糖尿病足风险自评工具的构建与验证

doi:10.3761/j.issn.0254-1769.2022.15.003

摘要/Abstract

摘要：

目的构建并验证适合患者自我报告的糖尿病足风险评估工具,为患者早期识别糖尿病足风险提供参考。方法采用便利抽样方法选取2021年6月—12月在浙江省某三级甲等医院住院的糖尿病患者660例,按照7：3的原则分为构建组和验证组,采用自制的糖尿病足风险因素调查表通过面对面方式进行调查,利用构建组数据建立Logistic回归方程,依据回归系数对风险因素进行赋分,构建糖尿病足风险自评工具。应用自评工具对构建组和验证组患者进行风险评分,通过受试者操作特征曲线下面积和Hosmer-Lemeshow拟合优度检验判断其预测能力。结果糖尿病足发生率为22.0%;Logistic回归分析显示,吸烟,视力障碍,足部感觉异常,足畸形,糖化血红蛋白,未选择软底、透气、前端宽大的鞋是糖尿病足的独立风险因素。糖尿病足风险自评工具得分为0~58分,分值>19.5分为高危人群。构建组受试者工作特征曲线下面积为0.803,灵敏度和特异度分别为0.696和0.793;验证组受试者工作特征曲线下面积为0.787,灵敏度和特异度分别为0.907和0.617,阳性预测值69.7%,阴性预测值71.0%,总体预测准确率为71.0%。结论糖尿病患者发生糖尿病足的风险比例较高,糖尿病足风险自评工具经验证具有较高的预测能力,可用于患者糖尿病足风险筛查。

关键词: 糖尿病足, 风险因素, 自评工具, 护理

Abstract:

Objective To construct and validate a self-reported risk assessment tool for diabetic foot,and to provide references for early identification of diabetic foot risk. Methods A total of 660 diabetic patients hospitalized in a tertiary hospital in Zhejiang Province from June to December 2021 were selected by convenience sampling method. According to the principle of 7：3,they were divided into a construction group and a verification group. The self-made diabetic foot risk factors questionnaire was used to investigate the risk factors of diabetic foot by face to face. Logistic regression equation was established using the data of the construction group. The risk factors were scored according to the β value,and the risk self-assessment tool for diabetic foot was constructed. The self-assessment tool was used to score the risk of patients in the construction group and the verification group,and the predictive ability was judged by the area under the receiver operating characteristic curve and the goodness of fit test of Hosmer-Lemeshow. Results The incidence of diabetic foot was 22.0%;logistic regression analysis showed that smoking,visual impairment,abnormal foot sensation,foot deformity,glycosylated hemoglobin,no choice of soft sole,breathable,front wide shoes were independent risk factors for diabetic foot. The score of diabetic foot risk self-assessment tool was 0-58,and the score >19.5 was divided into high-risk groups. The area under the ROC curve of the constructed group was 0.803,and the sensitivity and specificity were 0.696 and 0.793,respectively. The area under the ROC curve of the validation group was 0.787;the sensitivity and specificity were 0.907 and 0.617,respectively;the positive predictive value was 69.7%;the negative predictive value was 71.0%;the overall prediction accuracy was 71.0%. Conclusion The risk of diabetic foot is high in diabetic patients.

Key words: Diabetic Foot, Risk Factor, Self-Assessment Tool, Nursing Care

吴佳芸, 宁丽, 葛华英, 王莉, 陈为霞, 叶林斌, 刘海婷. 糖尿病足风险自评工具的构建与验证[J]. 中华护理杂志, 2022, 57(15): 1811-1817.

WU Jiayun, NING Li, GE Huaying, WANG Li, CHEN Weixia, YE Linbin, LIU Haiting. Construction and validation of diabetic foot risk self-assessment tool[J]. Chinese Journal of Nursing, 2022, 57(15): 1811-1817.

图/表 4

表1 糖尿病足风险因素的单因素分析结果

Table 1 Single factor analysis of diabetic foot risk factors

表2 糖尿病足风险因素Logistic回归分析结果

Table 2 Logistic regression analysis on risk factors of diabetic foot

图1 糖尿病足风险自评工具在构建组的ROC曲线

Figure 1 ROC curve of diabetic foot risk self-assessment tool in construction group

图2 糖尿病足风险自评工具在验证组的ROC曲线

Figure 2 ROC curve of diabetic foot risk self-assessment tool in verification group

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