【摘要】 目的 探讨糖尿病足溃疡（DFU）愈合后1年内复发的影响因素并构建预测模型，评估DMIST量表预测DFU愈合后1年内复发的应用价值。方法 收集2020年1月至2021年6月于山东第一医科大学附属省立医院接受治疗的172例DFU患者的临床资料，根据愈合后1年随访期内DFU是否复发将患者分为复发组（n=51）和DFU组（n=121）。比较两组患者的临床特征、血液指标和DMIST量表评分；采用多因素Cox回归模型分析DFU愈合后1年内复发的影响因素，构建预测模型并验证模型的准确性；分析DMIST量表对DFU愈合1年内复发的预测价值，并通过溃疡复发Kaplan-Meier风险曲线和受试者工作特征（ROC）曲线进行验证。结果 两组患者的踝肱指数（ABI）、合并冠心病比例、Wagner分级以及DMIST量表中的溃疡深度评分、感染评分、坏死组织类型评分、皮下窦道或潜行创面评分、总分比较，差异均有统计学意义（P﹤0.05）。多因素分析结果显示，冠心病、溃疡深度评分、皮下窦道或潜行创面评分均是DFU愈合后1年内复发的危险因素，ABI是DFU愈合后1年内复发的保护因素（P﹤0.05）。ROC曲线和预测模型的校准曲线分析结果显示，预测模型的曲线下面积为0.832(95%CI:0.763～0.901)，灵敏度为0.745，特异度为0.824，校准曲线与实际曲线重合良好。结论 ABI、冠心病、溃疡深度评分和皮下窦道或潜行创面评分均是DFU愈合后1年内复发的预测因素，根据各预测因素构建的预测模型准确性较好。更多还原

【Abstract】 Objective To investigate the influencing factors of the recurrence of diabetic foot ulcer(DFU) within 1 year after healing, construct the prediction model, and evaluate the application value of DMIST scale in predicting the recurrence of DFU within 1 year after healing. Method The clinical data of 172 patients with DFU admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2020 to June 2021 were collected. The patients were divided into recurrent group(n=51) and DFU group(n=121) according to whether the DFU recurred during the 1-year follow-up period. The clinical characteristics, blood indexes and DMIST scale scores of the two groups were compared. Multifactorial Cox regression model was used to screen for the factors influencing the recurrence of DFU within 1 year after healing. A prediction model for recurrence of DFU within 1 year after healing was constructed and its accuracy was verified. The value of DMIST scale in predicting the recurrence of DFU within 1 year after DFU healing was analyzed and the feasibility of DMIST scale in predicting the recurrence of DFU within 1 year after DFU healing was validated through Kaplan Meier risk curve and receiver operator characteristic(ROC) curve. Result There were statistically significant differences in ankle brachial index(ABI), proportion of patients with coronary heart disease, Wagner grade,wound depth score, infection score, necrotic tissue type score, wound tunnel or undermining score and DMIST total score between the two groups(P<0.05). Multivariate analysis showed that coronary heart disease, wound depth score, wound tunnel or undermining score were risk factors for recurrence of DFU within 1 year after healing, and ABI was protective factor for recurrence of DFU within 1 year after healing(P<0.05). The analysis results of ROC curve and calibration curve of the prediction model showed that the area under the curve of the prediction model was 0.832(95%CI: 0.763-0.901), the sensitivity and specificity were 0.745 and 0.824. The calibration curve coincided well with the actual curve. Conclusion Coronary artery disease, ABI, wound depth score, and wound tunnel or undermining score were predictors of recurrence of DFU within 1 year after healing, and the prediction model constructed had good accuracy.更多还原