季節變化與糖尿病患發生危及肢體足部潰瘍之相關性研究

The Association of Seasonal Changes on Diabetic Patients with Limb-threatening Foot Ulcers

10.6540/NTJN.202003_22(1).0003

彭美卿(Mei-Ching Peng)；黃禹堯(Yu-Yao Huang)；楊惠美(Hui-Mei Yang)；瞿馥苓(Fu-Ling Chu)

季節 ； 危及肢體足部潰瘍 ； 糖尿病 ； season ； limb-threatening foot ulcers ； diabetes

新臺北護理期刊

22卷1期（2020 / 03 / 01）

21 - 32

繁體中文

本研究為探討糖尿病患發生危及肢體（limb-threatening, LT）足部潰瘍與季節變化的相關性。研究採病歷回溯，收集2016年1月至2017年12月臺灣北部某醫學中心20歲以上糖尿病足部潰瘍住院病患，將個案分為危及肢體糖尿病足部潰瘍（limb-threatening diabetic foot ulcer, LT DFU）及糖尿病足部潰瘍（diabetic foot ulcer, DFU）二組，檢視糖尿病足病患是否發生LT DFU與季節變化之相關性。另收集同時期臺灣中央氣象局全球資訊網北部四個氣象站的每月平均溫度及相對濕度。依照氣候劃分四季。統計採用SPSS套裝軟體22.0版，進行卡方、獨立t檢定以及多元邏輯斯回歸等統計分析。共732位個案，平均年齡65.8（±13.79）歲，LT DFU 645位（88.1%），其他為只有DFU病患87位（11.9%）。春季時糖尿病足入院總人數最多（x^2=10.393, p＜.05），但秋季是LT DFU發生比例最高的季節（x^2=8.145,p＜.05），以秋季為參考組，春、夏、冬季發生LT DFU的odds ratio（OR）分別為0.289（p=.002）、0.360（p=.015）及0.325（p=.006）。糖尿病患者在冬季活動量較低，隨著氣候漸暖，活動量增加可能使腳部承受壓力，因而增加了春季發生糖尿病足部潰瘍的風險。臺灣地處亞熱帶，2016及2017年為臺灣氣象紀錄上最暖的兩年，秋季平均溫度為攝氏25.53度，相對濕度78.88%，溫暖潮濕的天氣可能增加了糖尿病足病患的感染率，因此秋季是糖尿病患發生LT DFU比例最高的季節。建議臨床醫療人員應加強春、秋季糖尿病患足部保護措施。

The main purpose of this study was to investigate the association between limb-threatening (LT) foot ulcers and seasonal variation. We retrospectively reviewed adult patients (≥20 yrs) treated at a major medical center in northern Taiwan between 2016~2017. The medical records and the classification of the wound were collected, and divided into limb-threatening diabetic foot ulcer (LT DFU) group and diabetic foot ulcer (DFU) group, thus examining whether seasonal changes are associated with LT DFU. The data of monthly average temperature and relative humidity were collected from the four weather stations in the north via Central Weather Bureau. The four seasons were divided according to the climate. All data analyses were conducted using SPSS version 22.0 with chi-square, student t test, and multiple logistic regression. There were 732 cases treated in the diabetic foot center, and mean age was 65.8(±13.79) yrs. 645 (88.1%) had LT foot ulcers (LT DFU group) and the remaining 87 (11.9%) had only foot ulcers (DFU group). In the spring, the number of admissions for diabetic foot ulcer was the highest (x^2=10.393, p＜.05), but autumn was the season with the highest incidence of LT foot ulcers (x^2=8.145, p＜.05). Logistic regression analysis showed that, taking autumn as reference, the odds ratio(OR) of LT DFU occurrence in spring, summer, and winter were 0.289 (p=.002), 0.360 (p=.015) and 0.325 (p=.006), respectively. As the temperature is warmer than winter, it may increase daily activity in diabetic patients and repetitive foot pressure increases the risk of foot injury, thus increasing the risk of developing diabetic foot in spring. Autumn is the season with the highest incidence of diabetic LT foot ulcers. During 2016-2017, the warm (average temperature 25.53°C) and humid (average relative humidity 78.88%) weather may increase the risk of LT foot ulcer infection. It is recommended that clinical health care workers should strengthen foot protection in spring and autumn.

