糖尿病足溃疡患者营养不良影响因素的Meta分析

doi:10.3761/j.issn.0254-1769.2025.20.015

摘要/Abstract

摘要：

目的系统评价糖尿病足患者营养不良的影响因素，为临床制订糖尿病足患者的营养干预提供循证依据。方法按照“6S”证据金字塔模型，自上而下检索计算机决策支持系统、临床指南网站、专业协会网站及数据库中关于糖尿病足溃疡患者并发营养不良危险因素有关的文献，检索时限为建库至2025年3月。由2名研究者独立进行文献筛选、质量评价和数据提取，采用Stata 18软件进行Meta分析。结果共纳入23篇研究，总样本量为5 068例。提取10种影响因素，包括年龄（OR=2.709）、BMI（MD=0.709）、糖尿病病程（OR=2.589）、糖化血红蛋白（OR=2.190）、白蛋白（MD=0.578）、血红蛋白（OR=2.948）、感染（OR=1.816）、C反应蛋白（OR=2.228）、糖尿病足Wagner分级（OR=4.620）和自理程度（OR=0.220）。使用微型营养评定简表、微营养评估表、全球营养领导人发起的营养不良倡议为评估工具的糖尿病足溃疡患者营养不良的发生率分别为52.2%、70.2%及41.4%。结论糖尿病足溃疡患者营养不良发生率相对较高，护理人员应持续监测糖尿病足溃疡患者的营养状况，实施个性化干预方案，以预防营养不良的发生。

关键词: 糖尿病足溃疡, 营养不良, 影响因素分析, Meta分析, 循证护理学

Abstract:

Objective To systematically evaluate malnutrition risk factors in diabetic foot patients through systematic review and inform evidence-based nutritional interventions. Methods A top-down search of the literature on risk factors for malnutrition in patients with diabetic foot was conducted according to the “6S” pyramid model，using a computerized decision-making system，clinical guideline websites，professional association websites and databases，with a timeframe of up to March 2025 for the search. Totally 2 researchers independently performed literature screening，quality assessment，and data extraction. Meta-analysis was conducted using Stata 18 software. Results Totally 23 studies with a total sample size of 5 068 cases were included. There were 10 influencing factors being extracted，including age（OR=2.709），BMI（MD=0.709），duration of diabetes mellitus（OR=2.589），glyco-sylated hemoglobin（OR=2.190），albumin（MD=0.578），hemoglobin（OR=2.948），infection（OR=1.816），C-reactive protein（OR=2.228），Wagner classification of diabetic foot（OR=4.620） and degree of self-care（OR=0.220）. The incidence of malnutrition in DFU patients who were assessed by the MNA-SF tool，the MNA tool and GLIM tool were 52.2%，70.2% and 41.4%. Conclusion The incidence of malnutrition in DFU patients is relatively high. Healthcare providers should continuously monitor the nutritional status of diabetic foot patients and implement personalized intervention plans to prevent malnutrition.

Key words: Diabetes Foot Ulcer, Malnutrition, Root Cause Analysis, Meta Analysis, Evidence-Based Nursing

周贵玲, 徐蓉, 边旭娜, 陶静, 刘清华, 向慧. 糖尿病足溃疡患者营养不良影响因素的Meta分析[J]. 中华护理杂志, 2025, 60(20): 2527-2533.

ZHOU Guiling, XU Rong, BIAN Xuna, TAO Jing, LIU Qinghua, XIANG Hui. Influencing factors of malnutrition in patients with diabetic foot ulcers：a Meta-analysis[J]. Chinese Journal of Nursing, 2025, 60(20): 2527-2533.

