摘要
目的观察糖尿病足溃疡(DFU)患者合并DR的发病情况与严重性,探讨DR对DFU病情及预后的影响。方法选取2015年1月至2016年12月于上海交通大学医学院附属瑞金医院远洋分院内分泌科住院治疗的DFU患者305例,分为单纯DFU组(DFU,n=70),合并DR组(DR,n=208),合并增殖性视网膜病变(PDR)组(PDR,n=27)。检查眼底病变情况,根据DR病变程度分析其与足溃疡范围、感染程度及缺血程度的关系;随访1年,分析其与DFU患者溃疡愈合率、溃疡复发率、截肢及死亡的关系。结果 68. 2%的患者合并DR,8. 9%的患者合并PDR;DR严重程度与踝肱指数相关(r=0. 518,P=0. 002),与DFU范围和感染程度无关。治疗过程中有1例严重眼底出血,其余DR治疗后未见明显加重;PDR组愈合率为63. 0%,低于无DR组(74. 3%)和DR组(71. 2%)。DR不是DFU患者溃疡愈合率、溃疡复发率、截肢、死亡风险的影响因素。结论 DFU患者合并PDR时,溃疡愈合率偏低;DR病变与下肢缺血程度相关;在改善血供治疗时,需要监控眼底出血。
Objective To investigate the prevalence and severity of diabetic retinopathy(DR)in patients with diabetic foot ulcers(DFU),and to evaluate the influence of diabetic retinopathy on the severity and prognosis of DFU.MethodsA total of 305 hospitalized DFU patients in Yuanyang branch of Ruijin Hospital Shanghai Jiaotong University School of Medicine were enrolled in this study from January 2015 to December 2016. fundus was examined in all the DFU patients. The relationship between the grades of DR and the grades of Wagner,infection,and lower extremity ischemia were analyzed. All the patients were followed up for 1 year. Then the association between the grades of DR and healing rates,recurrence rate of ulcer,amputation and mortality were calculated.ResultsThe prevalence of DR and proliferative DR were68. 2% and 8. 9% in DFU patients respectively. The degree of DR was related to lower extremity ischemia(r=0. 518,P=0. 002),but had no association with the grades of Wagner and infection. Serious fundus hemorrhage occurred in one case during treatment of DFU. In other patients,no aggravation of DR was found. Healing rate was lower in PDR patients(63. 0%)than in non-DR group(74. 3%)and DR group(71. 2%). DR was not a risk factor for healing rates of ulcer,recurrence rate of ulcer,amputation and mortality.ConclusionThe healing rate was low in DFU patients with PDR. DR was related to the ischemia degree in lower extremities. Fundus hemorrhage should be monitored during the treatment to improve the blood supply.
作者
张婴平
屠亚芬
莫冬兰
施建元
沈亚萍
顾雪明
汤正义
ZHANG Yingping;TU Yafen;MO Donglan(Department of Ophthalmology,Shanghai Electric Power Hospital,Shanghai 200050,China)
出处
《中国糖尿病杂志》
CAS
CSCD
北大核心
2019年第6期424-428,共5页
Chinese Journal of Diabetes
关键词
糖尿病视网膜病变
糖尿病足溃疡
下肢缺血
溃疡愈合率
Diabetic retinopathy
Diabetic foot ulcers
Lower extremity ischemia
Healing rate of ulcers
