[This corrects the article DOI: 10.3389/fendo.2025.1697718.].

AimsThis study aims to investigate the relationship between the neutrophil-to-lymphocyte (NLR) and the risk of sudden cardiac death (SCD) in the patients with diabetic foot ulcer (DFU).MethodsA retrospective study enrolled 688 patients with DFU who were admitted to Air Force Medical Center between January 2010 and December 2023. To control for potential confounding effects, a 1:1 propensity score matching (PSM) method was applied. The relationship between NLR and SCD risk was analyzed using the Kaplan-Meier (K-M) survival curve analysis, multivariate Cox proportional hazard regression model, Restricted cubic spline (RCS) model analysis and subgroup analyses.ResultsOver a median follow-up period of 61 months, 38 cases of SCD were documented. Based on median NLR, participants were stratified into higher (<4.22) and lower (≥4.22) NLR groups. Cox proportional hazard model revealed that individuals with higher NLR was independently associated with the increased risk of SCD (HR: 3.64, 95% CI: 1.21 ~ 10.91, P=0.021). RCS model showed that SCD risk was non-linearly correlated with gradual increases in NLR levels. Subgroup analyses confirmed the stability of the results.ConclusionsElevated NLR independently confers an increased risk for SCD in individuals with DFU.

BACKGROUND:This study examines the relationship between the TyG index and the risk of sudden cardiac death (SCD) in the patients with diabetic foot ulcer (DFU). METHODS:688 type 2 diabetes mellitus (T2DM) inpatients with DFU between January 2010 and December 2023 was included in this retrospective study. The 1:1 propensity score matching (PSM) method was applied. The relationship between TyG index and SCD risk was analyzed using the Kaplan-Meier (K-M) survival curve analysis, multivariate Cox proportional hazard regression model, Restricted cubic spline (RCS) model analysis and subgroup analyses. RESULTS:Over a median follow-up period of 61 months, 38 cases of SCD were recorded. After PSM, 71 pairs of score-matched patients according to TyG index were generated. K-M survival curves revealed higher SCD rates in patients with TyG index ≥9.65. The Cox proportional hazard model, independently associated with the risk of SCD (HR: 75.98; 95 % CI: 9.16 ∼ 630.40; P < 0.001). RCS model showed that SCD risk was non-linearly correlated with gradual increases in TyG index levels. Stratified analyses indicated a consistent relationship between increasing TyG index and SCD risk across all subgroups. CONCLUSIONS:Elevated TyG index independently confers an increased risk for SCD in individuals with DFU.

BACKGROUND:Lingual thyroid is a rare congenital anomaly resulting from the aberrant migration of thyroid tissue during embryonic development. Although frequently asymptomatic, its identification in military aircrew poses particular challenges given the rigorous standards of aeromedical certification. CASE PRESENTATION:A 37-year-old male military helicopter pilot was incidentally diagnosed with lingual thyroid during routine health screening. The patient remained asymptomatic throughout the clinical course. Comprehensive evaluations-including thyroid function tests, biochemical profiling, cervical magnetic resonance imaging, electronic laryngoscopy, radionuclide scanning, and portable sleep monitoring-confirmed the presence of a lingual thyroid with subclinical hypothyroidism. Imaging demonstrated the ectopic tissue at the tongue base to be the sole functioning thyroid gland. Levothyroxine therapy was initiated, resulting in normalization of thyroid hormone levels. Polysomnography was performed due to the anatomical location of the lesion and excluded obstructive sleep apnea or ventilatory compromise. Given the patient's strong motivation to resume flight duties, a multidisciplinary aeromedical evaluation was conducted. Based on clinical stability, absence of symptoms, and treatment response, the pilot was deemed aeromedically fit. Since June 2021, he has accumulated over 900 flight hours, with preserved thyroid function and no evidence of disease progression on longitudinal follow-up. CONCLUSIONS:To the best of our knowledge, this represents the first documented case in China of a military pilot with lingual thyroid successfully certified for continued flying duties. This case suggests that congenital endocrine anomalies may be compatible with high-demand occupational roles in select cases, pending comprehensive individual evaluation and risk-based aeromedical assessment. It further supports the adoption of a risk-stratified, non-invasive management paradigm in aviation medicine, with implications for enhancing both flight safety and personnel retention.