图/表 1

参考文献 39

[1]	Bus SA, Sacco ICN, Monteiro-Soares M, et al. Guidelines on the prevention of foot ulcers in persons with diabetes(IWGDF 2023 update)[J]. Diabetes Metab Res Rev, 2024, 40(3):e3651.
[2]	Schaper NC, van Netten JJ, Apelqvist J, et al. Practical guide-lines on the prevention and management of diabetes-related foot disease(IWGDF 2023 update)[J]. Diabetes Metab Res Rev, 2024, 40(3):e3657.
[3]	Armstrong DG, Swerdlow MA, Armstrong AA, et al. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer[J]. J Foot Ankle Res, 2020, 13(1):16. DOI PMID
[4]	蒋竹奕, 谢颖, 杨川. 中国糖尿病足溃疡患者预后危险因素研究进展[J]. 中国糖尿病杂志, 2020, 28(7):550-554.
	Jiang ZY, Xie Y, Yang C. Advances in prognostic risk factors of diabetic foot ulcer in China[J]. Chin J Diabetes, 2020, 28(7):550-554.
[5]	Arieta-Miranda JM, Ruiz-Yasuda CC, Pérez Vargas LF, et al. New pyramid proposal for the levels of scientific evidence accor-ding to SIGN[J]. Plast Reconstr Surg, 2022, 149(4):841e-843e.
[6]	曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四:观察性研究的质量评价工具[J]. 中国循证心血管医学杂志, 2012, 4(4):297-299.
	Zeng XT, Liu H, Chen X, et al. Meta-analysis series IV:quality evaluation tools for observational research[J]. Chin J Evid Based Cardiovasc Med, 2012, 4(4):297-299.
[7]	Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9):603-605. DOI PMID
[8]	谢晓冉, 徐蓉, 张静, 等. 局部氧疗对糖尿病足溃疡患者干预效果的Meta分析[J]. 中华护理杂志, 2023, 58(24):2976-2983. DOI
	Xie XR, Xu R, Zhang J, et al. The effect of topical oxygen therapy on the intervention of patients with diabetic foot ul-cers:a Meta-analysis[J]. Chin J Nurs, 2023, 58(24):2976-2983.
[9]	彭婷, 陶静, 刘清华, 等. 1型糖尿病患者低血糖感知受损发生率及其影响因素的Meta分析[J]. 中华糖尿病杂志, 2024, 16(6):669-679.
	Peng T, Tao J, Liu QH, et al. Meta-analysis of the incidence and influencing factors of hypoglycemia awareness impairment in patients with type 1 diabetes mellitus[J]. Chin J Diabet, 2024, 16(6):669-679.
[10]	Ran Q, Xu WW, Zhao XL, et al. Risk factors for malnutrition in patients with diabetic foot ulcer and its association with prolonged length of hospitalization[J]. Nutr Diabetes, 2024, 14(1):26. DOI PMID
[11]	冉倩, 赵锡丽, 徐蔚蔚, 等. 糖尿病足患者营养不良风险预测模型的构建与验证[J]. 临床内科杂志, 2024, 41(11):739-742.
	Ran Q, Zhao XL, Xu WW, et al. Construction and validation of a risk prediction model for malnutrition in patients with diabetic foot[J]. J Clin Intern Med, 2024, 41(11):739-742.
[12]	López-Valverde ME, Aragón-Sánchez J, Víquez-Molina G. Hand-grip strength but not malnutrition according to global lea-dership initiative on malnutrition criteria is a risk factor for mortality in hospitalized patients with ischemic diabetic foot ulcers[J]. Adv Wound Care(New Rochelle), 2023, 12(3):127-134.
[13]	Lauwers P, Hendriks JMH, Van Bouwel S, et al. Malnutrition according to the 2018 GLIM criteria is highly prevalent in people with a diabetic foot ulcer but does not affect outcome[J]. Clin Nutr ESPEN, 2021, 43:335-341. DOI PMID
[14]	黄晓冬, 贾庆梅, 葛华英, 等. 老年糖尿病足溃疡患者营养不良的影响因素分析[J]. 浙江临床医学, 2024, 26(6):843-845.
	Huang XD, Jia QM, Ge HY, et al. Analysis of influencing factors of malnutrition in elderly patients with diabetic foot ulcer[J]. Zhejiang Clin Med J, 2024, 26(6):843-845.
