Comparison of clinical characteristics and medical costs of patients with diabetic foot ulcer in some provinces of China

目的比较2004年和2012年的糖尿病足病患者的临床资料、溃疡特点、预后及住院费用。方法以统一的方法调查2004年全国10个省市14家三甲医院和2012年全国11个省市15家三甲医院住院糖尿病足病患者，包括病史、生化检查、足溃疡分类分期和预后及住院费用等。采用t检验、χ2检验和u检验比较两组有关数据，住院费用进行消费价格指数校正。结果2004、2012年糖尿病足病患者分别为386例、682例。2012年与2004年相比，患者的年龄、文化程度、糖尿病病程、腰臀比、糖化血红蛋白、甘油三酯、高密度脂蛋白胆固醇、尿酸、血脂异常的检出率、脑血管病和外周动脉病变及糖尿病周围神经病变的患病率、溃疡性质及住院费用的差异均无统计学意义（均P＞0.05）。与2004年相比，2012年患者的足病病程短[1（1～6）比6（1～16）月，u＝-7.955，P＜0.05]、男性比例高（65.2％比58.5％，χ2＝4.738，P＜0.05）；吸烟率（45.8％比39.0％，χ2＝4.602，P＜0.05）、饮酒率（41.1％比19.1％，χ2＝51.179，P＜0.05）高；空腹血糖、餐后血糖、总胆固醇及低密度脂蛋白胆固醇降低（ t＝-2.987、-2.855、-4.91、-3.748；均P＜0.05）；高血压、冠心病、糖尿病肾病、糖尿病视网膜病变的患病率升高（χ2＝47.572、13.297、9.638、4.329；均P＜0.05）；足溃疡的感染率、Wagner 3级以上比例及Texas D期比例升高（χ2＝6.787、40.880、11.028，均P＜0.05）；总截肢率升高，但大截肢率降低、愈合率升高（χ2＝8.838、8.908、107.773，均P＜0.05），住院天数缩短[18（12～32）比21（15～32）d，u＝-3.349，P＜0.05]。结论2012年与2004年的糖尿病足病患者具有高龄、男性居多、文化程度低、糖尿病病程长、血糖控制差、心血管危险因素及糖尿病并发症多、住院费用高的特点。2012年与2004年相比，糖尿病足病患者合并症及并发症更多、足溃疡更严重、总截肢率更高，但大截肢率降低、愈合率升高、住院天数缩短。Objective To compare and analyze clinical data , ulcer characteristics , prognosis and hospitalization expenses in the patients with diabetic foot ulcer in 2004 and 2012 in China.Methods Diabetic foot disease data from 14 great three A hospitals from 10 provinces or cities in 2004 and 15 great three A hospitals from 11 provinces or cities in 2012 in China were collected and analyzed , including the medical history , physical and biochemical examinations , demographic characteristics , prognosis and hospitalization expenses.The classification , stage and risk factors of diabetic foot ulcer were also compared between two groups.The t, χ2 and u tests were used for comparing between two groups of data.Hospitalization expenses of diabetic foot disease was corrected with consumer price index .Results 386 cases in 2004 and 682 cases in 2012 were recruited.No significant differences in age , educational level , duration of diabetes , waist hip ratio, glycosylated hemoglobin A1c, triglyceride, high density lipoprotein cholesterol, uric acid, prevalence of dyslipidemia, cerebrovascular, peripheral artery disease, diabetic peripheral neuropathy , ischemic foot ulcer , and hospitalization expenses between two groups ( all P >0.05).Compared with the patients in 2004, duration of diabetic foot (1(1-6) vs 6(1-16) m,u=-7.955, P<0.05) was shorter, more men(65.2%vs 58.5%,χ2 =4.738,P<0.05), more patients with smoking (45.8%vs 39.0%,χ2 =4.602,P<0.05) and/or drinking(41.1% vs 19.1%,χ2 =51.179,P<0.05), lower fasting and postprandial blood glucose , total cholesterol and low density lipoprotein cholesterol in 2012 (t=-2.987,-2.855,-4.910,-3.748,all P<0.05).The higher prevalence of hypertension , coronary heart disease, diabetic kidney disease, diabetic retinopathy (χ2 =47.572,13.297,9.638,4.329;all P<0.05), and more patients with infectious foot ulcer , more patients with severe foot disease whose foot ulcer classified as Wagner 3 and above or Texas D (χ2 =6.787,40.880,11.028,all P<0.05).There were significantly lower major amputation rate , higher ulcer healing rate (χ2 =8.838, 8.908, 107.773, all P<0.05), shorter hospital stay (18(12-32) vs 21(15-32)d, u=-3.349, P<0.05).Conclusions The patients with diabetic foot disease in 2004 and 2012 were older, with more men, low educational level , long duration of diabetes , poor control of hyperglycemia , high hospitalization expenses and with more cardiovascular risk factors and diabetic complications.Compared with the patients in 2004, patients with diabetic foot disease in 2012 had more concomitant diseases and complications , with more severe foot ulcers and infections , higher total amputation rate , but lower major amputation rate , higher ulcer healing rate , and shorter hospital stay.军队临床高新技术重大项目中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)07499-50