Background: The biology of papillary thyroid carcinoma (PTC) is highly varied. However, the intraregional heterogeneity present in PTC with or without lymphatic metastasis (LM) is still not well understood. Methods: Six tumor samples from patients with PTC were used for viable cell single-cell RNA sequencing (scRNA-seq) analysis. The cell types were identified using markers from the CellMarker database and published research. To perform functional enrichment analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses and Gene Set Enrichment Analysis (GSEA) were carried out using ClusterProfiler. The cell-chat package was used to analyze the cell–cell interaction. Results: 13 cell types were identified in the scRNA-seq dataset by published cell markers. Enrichment pathway analyses of tumor cells found that PTC with LM was associated with pathways related to cell proliferation, migration, and survival. Cell–cell interaction analysis showed increased CD44-TYROBP-mediated and decreased PPIA-BSG and APP-SORL1-mediated cell communication between tumor cells and other cells. Specifically, CD8+ resident memory T cells emerged as pivotal regulators in LM of PTC, primarily through the expression of MHC-I, CD99, and LCK. Conclusions: This study provides new insights into the heterogeneity of PTC and the basis for LM in PTC, which might provide potential therapeutic targets in future treatment.

ObjectiveTo compare the efficacy, safety and patients’ quality of life of radiofrequency ablation (RFA) and surgery in the treatment of papillary thyroid microcarcinoma (PTMC).MethodsMEDLINE, EMBASE, Cochrane, CNKI and other databases were searched for studies on radiofrequency ablation versus traditional surgery for PTMC up to October 2022. RevMan5.4 software was used for Meta-analysis.Results10 articles were selected from 392 articles, including 873 cases of radiofrequency ablation and 781 cases of open surgery. After meta-analysis, the incidence of postoperative complications in the radiofrequency ablation group was lower than that in the surgery group, and the difference was statistically significant [OR=0.24, 95%CI (0.14,0.41), P<0.001]. There were no significant differences in lymph node metastasis rate, local recurrence rate, and new tumor rate between the two groups [OR=1.6, 95%CI (0.21, 12.41), P>0.05; OR=0.85, 95%CI (0.05, 13.8), P>0.05; OR=0.12, 95%CI (0.01, 0.98), P>0.05]. The treatment time and hospital stay in the radiofrequency ablation group were shorter than those in the open surgery group [MD=-49.99, 95%CI (-62.02, -37.97), P<0.001; MD=-5.21, 95%CI(-7.19,-3.23),P<0.001], and the cost was significantly lower than that of the traditional surgery group [SMD=-14.97, 95%CI (-19.14, -10.81), P<0.001]. The quality of life of patients in the radiofrequency ablation group was higher than that in the surgery group [MD=-1.61, 95%CI (-2.06, -1.17), P<0.001].ConclusionCompared with traditional open surgery, radiofrequency ablation for papillary thyroid microcarcinoma has the advantages of less trauma, fewer complications, faster recovery and higher quality of life. The indications need to be strictly controlled in the treatment.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42022374987).

We present the case of a 54-year-old woman with reasonable blood sugar control who presented with a diabetic foot combined with severe peripheral neuropathy and vascular disease. Lower limb muscle weakness, muscle atrophy, skin pigmentation, and emaciation were also observed. Although her muscle strength improved after glucocorticoid treatment, it remained challenging to account for the other symptoms in this particular patient with chronic inflammatory demyelinating polyneuropathy. Plump liver and spleen, hidden bone lesions combined with seemingly unexplained cerebral infarction, and serous effusion led us to suspect polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome. The abnormal proliferation of monoclonal plasma cells and a significant increase in vascular endothelial growth factor (VEGF) levels confirmed the diagnosis of POEMS syndrome. After 1 month of treatment with lenalidomide and dexamethasone, the diabetic foot ulcers healed, and the symptoms of myasthenia and fatigue improved. Diabetic feet may represent only the tip of the iceberg of an underlying POEMS syndrome. Our report aimed to increase awareness of this rare yet significant situation, advocating for the prompt identification and treatment of POEMS syndrome.

