分析导致糖尿病足溃疡(DFU)患者再截肢的危险因素，旨在为优化该病的临床诊断和治疗提供帮助。

回顾性分析2018年1月至2021年12月在新疆维吾尔自治区人民医院因DFU截肢的510例患者病例资料。根据住院期间接受手术治疗方案不同(单次截肢与1次以上截肢)分为单次截肢组(n＝411)和再截肢组(n＝99)。统计2组患者入院人口学基线特征(性别、吸烟史、饮酒史、高血压病史、心脏病病史、下肢血管介入手术史、Wagner分级、年龄、糖尿病病程、体重指数)及实验室检验(血常规：白细胞、中性粒细胞百分比、血红蛋白、血小板计数；炎症指标：C反应蛋白、超敏C反应蛋白、降钙素原；凝血功能指标：凝血酶原时间、凝血酶时间、凝血酶原时间活动度、活化部分凝血活酶时间、纤维蛋白原、D-二聚体；肝功能指标：白蛋白、球蛋白、总胆红素、γ谷氨酰基转移酶、谷草转氨酶、谷丙转氨酶、胆碱酯酶；肾功能指标：尿素氮、肌酐、肾小球滤过率、尿酸；化学成分：钾离子、钠离子、镁离子、氯离子、钙离子、无机磷；心肌酶及蛋白：α-羟丁酸脱氢酶、乳酸脱氢酶、肌红蛋白、肌酸激酶同工酶、胱抑素、肌钙蛋白T、肌钙蛋白I；血脂指标：高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、总胆固醇、甘油三酯；其他生化指标：糖化血红蛋白、腺苷脱氢酶、乳酸)及检查[下肢动脉粥样硬化性疾病(LEAD)、细菌学培养)]结果。数据行Mann-Whitney U检验、χ²检验及二元Logistic多因素分析。

2组患者在饮酒史、Wagner分级、C反应蛋白、超敏C反应蛋白、凝血酶原时间、活化部分凝血活酶时间、胆碱酯酶、肌酐、肌红蛋白、总胆固醇、LEAD病史、金黄色葡萄球菌感染之间比较，差异均有统计学意义(P＝0.035、0.015、0.016、0.002、0.001、0.042、0.007、0.015、0.047、0.048、0.027、0.049)。二元Logistic多因素分析显示，饮酒史(OR＝2.343，95%CI: 1.218~4.507，P＝0.011)、Wagner 4~5级(OR＝3.267，95%CI: 1.008~10.589，P＝0.042)、凝血酶原时间(OR＝1.189，95%CI: 1.073~1.317，P＝0.001)、总胆固醇(OR＝1.276，95%CI: 1.023~1.592，P＝0.031)、LEAD病史(OR＝2.036，95%CI: 1.160~3.573，P＝0.013)、金黄色葡萄球菌感染(OR＝1.785，95%CI: 1.009~3.159，P＝0.047)是糖尿病足再截肢的独立危险因素。

饮酒史、Wagner 4~5级、凝血酶原时间升高、总胆固醇升高、LEAD病史和金黄色葡萄球菌感染是DFU再截肢的危险因素，揭示了DFU再截肢患者的临床特征，为临床正确识别再截肢高风险患者提供决策指导；为DFU截肢的一级预防提供临床依据；为优化该病的临床诊断和治疗提供帮助。

To explore the risk factors of re-amputation in patients with diabetic foot ulcers (DFU) with the aim of providing assistance in optimizing the clinical diagnosis and treatment of this disease.

The case data of 510 patients with amputation due to DFU in the People′s Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2021 were retrospectively analyzed. The patients were divided into single amputation group (n=411) and re-amputation group (n=99) according to the different surgical treatment options received during hospitalization (single amputation and more than one amputation). Baseline demographic characteristics(gender, history of smoking, history of alcohol consumption, history of hypertension, history of heart disease, history of lower extremity vascular interventions, Wagner classification, age, duration of diabetes, body mass index) and laboratory tests(routine blood indicators: white blood cells, neutrophil percentage, hemoglobin, platelet count; inflammatory indicators: C reactive protein, high-sensitivity C-reactive protein, procalcitonin; coagulation function indicators: prothrombin time, thrombin time, prothrombin time activity, activated partial thromboplastin time, fibrinogen, D-dimer.; liver function indicators: albumin, globulin, total bilirubin, gamma glutamyl transferase, glutamic oxaloacetic transaminase, glutamic alanine transaminase, cholinesterase; renal function indicators: urea nitrogen, creatinine, glomerular filtration rate, uric acid; chemical composition: potassium ions, sodium ions, magnesium ions, chloride ions, calcium ions, inorganic phosphorus; cardiac enzymes and proteins: alpha-hydroxybutyrate dehydrogenase, lactate dehydrogenase, myoglobin, creatine kinase isoenzyme, cystatin, troponin T, troponin I; blood lipid indicators: high density lipoprotein cholesterol, low density lipoprotein cholesterol, total cholesterol, triglycerides; other biochemical indicators: glycosylated hemoglobin, adenosine dehydrogenase, lactate and examination [lower extremity atherosclerotic disease (LEAD), bacteriological culture]. Data were processed with Mann-Whitney U test, chi-square test, and finally binary Logistic multivariate analysis.

The two groups were compared in alcohol consumption history, Wagner classification, C reactive protein, ultrasensitive C-reactive protein, prothrombin time, activated partial thromboplastin time, cholinesterase, creatinine, myoglobin, total cholesterol, LEAD history, and Staphylococcus aureus infection, the differences were statistically significant (P=0.035, 0.015, 0.016, 0.002, 0.001, 0.042, 0.007, 0.015, 0.047, 0.048, 0.027, 0.049). Binary Logistic multivariate analysis showed that history of alcohol consumption (OR=2.343, 95%CI: 1.218-4.507, P=0.011), Wagner class 4-5 (OR=3.267, 95%CI: 1.008-10.589, P=0.042), prothrombin time (OR=1.189, 95%CI: 1.073 -1.317, P=0.001), total cholesterol (OR=1.276, 95%CI: 1.023-1.592, P=0.031), LEAD history (OR=2.036, 95%CI: 1.160-3.573, P=0.013), Staphylococcus aureus infection (OR=1.785, 95%CI: 1.009- 3.159, P=0.047) were independent risk factors for diabetic foot re-amputation.

This study finally identifies history of alcohol consumption, Wagner classification 4-5, elevated prothrombin time, elevated total cholesterol, LEAD history and Staphylococcus aureus infection as risk factors for re-amputation in DFU, revealing the clinical characteristics of patients with re-amputation in DFU, providing clinical guidance for decision making to correctly identify patients at high risk of re-amputation; providing a clinical basis for primary prevention of DFU amputation; and helping to optimize the clinical diagnosis and treatment of this disease.