见的诱因,好发于足趾部位(63.7%)。(3)糖尿病足溃疡分泌物细菌培养阳性率为71.2%。截趾/肢均发生在Wagner分级3-5级(重型)患者中,气阴两虚证组发生率最高(20.0%)。(4)寒湿阻络证组总蛋白(TP)高于其他组,血清白蛋白(ALB)高于湿热毒盛证组、热毒伤阴证组、气阴两虚证组,气阴两虚组血小板计数(Pt)高于寒湿阻络证组、血脉瘀阻证组、湿热毒盛证组,p0.05。(5)下肢动脉闭塞以血脉瘀阻证组多见。(6)寒湿阻络证组、血脉瘀阻证组主要见于Wagner分级0-2级(轻型)的患者,p0.05;热毒伤阴证组、气阴两虚证组主要见于重型的患者,p0.01。(7)WBC计数高(OR=1.128,95%CI:1.032~1.233)、下肢动脉闭塞率高(OR=2.233,95%CI:1.253~3.980)为发生重型糖尿病足的危险因素,血红蛋白水平高(OR=0.979,95%CI:0.965~0.993)是其保护性因素。(8)足部骨坏死率高(OR=15.491,95%CI:5.016~47.847)、下肢动脉闭塞率高(OR=2.837,95%CI:1.106~7.275)是发生截趾/肢的危险因素。结论:(1)糖尿病病程较长、血糖控制偏差、年龄偏大的患者易发生糖尿病足。其发生常有诱因和病原菌感染。(2)寒湿阻络证组多见于糖尿病足初期,病情较轻,其总蛋白(TP)高于其他组;气阴两虚证组多见于糖尿病足后期,病情较重,发生截趾/肢率较高。(3)感染、下肢动脉闭塞率高是重型糖尿病足的危险因素,足部坏死、下肢动脉闭塞增加了截趾/肢的风险。
[Abstract]:Objective: To study the correlation factors of TCM syndrome types of diabetic foot and Wagner grading, severe diabetic foot risk factors, limb amputation. Methods: the patients with diabetic foot 2012-2016 in the Department of endocrinology of Shangdong Province-owned Hospital hospital, 270 cases which meet the inclusion criteria, the data were retrospectively analyzed by analysis. To determine the occurrence of the risk factors of limb with severe diabetic foot and amputation / two classification Logistic regression. Results: (1) 270 cases of patients with diabetic foot, male and female ratio: 1.4:1,91.5% of the patients were older than 51 years old, 87.4% patients with diabetes duration of 5 years, 91.1% of the patients with glycosylated hemoglobin (Hb A1c) 6.5%. (2) diabetic foot patients complicated with diabetic peripheral neuropathy, burn / scald (54.7%) is the most common cause of foot ulcers, good hair at the toe position (63.7%). (3) of diabetic foot ulcer secretions bacterial culture positive rate was 71.2 % of amputation occurred in 3-5 grade Wagner (severe) in patients with Qi and yin deficiency group had the highest rate (20%). (4) cold dampness syndrome group total protein (TP) was higher than other groups, serum albumin (ALB) was higher than that of dampness heat group, poison Yin Qi and Yin deficiency syndrome group. Qi and yin deficiency syndrome group, platelet count (Pt) group was higher than that of cold dampness syndrome group, blood stasis group, dampness heat group, p0.05. (5) with lower extremity arterial occlusion of blood stasis syndrome group. (6) cold dampness syndrome group, blood stasis group mainly in Wagner grade 0-2 level (light) in patients with P0.05; poison Yin Syndrome group, Qi deficiency group mainly in severe patients, p0.01. (7) WBC high count (OR=1.128,95%CI:1.032~1.233), lower extremity arterial occlusion rate (OR=2.233,95%CI:1.253~3.980) for high risk factors of severe diabetic foot, high levels of hemoglobin (OR=0.979,95%CI:0.965~0.993) is its protection Protective factors. (8) the foot bone necrosis rate (OR=15.491,95%CI:5.016~47.847), lower extremity arterial occlusion rate (OR=2.837,95%CI:1.106~7.275) is the risk factors of limb amputation. Conclusion: (1) a longer duration of diabetes, blood sugar control deviation, older patients susceptible to diabetic foot. It often causes and pathogens bacterial infection. (2) cold dampness syndrome group in early diabetic foot, the illness is lighter, the total protein (TP) was higher than that of other groups; Qi and yin deficiency was more common in diabetic foot late, severe illness, occurrence of amputation rate is higher. (3) infection, lower limb arterial occlusion rate is dangerous factors of severe diabetic foot foot necrosis, lower extremity arterial occlusion increased the risk of amputation.

【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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