Background Diabetes mellitus, as one of the world's fastest-growing diseases, is a chronic metabolic disease that has now become a public health problem worldwide. The purpose of this research was to develop a predictive nomogram model to demonstrate the risk of major amputation in patients with diabetic foot.Methods A total of 634 Type 2 Diabetes Mellitus (T2DM) patients with diabetic foot ulcer hospitalized at the Air Force Medical Center between January 2018 and December 2023 were included in our retrospective study. There were 468 males (73.82%) and 166 females (26.18%) with an average age of 61.64 +/- 11.27 years and average body mass index of 24.45 +/- 3.56 kg/m2. The predictive factors were evaluated by single factor logistic regression and multiple logistic regression and the predictive nomogram was established with these features. Receiver operating characteristic (subject working characteristic curve) and their area under the curve, calibration curve, and decision curve analysis of this major amputation nomogram were assessed. Model validation was performed by the internal validation set, and the receiver operating characteristic curve, calibration curve, and decision curve analysis were used to further evaluate the nomogram model performance and clinical usefulness.Results Predictors contained in this predictive model included body mass index, ulcer sites, hemoglobin, neutrophil-to-lymphocyte ratio, blood uric acid (BUA), and ejection fraction. Good discrimination with a C-index of 0.957 (95% CI, 0.931-0.983) in the training group and a C-index of 0.987 (95% CI, 0.969-1.000) in the validation cohort were showed with this predictive model. Good calibration were displayed. The decision curve analysis showed that using the nomogram prediction model in the training cohort and validation cohort would respectively have clinical benefits.Conclusion This new nomogram incorporating body mass index, ulcer sites, hemoglobin, neutrophil-to-lymphocyte ratio, BUA, and ejection fraction has good accuracy and good predictive value for predicting the risk of major amputation in patients with diabetic foot. Key message What is already known on this topic - DF is a leading cause of amputations, with the characteristics of high incidence, great difficulty in treatment and high disability rate. There is still a lack of an accurate and clinically useful predictive model to assess the risk of amputation in DF patients. What this study adds - This study marks a significant advancement in estimating risk of major amputation in patients with DF and validating nomograms that incorporate BMI, ulcer sites, HB, NLR, BUA, and EF. How this study might affect research, practice or policy - It demonstrate the risk of major amputation in patients with DF and to propose prevention options, thereby providing a useful tool for early identification and development of the best therapeutic options, so as to prevent the occurrence of major amputation.

目的 探讨老年糖尿病(DM)患者血清 25 羟维生素D[25(OH)D]水平与糖尿病足溃疡(DFU)的相关性.方法 选取 2020 年 1 月—2022 年 3 月在空军特色医学中心内分泌科住院的老年DM患者 339 例,根据有无 DFU 分为DFU组(n=204)和DM组(n=135),比较两组的临床和生化特征,并分析两组 25(OH)D的变化及其与 DFU 的关系.结果 DFU组患者 SBP和BUN高于DM组,病程长于 DM组患者,DFU 组 TC、TG、HDL-C、ALT、AST、ALB、Hb、血细胞比容(HCT)和血清 25(OH)D水平低于DM组患者,差异有统计学意义(均P<0.05).Logistic 回归分析结果提示,血清 25(OH)D、TG、HDL-C 水平升高是糖尿病合并 DFU 患者的保护因素,病程延长和 SBP 升高是糖尿病合并DFU的独立危险因素(P<0.05).DFU组维生素D缺乏比例明显高于DM组,差异有统计学意义(P<0.05).且随着Wagner分级的增加,25(OH)D水平呈逐渐下降趋势(P=0.004),多重比较显示,Wagner 2 级患者 25(OH)D水平显著高于 Wager 4 级(P<0.05).结论 老年DM患者维生素D缺乏或不足较为普遍,DFU 患者维生素 D缺乏更为严重,且随着 Wagner分级的增加,25(OH)D水平呈逐渐下降趋势.

