ﺑﺮرﺳﯽ ارﺗﺒﺎط ﺑﯿﻦ ﻣﯿﺰان ﻫﻤﻮﮔﻠﻮﺑﯿﻦ A1C و آﻣﭙﻮﺗﺎﺳﯿﻮن اﻧﺪام ﺗﺤﺘﺎﻧﯽ در ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﭘﺎي دﯾﺎﺑﺘﯽ

Association between HbA1C Level and Lower Extremity Amputation in Patients with Diabetic Foot

زﻣﯿﻨﻪ و ﻫﺪف: آﻣﭙﻮﺗﺎﺳﯿﻮنﻫﺎي اﻧﺪام ﺗﺤﺘﺎﻧﯽ از ﺟﻤﻠﻪ اﻧﻮاع ﺷﺎﯾﻊ ﻋﻮارض ﻣﻮرد ﻣﺸﺎﻫﺪه در ﺑﯿﻤﺎران دﯾﺎﺑﺘﯽ ﻣﺤﺴﻮب ﻣﯽﮔﺮدﻧﺪ. ﺑﯿﻤﺎري دﯾﺎﺑﺖ اﺣﺘﻤﺎل ﺧﻄﺮ آﻣﭙﻮﺗﺎﺳﯿﻮنﻫﺎي اﻧﺪام ﺗﺤﺘﺎﻧﯽ را اﻓﺰاﯾﺶ ﻣﯽدﻫﺪ، اﮔﺮﭼﻪ ﻣﻄﺎﻟﻌﺎت اﭘﯿﺪﻣﯿﻮﻟﻮژﯾﮏ راﺑﻄﻪ ﻣﺜﺒﺖ ﺑﯿﻦ ﺑﺎﻻ ﺑﻮدن ﻗﻨﺪ ﺧﻮن و اﺣﺘﻤﺎل آﻣﭙﻮﺗﺎﺳﯿﻮنﻫﺎي اﻧﺪام ﺗﺤﺘﺎﻧﯽ را ﻧﺸﺎن دادهاﻧﺪ، وﺳﻌﺖ اﺛﺮات ﻋﺪم ﮐﻨﺘﺮل ﻣﻨﺎﺳﺐ ﻗﻨﺪ ﺧﻮن ﺑﺮ اﯾﻦ ﻋﺎرﺿﻪ، ﮐﻪ ﯾﮑﯽ از ﭘﺮﻫﺰﯾﻨﻪﺗﺮﯾﻦ ﻋﻮارض دﯾﺎﺑﺖ اﺳﺖ، را ﺑﻪ ﺧﻮﺑﯽ ﺑﺮرﺳﯽ ﻧﮑﺮدهاﻧﺪ. ﻣﻮاد و روش ﻫﺎ: در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻣﺸﺎﻫﺪهاي ﮐﻪ ﺑﻪ ﺻﻮرت ﯾﮏ ﺑﺮرﺳﯽ ﺗﻮﺻﯿﻔﯽ ـ ﺗﺤﻠﯿﻠﯽ ﻣﻘﻄﻌﯽ اﻧﺠﺎم ﮔﺮدﯾﺪ. ﺗﻌﺪاد 100 ﻧﻔﺮ از ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﭘﺎي دﯾﺎﺑﺘﯽ ﻣـﺮاﺟﻌﻪ ﮐﻨﻨﺪه ﺑﻪ ﺑﯿﻤﺎرﺳﺘﺎن ﺷﻬﺪاي ﺗﺠﺮﯾﺶ )ﻣﺮﮐﺰ ارﺟﺎﻋﯽ ﺑﯿﻤﺎران ﭘﺎي دﯾﺎﺑﺘﯽ( در ﺳﺎلﻫﺎي 93 و 94 ﺑﻪ ﺻﻮرت در دﺳﺘـﺮس اﻧﺘﺨـﺎب ﺷﺪﻧﺪ و ارﺗﺒﺎط ﺑﯿﻦ ﻣﯿﺰان ﻫﻤﻮﮔﻠـﻮﺑﯿﻦ A1C و ﻧﯿﺎز ﺑﻪ اﻧﺠﺎم آﻣﭙﻮﺗﺎﺳﯿﻮن اﻧﺪام ﺗﺤﺘﺎﻧﯽ در آﻧﻬﺎ ﺑﺮرﺳﯽ ﮔﺮدﯾﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻧﺘﺎﯾﺞ ﺑﻪ دﺳﺖ آﻣﺪه، ﻣﯿﺎﻧﮕﯿﻦ ﻣﺪت ﺑﯿﻤﺎري در اﻓﺮاد ﻣﻮرد ﺑﺮرﺳﯽ 12/09±4/9 ﺳﺎل ﺑﻮد. در ﻣﻄﺎﻟﻌﻪ ﭘﯿﺶ رو 26 درﺻﺪ از ﺑﯿﻤﺎران ﻣﻨﺠﺮ ﺑﻪ آﻣﭙﻮﺗﺎﺳﯿﻮن اﻧﺪام ﺗﺤﺘﺎﻧﯽ ﺷﺪهاﻧﺪ. ﻣﯿﺎﻧﮕﯿﻦ ﻫﻤﻮﮔﻠﻮﺑﯿﻦ A1C در ﮔﺮوﻫﯽ ﮐﻪ آﻣﭙﻮﺗﺎﺳﯿﻮن داﺷﺘﻨﺪ 8/5±1/3 و در ﮔﺮوه ﺑﺪون آﻣﭙﻮﺗﺎﺳﯿﻮن 7/9±1/1 ﺑﻮد ﮐﻪ اﺧﺘﻼف آﻣﺎري ﻣﻌﻨﺎداري را ﻧﺸﺎن ﻣﯽداد P=0.016)(. ﺗﻮزﯾﻊ ﻓﺮاواﻧﯽ ﻣﺤﻞ آﻣﭙﻮﺗﺎﺳﯿﻮن ﺑﺮ اﺳﺎس ﻫﻤﻮﮔﻠﻮﺑﯿﻦ A1C در ﺑﯿﻤﺎران ﻣﻮرد ﺑﺮرﺳﯽ ﺗﻔﺎوت آﻣﺎري ﻣﻌﻨﺎداري ﻧﺸﺎن ﻧﻤﯽداد P > 0.05)(. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﺑﺮ اﺳﺎس ﻧﺘﺎﯾﺞ ﺣﺎﺻﻞ از ﻣﻄﺎﻟﻌﻪ ﭘﯿﺶ رو ﮐﻪ ﺑﻪ ﺻﻮرت ﺗﻮﺻﯿﻔﯽ اﻧﺠﺎم ﺷﺪه اﺳﺖ، ﻧﺸﺎن داده ﺷﺪه ﮐﻪ ﻣﯿﺰان ﻫﻤﻮﮔﻠﻮﺑﯿﻦ A1C ﺑﺼﻮرت ﻣﻌﻨﺎداري در ﺑﯿﻤﺎران ﻣﻨﺠﺮ ﺑﻪ آﻣﭙﻮﺗﺎﺳﯿﻮن اﻧﺪام ﺗﺤﺘﺎﻧﯽ ﺑﺎﻻﺗﺮ ﺑﻮده اﺳﺖ. اﮔﺮﭼﻪ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻧﺤﻮه ﻃﺮاﺣﯽ ﻣﻄﺎﻟﻌﻪ ﻧﻤﯽﺗﻮان راﺑﻄﻪ ﮐﻤﯽ ﻣﯿﺎن ﻫﻤﻮﮔﻠﻮﺑﯿﻦ A1C و ﭘﯿﺸﺮﻓﺖ ﺑﻪ ﺳﻤﺖ آﻣﭙﻮﺗﺎﺳﯿﻮن اﻧﺪام ﺗﺤﺘـﺎﻧﯽ را ﮔـﺰارش ﮐﺮد، وﻟﯿﮑـﻦ ﺑﻪ ﺧﻮﺑﯽ ﻧﺸﺎن داده ﺷﺪه ﮐﻪ ارﺗﺒﺎط ﻣﻌﻨﺎداري ﻣﯿﺎن ﻫﻤﻮﮔﻠﻮﺑﯿﻦ A1C و آﻣﭙﻮﺗﺎﺳﯿﻮن اﻧﺪام ﺗﺤﺘﺎﻧﯽ وﺟﻮد دارد. ﭘﯿﺸﻨﻬﺎد ﻣﯽﺷﻮد ﮐﻪ در ﻣﻄﺎﻟﻌﺎت آﺗﯽ ﻣﯿﺰان اﺛﺮ ﭘﺎﯾﯿﻦ آوردن ﻫﻤﻮﮔﻠﻮﺑﯿﻦ A1C ﺑﺮ روي ﮐﺎﻫﺶ ﻣﯿﺰان آﻣﭙﻮﺗﺎﺳﯿﻮن اﻧﺪام ﺗﺤﺘﺎﻧﯽ ﺑﺮرﺳﯽ ﮔﺮدد، ﺗﺎ از اﯾﻦ ﻣﺎرﮐﺮ ﺳﺮﻣﯽ در دﺳﺘﺮس در ﻣﺮاﮐﺰ درﻣﺎﻧﯽ ﺟﻬﺖ ﭘﯿﺶﺑﯿﻨﯽ آﻣﭙﻮﺗﺎﺳﯿﻮن اﻧﺪام ﺗﺤﺘﺎﻧﯽ ﺑﻬﺮهﺑﺮداري ﺷﺪه و در ﻧﻬﺎﯾﺖ ﮐﺎﻫﺶ اﯾﻦ ﻋﺎرﺿﻪ را ﺷﺎﻫﺪ ﺑﺎﺷﯿﻢ.

ntroduction & Objective: The lower limb amputations are common musculoskeletal complications of diabetes mellitus and determination of the contributing factors is important for preventive programs. Materials & Methods: In this observational descriptive-comparative cross-sectional study, 100 consecutive patients with diabetic foot attending to Shohada-e-Tajrish Hospital in 2014 and 2015 were enrolled and the association between HbA1C level and lower extremity amputation in them was determined. Results: The results in this study demonstrated that mean hemoglobin A1C levels were 8.5 ± 1.3 and 7.9 ± 1.1 g/dl in those with and without amputation, respectively showing statistically significant difference (P = 0.016). The hemoglobin A1C level was not related to location of limb amputation (P > 0.05). Conclusions: Totally, it may be concluded that there is significant association between HbA1C level and lower extremity amputation in patients with diabetic foot.