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| 下肢动脉硬化闭塞症合并足部溃疡患者小截肢的影响因素分析 |
| 梁新雨1,冯夏1,许永城2,徐洪涛2,王御震2,赵诚2,曹烨民2* |
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| (上海中医药大学市中西医结合临床医学院, 上海 201203;上海中医药大学附属上海市中西医结合医院脉管科, 上海 200082;1. 上海中医药大学市中西医结合临床医学院, 上海 201203) |
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| 摘要: |
| 目的 探究下肢动脉硬化闭塞症（LLASO）合并足部溃疡患者小截肢的影响因素。方法 回顾性分析2020年1月1日至12月30日上海中医药大学附属上海市中西医结合医院脉管科收治的179例LLASO合并足部溃疡患者的病例资料。采用单因素、多因素分析筛选LLASO合并足部溃疡患者截肢的潜在高危因素，采用Kaplan-Meier生存分析法探究高危因素与患者截肢的生存关系。结果 179例LLASO患者在随访期间发生截肢41例，均为小截肢。多因素logistic回归分析结果显示，白蛋白水平低、中性粒细胞/淋巴细胞比值（NLR）高、降脂治疗、溃疡部位是LLASO合并足部溃疡患者截肢的影响因素（P均＜0.05）；校正年龄、溃疡Wagner分级、溃疡面积的影响后，NLR高与前足跖部溃疡是LLASO合并足部溃疡患者截肢的独立影响因素（OR＝8.211，95% CI 1.774～37.998，P＝0.007；OR＝2.919，95% CI 1.040～8.484，P＝0.031）。Kaplan-Meier生存分析结果显示，高NLR（≥2.00，n＝136）组患者的无截肢生存时间短于低NLR（＜2.00，n＝43）组［8（5，9）个月vs 11（7，15）个月，P＝0.020］。结论 白蛋白水平低、NLR高与LLASO合并足部溃疡患者截肢相关，其中NLR高对足部溃疡进展为截肢有预测价值。 |
| 关键词: 下肢动脉硬化闭塞症 足溃疡 小截肢 影响因素 预后 存活率分析 |
| DOI：10.16781/j.CN31-2187/R.20211127 |
| 投稿时间：2021-11-06修订日期：2022-03-07 |
| 基金项目:国家科技重大专项(2019ZX09201004-002-091),国家自然科学基金(82174382),上海市2020年度科技创新行动计划项目(20Z21900200). |
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| Influencing factors of minor amputation in lower limb arteriosclerosis obliterans patients with foot ulcer |
| LIANG Xin-yu1,FENG Xia1,XU Yong-cheng2,XU Hong-tao2,WANG Yu-zhen2,ZHAO Cheng2,CAO Ye-min2* |
| (Clinical Faculty of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China;Department of Vasculature, Shanghai Traditional Chinese Medicine-Integrated Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200082, China;1. Clinical Faculty of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China) |
| Abstract: |
| Objective To explore the influencing factors of minor amputation in lower limb arteriosclerosis obliterans (LLASO) patients with foot ulcer.Methods The clinical data of 179 LLASO patients with foot ulcer who were admitted to Department of Vascular Surgery,Shanghai Traditional Chinese Medicine-Integrated Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from Jan.1 to Dec.30,2020 were retrospectively analyzed.Univariate and multivariate analyses were used to screen the potential high-risk factors of amputation in LLASO patients with foot ulcer,and Kaplan-Meier survival analysis was used to explore the relationship between high-risk factors and amputation survival.Results In 179 LLASO patients,41 minor amputations occurred during the follow-up period.Multivariate logistic regression analysis showed that low albumin level,high neutrophil to lymphocyte ratio (NLR),lipid-lowering therapy and ulcer site were the influencing factors of amputation in LLASO patients with foot ulcer (all P<0.05).After adjusting for the effects of age,Wagner classification and ulcer area,high NLR and plantar forefoot ulcer were independent influencing factors of amputation in LLASO patients with foot ulcer (odds ratio[OR]=8.211,95% confidence interval[CI]1.774-37.998,P=0.007;OR=2.919,95%CI 1.040-8.484,P=0.031).Kaplan-Meier survival analysis showed that the amputation-free survival time of patients in the high NLR group (NLR ≥ 2.00,n=136) was significantly shorter than that of those in the low NLR group (NLR<2.00,n=43)(8[5,9]months vs 11[7,15]months,P=0.020).Conclusion Low albumin level and high NLR are associated with amputation in LLASO patients with foot ulcer,and high NLR has predictive value for ulcer progression to amputation. |
| Key words: arteriosclerosis obliterans foot ulcer minor amputation influencing factors prognosis survival analysis |