目的 分析某军飞行人员糖尿病前期(PDM)流行现状,为糖尿病(DM)的防控提供参考依据.方法 采取整群抽样法随机抽取2018年4月至10月在某军两所特勤疗养中心疗养的飞行人员1 092人.设计调查问卷,收集飞行机种、人员类别、年龄、吸烟史、DM家族史,同时测量受调查者血压、身高、体质量,计算体质量指数(BMI),抽取受调查者空腹肘静脉血,检测空腹血糖(FPG)及服用75 g葡萄糖粉负荷后2 h血糖(2 h PG)水平.结果 飞行人员中PDM的患病率为7.05％(77/1 092),其中空腹血糖受损(IFG)、糖耐量减低(IGT)及IFG合并IGT所占比例分别为27.27％(21/77)、68.83％(53/77)和3.90％(3/77).不同年龄组的比较显示,20～30岁、＞30～40岁、＞40～50岁和＞50岁飞行人员的PDM患病率分别为3.35％(6/179)、5.98％(30/502)、9.68％(27/279)、11.29％(14/124),各组 PDM 患病率(P＜0.05)、FPG 及糖负荷后 2 h PG均具有统计学差异(P＜0.01),随着年龄的增长,PDM患病率、FPG及2 h PG均逐渐上升.根据BMI将飞行人员分为正常、超重和肥胖组,三组PDM患病率分别为4.35％(20/460)、9.92％(50/554)、11.11％(7/70),差异具有统计学意义(P＜0.05),PDM患病率及FPG、2 h PG血糖随着BMI的增大逐渐升高.不同机种(歼击机、轰炸机、直升机、运输机、无人机)飞行人员、不同人员类别飞行人员(飞行员、技勤或战勤人员)PDM患病率无显著差异(P＞0.05).与血糖正常的飞行人员相比,PDM组具有年龄大,BMI、FPG、糖负荷后2hPG高的特点(P＜0.05).结论 PDM飞行人员以IGT为主,随着年龄的增加及BMI的增大,飞行人员PDM患病率及FPG、糖负荷后2 hPG水平逐步升高.对于年龄超过40岁或体型为超重、肥胖的飞行人员,应当有针对性地进行糖耐量筛查,做好DM防控工作.

目的 分析军事飞行人员糖尿病前期(pre-diabetes mellitus,PDM)的转归情况及影响因素,为进一步干预及预警提供理论依据.方法 序贯纳入2017年1月—12月在空军杭州特勤疗养中心疗养的56例PDM飞行人员,进行生活方式干预并随访3年后,调查糖代谢转归情况;根据不同转归结局分为正常组(n=45)和糖代谢异常组(n=11),分析2组飞行人员的临床特点并探讨转归结局的影响因素.结果 PDM飞行人员经过3年生活方式干预,糖代谢转归为正常者比例为80.36%,仍为糖尿病前期者为14.29%,进展为糖尿病的为5.35%.转归结局为糖代谢异常组的年龄、飞行时间、体质量、收缩压、舒张压、空腹血糖(fasting plasma glucose,FPG)均高于正常组,差异具有统计学意义(P均＜0.05).单因素Logistic回归分析显示,飞行人员的年龄、飞行时间、体质量、收缩压、舒张压、FPG是转归结局为糖代谢异常的危险因素,其预测转归结局为糖代谢异常的曲线下面积分别为0.778、0.755、0.703、0.786、0.785、0.760(P均＜0.05).多因素Logistic回归分析结果显示,体质量是PDM转归为血糖异常的独立危险因素(OR=1.198,P=0.009),飞行岗位是PDM转归血糖异常的独立保护因素(OR=0.040,P=0.001).结论 对PDM飞行人员应加强健康宣教,控制体质量和血压,并定期复查口服糖耐量试验,通过早期干预措施降低飞行人员PDM及糖尿病的发病风险.