[15]	吕战虎, 马秋洁, 汤志辉, 等. 110例糖尿病足患者的营养不良发生状况及影响因素分析[J]. 新疆医学, 2023, 53(11):1340-1343.
	Lv ZH, Ma QJ, Tang ZH, et al. Analysis of malnutrition and its influencing factors in 110 patients with diabetic foots[J]. Xinjiang Med J, 2023, 53(11):1340-1343.
[16]	何冰心, 顾仕林, 金珏安, 等. 老年女性糖尿病足溃疡患者的营养不良发生状况及影响因素分析[J]. 中国妇幼保健, 2020, 35(24):4840-4842.
	He BX, Gu SL, Jin JA, et al. Analysis of malnutrition and its influencing factors in elderly female patients with diabetic foot ulcer[J]. Matern Child Health Care China, 2020, 35(24):4840-4842.
[17]	姜萍. 老年糖尿病足溃疡患者的营养状况及其影响因素[J]. 世界最新医学信息文摘, 2019, 19(16):152-153.
	Jiang P. Nutritional status of elderly patients with diabetic foot ulcer and its influencing factors[J]. World Latest Med Inf, 2019, 19(16):152-153.
[18]	Mutailipu M, Zhang BH, Zhu HJ. Correlation analysis of nutri-tional status of diabetic foot patients with different Wagner grades[J]. Int J Diabetes Dev Countr, 2023.
[19]	冉妮娜, 史敏青, 薛娟, 等. 老年糖尿病足溃疡住院患者营养状况及营养不良相关影响因素研究[J]. 华南预防医学, 2021, 47(12):1523-1527.
	Ran NN, Shi MQ, Xue J, et al. Nutritional status and related factors of malnutrition in elderly inpatients with diabetic foot ulcer[J]. South China J Prev Med, 2021, 47(12):1523-1527.
[20]	廖立斌. 老年糖尿病足溃疡患者营养状况调查及其影响因素分析[J]. 中医临床研究, 2019, 11(27):56-57.
	Liao LB. Nutritional status of elderly diabetic foot ulcer patients and analysis of influencing factors[J]. Clin J Chin Med, 2019, 11(27):56-57.
[21]	龚雪梅, 苏飞. 老年糖尿病足溃疡的营养状况及影响因素分析[J]. 中国乡村医药, 2018, 25(12):15-16.
	Gong XM, Su F. Nutritional status and influencing factors of diabetic foot ulcer in the elderly[J]. Chin J Rural Med Pharm, 2018, 25(12):15-16.
[22]	符秀梅, 龙登毅, 王素萍, 等. 海南省老年糖尿病足溃疡患者的营养状况[J]. 中国老年学杂志, 2017, 37(17):4385-4386.
	Fu XM, Long DY, Wang SP, et al. Nutritional status of elderly patients with diabetic foot ulcer in Hainan Province[J]. Chin J Gerontol, 2017, 37(17):4385-4386.
[23]	吕丽雪, 黄丽容, 劳美铃, 等. 老年糖尿病足溃疡患者营养状况调查及其影响因素分析[J]. 中华护理杂志, 2017, 52(3):332-335.
	Lü LX, Huang LR, Lao ML, et al. Nutritional status and its influencing factors in elderly patients with diabetic foot ulcers[J]. Chin J Nurs, 2017, 52(3):332-335.
[24]	Ali Shaikh DI, Masood DN, Aijaz Shaikh DF, et al. Diabetic foot ulcers; correlation of nutritional status of type 2 diabetic patients of Hyderabad Sindh Pakistan[J]. Prof Med J, 2017, 24(5):707-712.
[25]	Gau BR, Chen HY, Hung SY, et al. The impact of nutritional status on treatment outcomes of patients with limb-threatening diabetic foot ulcers[J]. J Diabetes Complicat, 2016, 30(1):138-142.
[26]	董源源, 张春玲, 史青, 等. 老年糖尿病足溃疡住院患者营养现状调查及因素分析研究[J]. 糖尿病新世界, 2023, 26(19):179-183.
	Dong YY, Zhang CL, Shi Q, et al. Survey on the current nutritional status of elderly hospitalized patients with diabetic foot ulcers and factor analysis study[J]. Diabetes New World, 2023, 26(19):179-183.
[27]	黎文明, 黎佩君, 张敏, 等. 营养风险筛查应用于糖尿病足溃疡患者营养评估的效果及价值[J]. 糖尿病新世界, 2020, 23(12):186-188.
	Li WM, Li PJ, Zhang M, et al. Effect and value of Nutrition Risk Screening applied to nutritional assessment of Patients with diabetic foot ulcer[J]. Diabetes New World, 2020, 23(12):186-188.
