摘要
目的:分析2型糖尿病足溃疡(DFU)患者的临床特点,探讨患者营养控制营养状态(CONUT)评分与足溃疡Wagner分级的相关性。方法:选取2020年1月—2023年6月柳州市柳铁中心医院收治的DFU患者为研究对象,收集并比较患者的临床及实验室数据等资料,回顾性分析DFU患者的临床特征与Wagner分级的相关性;计算CONUT评分,分析CONUT评分评估DFU严重程度的效能。结果:本研究共纳入137例患者,根据Wagner分级标准,其中轻度溃疡组93例(占67.9%),重度溃疡组44例(占32.1%)。重度溃疡组与轻度溃疡组患者在发病年龄、合并高血压病、CONUT评分方面比较,差异均有统计学意义(P<0.05);重度溃疡组患者白细胞、中性粒细胞计数、红细胞沉降率、C反应蛋白、中性粒细胞/淋巴细胞计数比值等炎性指标水平高于轻度溃疡组;血红蛋白、前白蛋白、白蛋白、高密度脂蛋白胆固醇等营养指标水平低于轻度溃疡组,差异均有统计学意义(P<0.05)。137例患者中轻度营养不良56例,占40.9%;中重度营养不良81例,占59.1%。中重度营养不良组患者合并高血压病比例低于轻度营养不良组,Wagner分级高于轻度营养不良组,差异均有统计学意义(P<0.05)。中重度营养不良组患者中性粒细胞计数、红细胞沉降率、C反应蛋白、中性粒细胞/淋巴细胞计数比值、血小板/淋巴细胞计数比值等炎性指标水平高于轻度营养不良组,淋巴细胞计数比值低于轻度营养不良组,血红蛋白、前白蛋白、白蛋白、视黄醇结合蛋白、总胆固醇、甘油三酯、低密度脂蛋白胆固醇等营养指标水平低于轻度营养不良组,差异均有统计学意义(P<0.05)。CONUT评分评估DFU严重程度的效能ROC曲线结果显示,AUC=0.661,P=0.002,95%CI:0.558~0.765。最佳临界值为6.5分,敏感度为43.2%,特异度为84.9%。结论:重度溃疡DFU患者呈现更明显的炎性反应及营养不良,DFU患者的炎性反应和营养状况可能是评估DFU严重程度的潜在标志物,从而充分准确评估及改善患者的营养状态与溃疡严重程度可能改善DFU患者的状况。
Objective To analyze the clinical characteristics of patients with type 2 diabetic foot ulcer(DFU),and to explore the correlation between the Controlled nutritional status(CONUT)score and Wagner grade of foot ulcer.Methods DFU patients admitted to Liuzhou Municipal Liutie Central Hospital from January 2020 to June 2023 were selected.The clinical and laboratory data of the patients were collected and compared,and the correlation between the clinical characteristics of DFU patients and Wagner grade was retrospectively analyzed.The CONUT score was calculated to evaluate the efficacy of the CONUT score in assessing the severity of DFU.Results A total of 137 patients were included in this study.According to Wagner’s DFU classification,there were 93 patients(67.9%)in the mild ulcer group and 44 patients(32.1%)in the severe ulcer group.There were significant differences in the age of onset,hypertension and CONUT score between the severe ulcer group and the mild ulcer group(P<0.05).The levels of white blood cell,neutrophil count,erythrocyte sedimentation rate,C-reactive protein,neutrophil/lymphocyte count ratio and other inflammatory indicators in severe ulcer group were higher than those in mild ulcer group.The levels of hemoglobin,prealbumin,albumin,high density lipoprotein cholesterol and other nutritional indicators in the ulcer group were lower than those in the mild ulcer group,and the differences were statistically significant(P<0.05).Among 137 patients,56(40.9%)had mild malnutrition.There were 81 cases of moderate and severe malnutrition,accounting for 59.1%.The proportion of hypertension in the moderate-severe malnutrition group was lower than that in the mild malnutrition group,and the Wagner grade was higher than that in the mild malnutrition group,and the differences were statistically significant(P<0.05).The levels of neutrophil count,erythrocyte sedimentation rate,C-reactive protein,neutrophil/lymphocyte count ratio,platelet/lymphocyte count ratio and other inflammatory indicators in the moderatesevere malnutrition group were higher than those in the mild malnutrition group,and the lymphocyte count was lower than that in the mild malnutrition group.The levels of hemoglobin,prealbumin,albumin,retinol-binding protein,total cholesterol,triglyceride,and low-density lipoprotein cholesterol in the malnutrition group were lower than those in the mild malnutrition group,and the differences were statistically significant(P<0.05).The ROC curve of CONUT score for evaluating the severity of DFU showed that AUC=0.661,P=0.002,95%CI:0.558~0.765.The optimal cut-off value was 6.5,with a sensitivity of 43.2%and a specificity of 84.9%.Conclusions DFU patients with severe ulcers show more obvious inflammatory response and malnutrition.The inflammatory response and nutritional status of DFU patients may be potential markers for evaluating the severity of DFU,so fully and accurately evaluating and improving the nutritional status and ulcer severity of patients may help improve the status of DFU patients.
作者
韦秋华
WEI Qiuhua(Department of Clinical Nutrition,Liuzhou Municipal Liutie Central Hospital,Liuzhou,Guangxi 545007,China)
出处
《医药前沿》
2023年第27期17-22,共6页
Journal of Frontiers of Medicine