Objective To develop a new, alternative sarcopenia risk score to screen for sarcopenia in type 2 diabetes patients in China and to demonstrate its validity. Research design and methods The data for this study came from a multicenter, cross-sectional study that had been designed to estimate the prevalence of sarcopenia among adults with type 2 diabetes and had been conducted in several hospitals in Beijing, China. A total of 1125 participants were randomly divided into two groups: an exploratory population and a validation population. A multivariable logistic regression model using the backward stepwise likelihood ratio method to estimate the probability of sarcopenia was fitted with candidate variables in the exploratory population. A new, alternative sarcopenia risk score was developed based on the multivariable model. The internal and external validations were performed in the exploratory and validation populations. The study was registered at Chinese Clinical Trial Registry (ChiCTR-EOC-15006901). Results The new, alternative sarcopenia risk score included five variables: age, gender, BMI, total energy intake per day, and the proportion of calories supplied by protein. The score ranged from − 2 to 19. The area under the receiver operating characteristic (ROC) curve of the risk score for the prediction of sarcopenia in type 2 diabetes patients was 0.806 (95% CI 0.741–0.872) and 0.836 (95% CI 0.781–0.892) in the exploratory and validation populations, respectively. At the optimal cutoff value of 12, the sensitivity and specificity of the score for the prediction of sarcopenia were 70.9% and 81.0% in the exploratory population and 53.7% and 88.8% in the validation population, respectively. The Hosmer–Lemeshow goodness-of-fit test showed a good calibration with the risk score in external validation ( χ 2 = 4.459, P = 0.813). Conclusions The new, alternative sarcopenia risk score appears to be an effective screening tool for identification of sarcopenia in Chinese patients with type 2 diabetes in clinical practice. Clinical trial registration Chinese Clinical Trial Registry, ChiCTR-EOC-15006901.

The present study was designed to detect possible biomarkers associated with Type 1 diabetes mellitus (T1DM) incidence in an effort to develop novel treatments for this condition. Three mRNA expression datasets of peripheral blood mononuclear cells (PBMCs) were obtained from the GEO database. Differentially expressed genes (DEGs) between T1DM patients and healthy controls were identified by Limma package in R, and using the DEGs to conduct GO and DO pathway enrichment. The LASSO-SVM were used to screen the hub genes. We performed immune correlation analysis of hub genes and established a T1DM prognosis model. CIBERSORT algorithm was used to identify the different immune cells in distribution between T1DM and normal samples. The correlation of the hub genes and immune cells was analyzed by Spearman. ROC curves were used to assess the diagnostic value of genes in T1DM. A total of 60 immune related DEGs were obtained from the T1DM and normal samples. Then, DEGs were further screened to obtain 3 hub genes, ANP32A-IT1, ESCO2 and NBPF1. CIBERSORT analysis revealed the percentage of immune cells in each sample, indicating that there was significant difference in monocytes, T cells CD8+, gamma delta T cells, naive CD4+ T cells and activated memory CD4+ T cells between T1DM and normal samples. The area under curve (AUC) of ESCO2, ANP32A-IT1 and NBPF1 were all greater than 0.8, indicating that these three genes have high diagnostic value for T1DM. Together, the findings of these bioinformatics analyses thus identified key hub genes associated with T1DM development.