[28]	Skórka M, Bazaliński D, Wi ch P, et al. Nutritional status in a group of patients with wounds due to diabetic foot disease and chronic venous insufficiency[J]. J Clin Med, 2024, 14(1):43.
[29]	吴文霞, 陈桂珊, 刘兴州, 等. 基线老年营养风险指数对糖尿病足合并下肢动脉病变患者血管腔内治疗后临床结局的影响研究[J]. 中国全科医学, 2022, 25(36):4496-4501,4508. DOI
	Wu WX, Chen GS, Liu XZ, et al. Association of baseline geriatric nutritional risk index and clinical outcome of endovascular therapy in patients with diabetic foot and lower extremity arterial disease[J]. Chin Gen Pract, 2022, 25(36):4496-4501,4508.
[30]	蔡开秀, 张艳琳, 唐小庆, 等. 2型糖尿病足溃疡合并营养不良患者血清Tol样受体9、糖化血红蛋白、25羟维生素D检测的临床意义[J]. 现代生物医学进展, 2020, 20(24):4656-4659, 4650.
	Cai KX, Zhang YL, Tang XQ, et al. Clinical significance of serum tol receptor 9,glycosylated hemoglobin and 25 hydro-xyvitamin D in patients with type 2 diabetic foot ulcer com-plicated with malnutrition[J]. Prog Mod Biomed, 2020, 20(24):4656-4659,4650.
[31]	Mineoka Y, Ishii M, Hashimoto Y, et al. Nutritional status as-sessed with objective data assessment correlates with a high-risk foot in patients with type 2 diabetes[J]. J Clin Med, 2022, 11(5):1314.
[32]	Zhang SS, Tang ZY, Fang P, et al. Nutritional status deterio-rates as the severity of diabetic foot ulcers increases and in-dependently associates with prognosis[J]. Exp Ther Med, 2013, 5(1):215-222.
[33]	周蓉, 周雁琼. 老年人认知衰弱与营养不良相关性及营养干预的研究进展[J]. 当代护士(中旬刊), 2022, 29(8):5-8.
	Zhou R, Zhou YQ. Research progress on the correlation between cognitive decline and malnutrition in the elderly and nutritional intervention[J]. Mod Nurse, 2022, 29(8):5-8.
[34]	路云丽, 孙萍. 全球领导人共识营养不良诊断标准在临床实践中的实施方法与应用[J]. 安徽医药, 2023, 27(5):1030-1036.
	Lu YL, Sun P. Implementation method and application of the GLIM criteria for diagnosis of malnutrition in clinical prac-tice[J]. Anhui Med Pharm J, 2023, 27(5):1030-1036.
[35]	王楠. 2型糖尿病住院患者营养状况分析及影响因素[J]. 河南医学研究, 2023, 32(14):2538-2541.
	Wang N. Nutritional status and influencing factors in hospi-talized patients with type 2 diabetes mellitus[J]. Henan Med Res, 2023, 32(14):2538-2541.
[36]	祝红娟, 王倩, 王淑君, 等. 老年糖尿病足小截肢患者生活质量影响因素的混合研究[J]. 中华护理杂志, 2025, 60(1):83-89. DOI
	Zhu HJ, Wang Q, Wang SJ, et al. A mixed study of factors influencing quality of life in elderly patients with minor amputations of the diabetic foot[J]. Chin J Nurs, 2025, 60(1):83-89.
[37]	谢晓冉, 徐蓉, 张静, 等. 糖尿病足风险预测模型的构建与验证[J]. 护理学杂志, 2022, 37(11):9-14.
	Xie XR, Xu R, Zhang J, et al. Development and validation of a risk prediction model for diabetic foot[J]. J Nurs Sci, 2022, 37(11):9-14.
[38]	陈艳, 王萍. 糖化血红蛋白水平对老年糖尿病肾病患者营养状况的影响[J]. 中国食物与营养, 2023, 29(1):81-83,88.
	Chen Y, Wang P. Effect of glycated hemoglobin levels on nutritional status of elderly patients with diabetic nephropa-thy[J]. Food Nutr China, 2023, 29(1):81-83,88.
[39]	朱婧怡, 陈曦, 朱彦媛, 等. 糖尿病足感染风险预测模型的系统评价[J]. 中华护理杂志, 2024, 59(19):2346-2352. DOI
	Zhu JY, Chen X, Zhu YY, et al. A systematic review of risk prediction models for diabetic foot infections[J]. Chin J Nurs, 2024, 59(19):2346-2352. DOI