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Abstract：
OBJECTIVE: The aim of this study is to investigate the factors influencing the recurrence of diabetic foot ulcers (DFU) and provide guidance for reducing the recurrence rate.
METHODS: A total of 211 patients diagnosed with DFU who were hospitalized and discharged from the hospital from October 2015 to January 2020 were included as the study cohort. Participants were divided into two groups according to whether the foot ulcer recurred during the 2-year follow-up period: a recurrence group (n = 84) and a non-recurrence group (n = 127). The following data were collected and analyzed for the two groups of patients: general information, foot information, laboratory indicators, diabetes comorbidities, and complications.
RESULTS: (1) The overall recurrence rate of diabetic foot ulcers (DFU) within 2 years was 39.8%, indicating a high recurrence rate. (2) Significant differences were observed between the two patient groups in terms of BMI, HbA1c, TBIL, CRP, financial situation, foot deformity, first ulcer on the sole of the foot, previous amputation history, Wagner grade of the first ulcer, osteomyelitis, DFU duration (>60 days), lower limb vascular reconstruction, peripheral arterial disease (PAD), and diabetic peripheral neuropathy (DPN) (t = 2.455; Z = -1.988, -3.731, -3.618; χ2 = 7.88, 5.004, 3.906, 17.178, 16.237, 5.007, 24.642, 4.782, 29.334, 10.253). No significant differences were found for the other indicators. (3) Logistic regression analysis revealed that TBIL (OR = 0.886, p = 0.036) was a protective factor against ulcer recurrence. In contrast, PAD, previous amputation history, DPN, and the first ulcer on the sole of the foot (OR = 3.987, 6.758, 4.681, 2.405; p < 0.05 or p < 0.01) were identified as risk factors for ulcer recurrence.
CONCLUSIONS: Early screening and preventive education targeting high-risk factors such as DPN, PAD and the initial ulcer location on the sole of the foot are essential to mitigate the high long-term recurrence rate of DFU. Furthermore, the protective role of TBIL in preventing ulcer recurrence underscores the importance of monitoring bilirubin levels as part of a comprehensive management strategy for DFU patients.
METHODS: A total of 211 patients diagnosed with DFU who were hospitalized and discharged from the hospital from October 2015 to January 2020 were included as the study cohort. Participants were divided into two groups according to whether the foot ulcer recurred during the 2-year follow-up period: a recurrence group (n = 84) and a non-recurrence group (n = 127). The following data were collected and analyzed for the two groups of patients: general information, foot information, laboratory indicators, diabetes comorbidities, and complications.
RESULTS: (1) The overall recurrence rate of diabetic foot ulcers (DFU) within 2 years was 39.8%, indicating a high recurrence rate. (2) Significant differences were observed between the two patient groups in terms of BMI, HbA1c, TBIL, CRP, financial situation, foot deformity, first ulcer on the sole of the foot, previous amputation history, Wagner grade of the first ulcer, osteomyelitis, DFU duration (>60 days), lower limb vascular reconstruction, peripheral arterial disease (PAD), and diabetic peripheral neuropathy (DPN) (t = 2.455; Z = -1.988, -3.731, -3.618; χ2 = 7.88, 5.004, 3.906, 17.178, 16.237, 5.007, 24.642, 4.782, 29.334, 10.253). No significant differences were found for the other indicators. (3) Logistic regression analysis revealed that TBIL (OR = 0.886, p = 0.036) was a protective factor against ulcer recurrence. In contrast, PAD, previous amputation history, DPN, and the first ulcer on the sole of the foot (OR = 3.987, 6.758, 4.681, 2.405; p < 0.05 or p < 0.01) were identified as risk factors for ulcer recurrence.
CONCLUSIONS: Early screening and preventive education targeting high-risk factors such as DPN, PAD and the initial ulcer location on the sole of the foot are essential to mitigate the high long-term recurrence rate of DFU. Furthermore, the protective role of TBIL in preventing ulcer recurrence underscores the importance of monitoring bilirubin levels as part of a comprehensive management strategy for DFU patients.
摘要：
目的：本研究旨在探讨糖尿病足溃疡(DFU)复发的影响因素,为降低复发率提供指导。
方法：纳入2015年10月至2020年1月住院出院的211例DFU患者作为研究队列。根据2年随访期间足部溃疡是否复发，将参与者分为两组：复发组（n=84）和未复发组（n=127）。收集并分析两组患者的一般资料,足部信息,实验室指标,糖尿病合并症,和并发症。
结果：（1）2年内糖尿病足溃疡（DFU）的总复发率为39.8％，表明复发率高。(2)两组患者在BMI、HbA1c,TBIL,CRP,财务状况,足部畸形,脚底第一次溃疡，以前的截肢史,瓦格纳级别的第一次溃疡，骨髓炎,DFU持续时间（>60天），下肢血管重建,外周动脉疾病（PAD），糖尿病周围神经病变（DPN）（t=2.455；Z=-1.988、-3.731、-3.618；χ2=7.88、5.004、3.906、17.178、16.237、5.007、24.642、4.782、29.334、10.253）。其他指标无显著差异。(3)Logistic回归分析显示TBIL(OR=0.886,p=0.036)是溃疡复发的保护因素。相比之下,PAD,以前的截肢史,DPN,足底首次溃疡（OR=3.987、6.758、4.681、2.405；p<0.05或p<0.01）被确定为溃疡复发的危险因素。
结论：针对DPN等高危因素的早期筛查和预防教育，PAD和脚底的初始溃疡位置对于减轻DFU的长期高复发率至关重要。此外，TBIL在预防溃疡复发中的保护作用强调了监测胆红素水平作为DFU患者综合管理策略一部分的重要性.
方法：纳入2015年10月至2020年1月住院出院的211例DFU患者作为研究队列。根据2年随访期间足部溃疡是否复发，将参与者分为两组：复发组（n=84）和未复发组（n=127）。收集并分析两组患者的一般资料,足部信息,实验室指标,糖尿病合并症,和并发症。
结果：（1）2年内糖尿病足溃疡（DFU）的总复发率为39.8％，表明复发率高。(2)两组患者在BMI、HbA1c,TBIL,CRP,财务状况,足部畸形,脚底第一次溃疡，以前的截肢史,瓦格纳级别的第一次溃疡，骨髓炎,DFU持续时间（>60天），下肢血管重建,外周动脉疾病（PAD），糖尿病周围神经病变（DPN）（t=2.455；Z=-1.988、-3.731、-3.618；χ2=7.88、5.004、3.906、17.178、16.237、5.007、24.642、4.782、29.334、10.253）。其他指标无显著差异。(3)Logistic回归分析显示TBIL(OR=0.886,p=0.036)是溃疡复发的保护因素。相比之下,PAD,以前的截肢史,DPN,足底首次溃疡（OR=3.987、6.758、4.681、2.405；p<0.05或p<0.01）被确定为溃疡复发的危险因素。
结论：针对DPN等高危因素的早期筛查和预防教育，PAD和脚底的初始溃疡位置对于减轻DFU的长期高复发率至关重要。此外，TBIL在预防溃疡复发中的保护作用强调了监测胆红素水平作为DFU患者综合管理策略一部分的重要性.