The present study was designed to detect possible biomarkers associated with Type 1 diabetes mellitus (T1DM) incidence in an effort to develop novel treatments for this condition. Three mRNA expression datasets of peripheral blood mononuclear cells (PBMCs) were obtained from the GEO database. Differentially expressed genes (DEGs) between T1DM patients and healthy controls were identified by Limma package in R, and using the DEGs to conduct GO and DO pathway enrichment. The LASSO-SVM were used to screen the hub genes. We performed immune correlation analysis of hub genes and established a T1DM prognosis model. CIBERSORT algorithm was used to identify the different immune cells in distribution between T1DM and normal samples. The correlation of the hub genes and immune cells was analyzed by Spearman. ROC curves were used to assess the diagnostic value of genes in T1DM. A total of 60 immune related DEGs were obtained from the T1DM and normal samples. Then, DEGs were further screened to obtain 3 hub genes, ANP32A-IT1, ESCO2 and NBPF1. CIBERSORT analysis revealed the percentage of immune cells in each sample, indicating that there was significant difference in monocytes, T cells CD8+, gamma delta T cells, naive CD4+ T cells and activated memory CD4+ T cells between T1DM and normal samples. The area under curve (AUC) of ESCO2, ANP32A-IT1 and NBPF1 were all greater than 0.8, indicating that these three genes have high diagnostic value for T1DM. Together, the findings of these bioinformatics analyses thus identified key hub genes associated with T1DM development.

Background: The fat-soluble molecule vitamin D has attracted much attention since its pleiotropism was discovered. Its effectiveness can be attributed to the presence of vitamin D receptors in most of the body's tissues. Based on the classical role of vitamin D in regulating calcium and phosphorus metabolism and maintaining bone health, the role of vitamin D in immunity, type 2 diabetes mellitus (T2DM), tumor and cardiovascular diseases has been further discovered. Some experiments have shown that vitamin D can restore the production of antimicrobial peptides (AMP) in primary diabetic foot ulcer (DFU) cells, which can improve in vitro wound healing, indicating its potential therapeutic use in DFU therapy. In addition, vitamin D can also inhibit the secretion of T-helper type 1 (Th1) cytokines IFN-Y and IL-2 while stimulating the production of Th2 cytokines, thereby promoting wound healing. Objective: To investigate the relationship between 25-OH-vitamin D level and DFU in diabetes mellitus (DM) patients, and to provide a theoretical basis for the early prevention and treatment of DFU. Methods: The clinical data of 429 hospitalized patients with DM were retrospectively analyzed in this case-control study. The patients were divided into the DFU group (n = 242) and non-DFU group (n = 187). Fasting venous blood was drawn from all subjects to detect serum 25-OH-vitamin D levels and blood biochemical parameters, the difference of parameters between DFU group and nonDFU group were analyzed, and the risk factors of DFU were analyzed by logistic regression. Results: The difference between the two groups in age, DM duration, gender, diastolic blood pressure, serum creatinine, total Multivariate logistic regression analysis showed that 25-OH-vitamin D is an independent protective factor for DFU [OR 95%, CI 0.984 (0.969, 0.998), p < 0.05]. 25-OH-vitamin D nutrition status distribution was different between non-DFU group and DFU group (P < 0.05). Vitamin D deficiency (< 50 nmol/L) accounted for 86.78% of all DFU patients, which was only 74.33% in non-DFU patients. The 25-OH-vitamin D levels of DFU patients from Wagner Grades 1 to 5 showed a downward trend (p < 0.01). Conclusion: In conclusion, our study confirms that 25-OH-vitamin D is closely correlated with DFU and that 25-OH-vitamin D is an independent protective factor for DFU. Therefore, vitamin D screening or supplementation might be beneficial to prevent DFU and improve the prognosis of DM patients.

Abstract Objective To investigate the relationship between the level of 25-OH-vitamin D [25 (OH) D] and diabetic foot ulcers (DFU) in aged Diabetes Mellitus (DM) patients. Methods from January 2020 to March 2022, 339 elderly DM patients, aged 60 to 90 years old, hospitalized in the Department of Endocrinology, Air Force Special Medical Center, were selected and divided into DFU group (n=204) and DM group (n=135) according to the presence or absence of DFU. The clinical and biochemical characteristics of the two groups were compared. The change of 25 (OH) D and its relationship with DFU was analyzed. Results SBP and BUN in DFU group were higher than those in DM group, and the course of disease was longer than that in DM group. The levels of TC, TG, HDL-C, ALT, AST, ALB, Hb, HCT and serum 25 (OH) D in DFU group were lower than those in DM group, the differences were statistically significant (p < 0.05). Logistic regression analysis showed that increased serum 25 (OH) D level was a protective factor for DFU in DM patients (p < 0.05). In this study, 80.5% of elderly DM patients suffered from vitamin D deficiency, and the proportion of vitamin D deficiency in DFU group was significantly higher than that in DM group. The difference was statistically significant (p < 0.05). With the increase of Wagner grade, the level of 25 (OH) D gradually decreased (p = 0.004). Multiple comparisons showed that the level of 25-OH-vitamin D in Wagner grade 2 patients was significantly higher than that in wager Grade 4 patients (P < 0.05). Spearman correlation analysis showed that the serum 25-(OH)-D level was negatively correlated with DFU (P =0.001, R =-0. 182). Conclusion vitamin D deficiency or insufficiency is common in elderly DM patients, and is more serious in DFU patients.