1. 吳佩芝,李其蓁(2016)。面對氣候變遷與健康的挑戰—未來的護理教育。護理雜誌，63(4)，5-12。
   連結：
2. Ahmad, J.(2016).The diabetic foot.Diabetes & Metabolic Syndrome: Clinical Research & Reviews,10(1),48-60.
3. Al-Rubeaan, K.,Al Derwish, M.,Ouizi, S.,Youssef, A. M.,Subhani, S. N.,Ibrahim, H. M.,Alamri, B. N.(2015).Diabetic foot complications and their risk factors from a large retrospective cohort study.PLoS One,10(5),e0124446.
4. Brito, L. D. A. R.,Nascimento, A. C. M. D.,Marque, C. D.,Miot, H. A.(2018).Seasonality of the hospitalizations at a dermatologic ward (2007-2017).Anais Brasileiros de Dermatologia,93(5),755-758.
5. Grigoropoulou, P.,Eleftheriadou, I.,Jude, E. B.,Tentolouris, N.(2017).Diabetic foot infections: An update in diagnosis and management.Current Diabetes Reports,17(1),3.
6. Hobizal, K. B.,Wukich, D. K.(2012).Diabetic foot infections: current concept review.Diabetic Foot & Ankle,3,18409.
7. Hsu, C. R.,Chang, C. C.,Chen, Y. T.,Lin, W. N.,Chen, M. Y.(2015).Organization of wound healing services: The impact on lowering the diabetes foot amputation rate in a ten-year review and the importance of early debridement.Diabetes Research and Clinical Practice,109(1),77-84.
8. International Diabetes Federation(2017).IDF Diabetes Atlas.
9. Kim, Y. J.,Park, S.,Yi, W.,Yu, K. S.,Kim, T. H.,Oh, T. J.,Cho, Y. M.(2014).Seasonal variation in hemoglobin A1c in Korean patients with type 2 diabetes mellitus.Journal of Korean Medical Science,29(4),550-555.
10. Lavery, L. A.,Armstrong, D. G.,Murdoch, D. P.,Peters, E. J.,Lipsky, B. A.(2007).Validation of the infectious diseases society of America's diabetic foot infection classification system.Clinical Infectious Diseases,44(4),562-565.
11. Lavery, L. A.,Armstrong, D. G.,Wunderlich, R. P.,Mohler, M. J.,Wendel, C. S.,Lipsky, B. A.(2006).Risk factors for foot infections in individuals with diabetes.Diabetes Care,29(6),1288-1293.
12. Leung, H. B.,Ho, Y. C.,Wong, W. C.,Guerin, J.(2007).Seasonal variations in non-traumatic major lower limb amputation in Hong Kong Chinese diabetic patients.Hong Kong Medical Journal,13(5),379.
13. Lipsky, B. A.,Berendt, A. R.,Cornia, P. B.,Pile, J. C.,Peters, E. J.,Armstrong, D. G.,Pinzur, M. S.(2012).2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections.Clinical Infectious Diseases,54(12),e132-e173.
14. Mavri, A.,Gužic-Salobir, B.,Salobir-Pajnic, B.,Keber, I.,Stare, J.,Stegnar, M.(2001).Seasonal variation of some metabolic and haemostatic risk factors in subjects with and without coronary artery disease.Blood Coagulation & Fibrinolysis,12(5),359-365.
15. Ndip, A.,Lavery, L. A.,LaFontaine, J.,Rutter, M. K.,Vardhan, A.,Vileikyte, L.,Boulton, A. J.(2010).High levels of foot ulceration and amputation risk in a multiracial cohort of diabetic patients on dialysis therapy.Diabetes Care,33(4),878-880.
16. Peters, E. J.,Lavery, L. A.,Armstrong, D. G.(2005).Diabetic lower extremity infection: Influence of physical, psychological, and social factors.Journal of Diabetes and its Complications,19(2),107-112.
17. Sakura, H.,Tanaka, Y.,Iwamoto, Y.(2010).Seasonal fluctuations of glycated hemoglobin levels in Japanese diabetic patients.Diabetes Research and Clinical Practice,88(1),65-70.
18. Schaper, N. C.(2004).Diabetic foot ulcer classification system for research purposes: A progress report on criteria for including patients in research studies.Diabetes/Metabolism Research and Reviews,20(S1),S90-S95.
19. Shahi, S. K.,Kumar, A.,Kumar, S.,Singh, S. K.,Gupta, S. K.,Singh, T. B.(2012).Prevalence of diabetic foot ulcer and associated risk factors in diabetic patients from North India.The Journal of Diabetic Foot Complications,4(3),83-91.
20. Uysal, S.,Ozturk, A. M.,Tasbakan, M.,Simsir, I. Y.,Unver, A.,Turgay, N.,Pullukcu, H.(2018).Human myiasis in patients with diabetic foot: 18 cases.Annals of Saudi Medicine,38(3),208.
21. World Health Organization(2016).Global report on diabetes.
22. Wukich, D. K.,Hobizal, K. B.,Brooks, M. M.(2013).Severity of diabetic foot infection and rate of limb salvage.Foot & Ankle International,34(3),351-358.
23. Yusof, N. M.,Ab Rahman, J.,Zulkifly, A. H.,Che-Ahmad, A.,Khalid, K. A.,Sulong, A. F.,Vijayasingham, N.(2015).Predictors of major lower limb amputation among type II diabetic patients admitted for diabetic foot problems.Singapore Medical Journal,56(11),626.
24. Zhang, P.,Lu, J.,Jing, Y.,Tang, S.,Zhu, D.,Bi, Y.(2017).Global epidemiology of diabetic foot ulceration: A systematic review and meta-analysis.Annals of Medicine,49(2),106-116.
25. 中央氣象局全球資訊網-交通部中央氣象局（2018）‧氣候統計-觀測資料查詢‧2018年8月18日‧取自https://e-service.cwb.gov.tw/HistoryDataQuery/index.jsp
26. 交通部中央氣象局(2019).106氣候年報.
27. 黃禹堯(2017)。糖尿病足防治指引專刊─糖尿病足照護。長庚醫訊，38(7)
28. 楊惠美,孫瑞鴻,黃禹堯,靳燕芬,黃子庭(2011)。季節變化對糖尿病足部潰瘍患者下肢截肢之影響。長庚護理，22(4)，463-471。
29. 衛生福利部國民健康署（2018，6月12日）‧健康主題、疾病防治、慢性病防治、三高防治專區(高血壓、高血脂、糖尿病)糖尿病‧取自https://www.hpa.gov.tw/Pages/List.aspx?nodeid=359
30. 賴昂廷,林益卿,楊鈺雯,吳美鳳(2012)。氣候變遷與人類健康。內科學誌，23(5)，343-350。