| Diabetic foot（DF）is one of the most serious complications of diabetes,which can lead to amputation and death.The aim of this study is to investigate the nutritional status of vitamin D in inpatients with diabetes in our hospital and to analyze the correlation between DF and serum hydroxyvitamin D[25（OH）D],so as to provide clues for clinical treatment and prevention of DF.The 429 DM patients who are hospitalized in the Endocrinology Department of the Air Force Special Medical Center from January 2019 to October 2021 are selected according to the inclusion and exclusion criteria.The patients are divided into DF group（n=242）and NDF（Non-diabetic foot）group（n=187）according to whether they are diabetic foot or not.General clinical data of patients were collected through the medical record system:gender,age,body mass index,smoking history,alcohol consumption history,hypertension history,coronary heart disease history,diabetes course,DF location and grade,admission season.Laboratory data were collected,including fasting blood glucose,total cholesterol,triglycerides,HDL cholesterol,LDL cholesterol,alanine aminotransferase,aspartate aminotransferase,and serum uric acid.Serum levels of 25（OH）D were measured by electrochemiluminescence immunoassay（Roche E25 analyzer）.The patients with DF were followed up and the healing time was recorded.The 25（OH）D levels in DF group and NDF group were compared,and the correlation between 25（OH）D and DF was analyzed.In this study,there were 429 DM patients and 349 patients with vitamin D deficiency,with a prevalence of 81.35%.There were 139 cases（74.33%）with vitamin D deficiency in NDF group and 210 cases（86.78%）with vitamin D deficiency in DF group.The proportion of patients with vitamin D deficiency in DF group was significantly higher than that in NDF group（P<0.05）.The age,DM course,male percentage,creatinine and white blood cells in DF group were higher than those in non-DF group.Diastolic blood pressure,total cholesterol,triglyceride,high density lipoprotein cholesterol,low density lipoprotein cholesterol,alanine aminotransferase,aspartate aminotransferase,albumin,hemoglobin,erythrocyte volume and 25（OH）D levels in DF group were lower than those in NDF group,and the differences were statistically significant（P<0.05）.Among 242 patients with diabetic foot,ulcers occurred on the toes（124 cases,51.23%）,sole（72 cases,29.75%）,heel（18 cases,7.44%）,dorsum of foot（16 cases,6.61%）,and ankle（12 cases,4.96%）.Logistic regression analysis showed that leukocyte count and diabetes course were significant risk factors for DF,and serum 25（OH）D,albumin,triglyceride and high density lipoprotein cholesterol were protective factors for DF in DM patients（P<0.05）.Spearman correlation analysis further showed that 25（OH）D level was negatively correlated with DF（p=0.000,r=-0.217）.With the increase of Wagner grading,the 25（OH）D level showed a gradual downward trend（p=0.004）.Multiple comparisons showed that the 25（OH）D level in Wagner1 and 2 patients was significantly higher than that in Wagner4 patients（p<0.05）.The level of vitamin D in amputation group 27.86（24.37,31.37）nmol·L-1 was significantly lower than that in non-amputation group35.0（32.04,37.96）nmol·L-1.The level of vitamin D in healing group 30.21（21.29,43.68）nmol·L-1 was significantly higher than that in non-healing group at 25.01（17.80,34.56）nmol·L-1（p<0.05）.81.35%of DM patients had vitamin D deficiency（<50nmol·L-1）,and the proportion of vitamin D deficiency in DF group（86.78%）was significantly higher than that in NDF group（74.33%）.DF was closely correlated with25（OH）D,and 25（OH）D was an independent protective factor for DFU.With the increase of Wagner grading,25（OH）D level decreased.The level of vitamin D in the healing group was higher than that in the non-healing group,and the level of vitamin D in the non-amputation group was higher than that in the amputation group.Vitamin D screening is essential for diabetic foot prevention. |
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