目的 调查新冠肺炎疫情期间糖尿病足患者相关心理痛苦的现状,并剖析其产生的影响因素,为实施针对性的干预提供临床指导.方法 采用一般情况调查表、糖尿病痛苦量表对该院2020年9月至2021年3月收治的102例糖尿病足患者进行调查.结果 102例糖尿病足患者相关心理痛苦得分为(39.46±16.66)分;病程、足部破溃次数、并发症情况、是否合并其他疾病、治疗方式、疫情对就诊的影响等是糖尿病足患者产生相关心理痛苦的重要因素(P<0.05).结论 新冠肺炎疫情期间糖尿病足患者相关心理痛苦发生率明显增高,应该予以更高的关注,并积极分析引起其心理痛苦的相关因素,针对性地改进干预措施.

Abstract Objective: To investigate the factors that influence diabetic foot (DF) minor amputation. Methods: In this case-control study, the clinical data of 955 hospitalized patients with DF were retrospectively analyzed, according to whether hospitalization amputation was divided into minor amputation and the non-amputation group, compared two groups of general data, laboratory examination, diabetes complications and complications, such as differences, multiple factors regression analysis DF Risk factors associated with minor amputation in patients. Results: There were statistically significant differences between the two groups in DPN, DR, PAD, ABI, TBI, and Wagner grades, as well as age, sex, HbA1c, FPG, Scr, SUA, TC, ALB, HDL-C, WBC, and Hb (P<0.05). The logistic regression analysis that HbA1c (odds ratio [OR] 1.082 [95% CI 1.011–1.158], p= 0.023), ABI＜0.9 (odds ratio [OR] 1.793 [95% CI 1.316–2.443],p=0.000), TBI＜0.7(odds ratio [OR] 2.569 [95% CI 1.889–3.495], p=0.000), Wagner classification (odds ratio [OR] 2.792 [95% CI 2.303–3.384], p=0.000) and PAD (odds ratio [OR] 2.343 [95% CI 1.731–3.170], p=0.000) were significant risk factors for DF minor amputation (P＜0.05). Higher Hb (odds ratio [OR] 0.981 [95% CI 0.973–0.988], p=0.000) was an independent protective factor for minor amputation. Conclusion:HbA1c, lower ankle brachial index level, and lower toe-brachial index level were all related with minor amputation. Wagner classification and diabetic peripheral angiopathy may represent a novel independent factor. In light of these concerns, early preventive and timely multidisciplinary assistance is critical to prevent diabetic foot minor amputation.

报道1例青年女性患者，有糖尿病病史14年，左足溃烂1年，6年前出现双眼白内障，入院后发现高甘油三酯血症、非均匀型脂肪肝及多发动脉粥样硬化。患者呈“鸟样外貌”，头发花白，声音高调且沙哑，四肢纤细，皮肤菲薄，左足第一跖骨背侧及外踝处可见深达骨质溃疡。采集口腔拭子样本，提取基因组DNA进行全外显子高通量测序，检测到患者WRN基因存在2处（c.1270-1G>A和c.3475A>T）杂合突变，诊断为Werner综合征。在临床工作中，对于糖尿病足溃疡的患者，应当注意鉴别诊断。