Diabetic foot ulcer (DFU) is a serious diabetic complication with a high recurrence rate after healing. There is a lack of systematic evidence-based studies on multiple risk factors associated with its recurrence.

To investigate the risk factors for DFU recurrence after healing, providing evidence to inform the prevention and treatment of DFU.

A case-control study design was used. Patients with an initial inpatient diagnosis of DFU were selected from Hospital of Chengdu University of TCM from January 1, 2016 to February 1, 2019 as the source population, among whom those with and without a recurrence within three years after healing were assigned to case and control groups, respectively. Baseline characteristics, information related to diabetes and DFU were collected from both groups. Risk factors for DFU recurrence were screened by unconditional multivariate Logistic regression analysis. The relationships of DFU recurrence with the number of risk factors and the time to recurrence were further analyzed.

Among the source population (n=256), 210 had healed DFU, and 190 of them were included for final analysis after excluding 12 missing cases and 8 with incomplete information. The overall recurrence rate within three years after DFU healing was 45.3% (86/190). Multivariate Logistic regression analysis showed that age >60 years〔OR=3.270, 95%CI (1.335, 8.005), P=0.010〕, HbA_1c >7.5%〔OR=2.691, 95%CI (1.242, 7.687), P=0.045〕, peripheral arterial disease (PAD) 〔OR=2.241, 95%CI (1.185, 5.101), P=0.044〕, osteomyelitis〔OR=3.256, 95%CI (1.369, 7.744), P=0.008〕, callus〔OR=2.068, 95%CI (1.262, 4.446), P=0.043〕, ankle-brachial index (ABI) <0.9〔OR=3.616, 95%CI (1.436, 9.102), P=0.006〕, plantar ulcers〔OR=2.192, 95%CI (1.061, 4.998), P=0.042〕, and Wagner grade ≥3〔OR=5.522, 95%CI (2.484, 12.273), P<0.001〕 were risk factors for DFU recurrence. The number of comorbid risk factors mainly ranged from 5 to 9 in the case group (n=86), and 2 to 5 in the control group (n=104). The number of recurrent cases within one, two and three years in the case group was 35, 28 and 23, respectively. The one-, two- and three-year cumulative recurrence rates were 18.4% (35/190), 33.2% (63/190), and 45.3% (86/190), respectively.

The high recurrence rate of DFU may be associated with risk factors such as age >60 years, HbA_1c >7.5%, PAD, osteomyelitis, callus, ABI <0.9, plantar ulcers, and Wagner grade ≥3.

糖尿病足溃疡（DFU）是严重的糖尿病并发症，其愈合后有较高的复发率，而复发的危险因素较多，尚缺乏系统的循证研究。

探讨DFU愈合后复发的危险因素，为DFU的防治提供更多依据。

采用病例对照研究方法，回顾性选取2016-01-01至2019-02-01于成都中医药大学附属医院住院并首次诊断为DFU的患者作为源人群，按愈合后3年内是否复发分为病例组和对照组，收集两组患者基本信息、糖尿病相关信息、DFU相关信息，以非条件多因素Logistic回归分析方法筛选DFU复发的危险因素，并进一步分析了DFU复发与危险因素数量和时间的关系。

首次诊断为DFU的患者共256例，其中溃疡愈合210例，剔除12例失访、8例资料不全者，最终纳入190例DFU愈合患者。DFU愈合后3年内总复发率为45.3%（86/190）。86例DFU愈合后复发患者纳入病例组，104例未复发患者纳入对照组。多因素Logistic回归分析显示，年龄>60岁〔OR=3.270，95%CI（1.335，8.005），P=0.010〕、糖化血红蛋白（HbA_1c）>7.5%〔OR=2.691，95%CI（1.242，7.687），P=0.045〕、外周动脉基本（PAD）〔OR=2.241，95%CI（1.185，5.101），P=0.044〕、骨髓炎〔OR=3.256，95%CI（1.369，7.744），P=0.008〕、胼胝〔OR=2.068，95%CI（1.262，4.446），P=0.043〕、踝肱指数（ABI）<0.9〔OR=3.616，95%CI（1.436，9.102），P=0.006〕、足底部溃疡〔OR=2.192，95%CI（1.061，4.998），P=0.042〕、Wagner分级≥3级〔OR=5.522，95%CI（2.484，12.273），P<0.001〕是DFU复发的危险因素。病例组患者合并危险因素的个数集中在5~9个，而对照组中大部分患者合并2~5个危险因素。病例组第1年复发35例、第2年28例、第3年23例，累积复发率第1年18.4%（35/190）、第2年33.2%（63/190）、第3年45.3%（86/190）。

DFU的复发率较高，可能与年龄>60岁、HbA_1c>7.5%、PAD、骨髓炎、胼胝、ABI<0.9、足底部溃疡、Wagner分级≥3级等危险因素有关。