Risk factors for aggravation of type 2 diabetic foot ulcer and features of bacterial infection

Mei Keqiang; Liu Zehui; Zhu Rong; Ma Lijuan; Han Rui

doi:10.13406/j.cnki.cyxb.003761

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Risk factors for aggravation of type 2 diabetic foot ulcer and features of bacterial infection

Endocrine regulation and metabolic diseases | 更新时间：2025-10-22

- Risk factors for aggravation of type 2 diabetic foot ulcer and features of bacterial infection
- Journal of Chongqing Medical University Vol. 50, Issue 6, Pages: 770-777(2025)
- 作者机构：
  
  昆明医科大学第一附属医院国际医学部，昆明 650000
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.003761
  CLC： R587.1
- Received：08 November 2024，
  
  Revised：2024-12-20，
  
  Accepted：07 January 2025，
  
  Published：28 June 2025
- 稿件说明：
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梅柯强,刘泽慧,祝蓉,等.2型糖尿病足溃疡加重的危险因素及细菌感染特征分析[J].重庆医科大学学报,2025,50(6):770-777.

Mei Keqiang,Liu Zehui,Zhu Rong,et al.Risk factors for aggravation of type 2 diabetic foot ulcer and features of bacterial infection[J].Journal of Chongqing Medical University,2025,50(6):770-777.
梅柯强,刘泽慧,祝蓉,等.2型糖尿病足溃疡加重的危险因素及细菌感染特征分析[J].重庆医科大学学报,2025,50(6):770-777. DOI： 10.13406/j.cnki.cyxb.003761.

Mei Keqiang,Liu Zehui,Zhu Rong,et al.Risk factors for aggravation of type 2 diabetic foot ulcer and features of bacterial infection[J].Journal of Chongqing Medical University,2025,50(6):770-777. DOI： 10.13406/j.cnki.cyxb.003761.

摘要

目的

探讨2型糖尿病足溃疡加重的危险因素及感染水平与病情严重程度的相关性，并进一步获得2型糖尿病足患者的足部溃疡组织中细菌检出率、细菌种类与病情严重程度的关系，为2型糖尿病足的疾病预防及临床诊治提供个性化指导方案。

方法

回顾性收集2021年10月至2023年6月昆明医科大学第一附属医院内分泌科治疗的150例2型糖尿病足患者资料，根据糖尿病足的Wagner分级标准，进一步将糖尿病足患者分为3组，轻度A组（Wagner 2级，

35）、中度B组（Wagner 3级，

58）、重度C组（Wagner 4级，

57），并对3组的临床数据进行分析。

结果

2型糖尿病足溃疡的严重程度与白细胞计数、中性粒细胞计数、血小板计数、单核细胞计数、球蛋白、碱性磷酸酶、中性粒细胞-淋巴细胞比值、单核细胞-淋巴细胞比值、血小板-淋巴细胞比值、超敏C反应蛋白、降钙素原、白细胞介素-6、红细胞沉降率、血红蛋白、白球比、淋巴细胞计数、胆碱酯酶、白蛋白、空腹血糖、γ-谷氨酰转移酶、糖化血红蛋白、血尿酸、高密度脂蛋白胆固醇、总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平有关，差异有统计学意义（

0.05）。采用多元有序logistic回归分析，结果提示中性粒细胞-淋巴细胞比值、红细胞沉降率是糖尿病足Wagner分级进展的独立危险因素（

0.05）。3组患者的足部溃疡分泌物中细菌的检出率随糖尿病足的严重程度出现上升趋势，呈C组

B组

A组。3组共计检出31类菌种，革兰阳性菌占比

革兰阴性菌占比，其中金黄色葡萄球菌在总体样本中的占比最高（27.72%）。

结论

超敏C反应蛋白、降钙素原、白细胞介素-6、红细胞沉降率随糖尿病足Wagner分级进展而上升，中性粒细胞-淋巴细胞比值、红细胞沉降率是糖尿病足Wagner分级进展的独立危险因素；足部溃疡分泌物中细菌的检出率随糖尿病足Wagner分级出现上升趋势，革兰阳性菌占比大于革兰阴性菌占比，其中金黄色葡萄球菌检出率最高。

Abstract

Objective

To investigate the risk factors for aggravation of type 2 diabetic foot ulcer and the correlation between the level of infection and the severity of the disease，as well as the association of the detection rate of bacteria and the types of bacteria with disease severity in patients with type 2 diabetic foot ulcer，and to provide individualized guidance for the prevention，diagnosis，and treatment of type 2 diabetic foot.

Methods

A retrospective analysis was performed for the data of 150 patients with type 2 diabetic foot who were treated in Department of Endocrinology，The First Affiliated Hospital of Kunming Medical University，from October 2021 to June 2023，and according to the Wagner grade of diabetic foot，these patients were divided into mild group A（35 patients with Wagner grade 2），moderate group B（58 patients with Wagner grade 3），and severe group C（57 patients with Wagner grade 4）. The clinical data of the three groups were analyzed.

Results

The severity of type 2 diabetic foot ulcer was correlated with white blood cell count，neutrophil count，platelet count，monocyte count，globulin，alkaline phosphatase，neutrophil-lymphocyte ratio，monocyte-lymphocyte ratio，platelet-lymphocyte ratio，high-sensitivity C-reactive protein，procalcitonin，interleukin-6，erythrocyte sedimentation rate，hemoglobin，albumin/globulin ratio，lymphocyte count，cholinesterase，albumin，fasting blood glucose，gamma-glutamyl transferase，glycated hemoglobin，blood uric acid，high-density lipoprotein cholesterol，total cholesterol，triglycerides，and low-density lipoprotein cholesterol（

0.05）. The multivariate ordinal logistic regression analysis s

howed that the neutrophil-lymphocyte ratio and erythrocyte sedimentation rate were independent risk factors for the progression of Wagner grade of diabetic foot（

0.05）. For groups A，B，and C，the detection rate of bacteria in foot ulcer secretion tended to increase with the severity of diabetic foot，with the highest detection rate in group C，followed by groups B and A. A total of 31 types of bacteria were detected in the three groups，and the proportion of Gram-positive bacteria was higher than that of Gram-negative bacteria，with

Staphylococcus aureus

accounting for the highest proportion of 27.72% in all samples.

Conclusion

High-sensitivity C-reactive protein，procalcitonin，interleukin-6，and erythrocyte sedimentation rate increase with the progression of the Wagner grade of diabetic foot，and neutrophil-lymphocyte ratio and erythrocyte sedimentation rate are independent risk factors for the progression of the Wagner grade of diabetic foot. The detection rate of bacteria in foot ulcer secretion tends to increase with the Wagner grade of diabetic foot，and Gram-positive bacteria account for a higher proportion than Gram-negative bacteria，with

Staphylococcus aureus

accounting for the highest proportion.

关键词

Keywords

references

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