糖尿病足溃疡愈合后复发危险因素的病例对照研究

Background Diabetic foot ulcer (DFU) is a serious diabetic complication with a high recurrence rate after healing, and there are many risk factors affecting recurrence. There is a lack of systematic evidence-based studies. Objective To investigate the risk factors for DFU recurrence after healing and provide more basis for the prevention and treatment of DFU. Methods A non-matched case-control study was carried out. Patients who were first hospitalized and diagnosed with DFU at the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from January 1, 2016 to February 1, 2019 were selected as the source population and divided into case and control groups according to whether they recurred within 3 years after healing, and data on baseline characteristics and major exposure factors were collected from both groups. Qualitative data was compared by using the χ2 test. Risk factors for DFU recurrence were screened by unconditional logistic regression analysis, and the relationship between DFU recurrence and the number and timing of risk factors was further analyzed. Results The overall recurrence rate within 3 years after DFU healing was 45.3% (86/190), and logistic regression analysis showed that age > 60 years (OR= 1.88, 95% CI 1.06-3.76, P=0.04), HbA1c > 7.5% (OR= 5.04, 95% CI 2.02-11.8, P=<0.001), PAD (OR= 2.56, 95% CI 1.46-4.84, P=0.008), osteomyelitis (OR= 2.22, 95% CI 1.25-4.18, P=0.01), callus (OR= 3.01, 95% CI 1.65-5.20, P=0.002), ABI <0.9 (OR= 2.98, 95% CI 1.42- 5.66, P=0.022), plantar foot ulcers (OR= 5.88, 95% CI 2.24-8.99, P<0.001) , and Wagner’s classification ≥grade 3 (OR= 4.66, 95% CI 2.01-9.42, P<0.001) were risk factors for DFU recurrence. The number of comorbid risk factors in the case group was concentrated between 5 and 9, while the majority of patients in the control group had a combination of 2 to 5 risk factors. The case group had 35 recurrences in year 1, 28 in year 2, and 23 in year 3, with involvement recurrence rates of 18.4% (35/190) in year 1, 33.2% (63/190) in year 2, and 45.3% (86/190) in year 3. Conclusion The higher recurrence rate of DFU may be associated with risk factors such as age >60 years, HbA1c >7.5%, PAD , osteomyelitis, callus, ABI <0.9, plantar ulcers, and Wagner’s classification ≥grade 3, and the number of comorbid risk factors was positively correlated with the recurrence rate.