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性别对重症糖尿病足血管病变腔内治疗效果的影响

The impact of gender on severe diabetic foot endovascular interventions

  • 摘要:
    目的 探讨性别与重症糖尿病足患者(Wagner分级3~5级)的外周血管腔内治疗效果的关系。
    方法 纳入2019年1月至2022年1月海军军医大学第一附属医院收治的接受外周血管腔内治疗的重症糖尿病足患者168例,根据性别分为男性组(n=118)和女性组(n=50)。比较两组患者下肢血管病变特点、术中处理方式,收集术后创面愈合率及截肢等资料。
    结果 在重症糖尿病足患者中,女性组术后3个月及6个月的创面愈合较男性组差(P=0.035,P=0.002),但两组患者截肢率差异无统计学意义。多因素回归分析结果显示,女性(OR=5.24,95%CI 1.227~22.382;P=0.025)和病变累及膝下动脉数量(OR=5.24,95%CI 1.213~14.709;P=0.024)与术后6个月创面愈合不良相关。在病变累及膝下动脉的人群中,女性患者的术后6个月创面愈合较差(P<0.001)。
    结论 女性患者就诊时年龄大,合并症复杂,以膝下血管病变为主,且术中干预及术后创面愈合情况较差。女性糖尿病足患者应更早更积极地进行腔内治疗,这对改善女性患者的预后有积极意义。

     

    Abstract:
    Objective To explore the relationship between gender and the efficacy of endovascular therapy in patients with severe diabetes foot (Wagner grade 3-5).
    Methods From January 2019 to January 2022, 168 patients with severe diabetes foot who received peripheral endovascular treatment in the First Affiliated Hospital of Naval Military Medical University were included. They were divided into male group (n=118) and female group (n=50) according to gender. To compare the characteristics of lower limb vascular disease, the treatment methods during operation, and collect the data of wound healing rate and amputation after operation.
    Results In patients with severe diabetes foot, the wound healing of the female group was worse than that of the male group at 3 and 6 months after surgery (P=0.035, P=0.002), but there was no significant difference in the amputation rate between the two groups. Multivariate regression analysis showed that women (OR=5.24, 95%CI 1.227-22.382; P=0.025) and the number of lesions involving the inferior genicular artery (OR=5.24, 95%CI 1.213-14.709; P=0.024) were associated with poor wound healing 6 months after surgery. Among the patients with lesions involving the inferior genicular artery, the wound healing of female patients was poor 6 months after operation (P < 0.001).
    Conclusions The female patients are old at the time of treatment, with complicated complications, and the main complication is infragenual vascular disease, and the condition of intraoperative intervention and postoperative wound healing is poor. Female patients with diabetes foot should receive endovascular treatment earlier and more actively, which has positive significance for improving the prognosis of female patients.

     

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