糖尿病病人足底压力峰值与糖尿病足底压力性溃疡发生的相关性研究

谢翠华，张　倩，符霞军，蒋　娅，何飞英，罗祥蓉，方素真



糖尿病病人足底压力峰值与糖尿病足底压力性溃疡发生的相关性研究

谢翠华，张倩，符霞军，蒋娅，何飞英，罗祥蓉，方素真

摘要：[目的]探讨异常足底压力峰值(PPP)分布的特点与糖尿病足底压力性溃疡发生的相关性，分析糖尿病足底压力性溃疡发生的风险因素，为预防糖尿病足提供依据。[方法]选取广州市2013年5月—2014年9月在广州市某三级甲等医院就诊的453例糖尿病病人，采用改进的神经残疾评分(MNDS)评估病人是否合并周围神经病变，根据发生糖尿病足压力性溃疡情况将病人分为3组，正常组(DC组)211例、神经病变组(DN组)165例、糖尿病压力性溃疡组(DU组)77例。采用比利时RS-SCAN公司生产的Footscan 1 m板进行足底压力测定，结合足底压力分析仪将足部分为足跟内侧(HM)、足跟外侧(HL)、足中部(MF)、第1趾(T1)、第2趾～第5趾(T2~T5)及第1跖骨～第5跖骨(M1～M5)共10个解剖区域。[结果]与DC组比较，DN组及DU组病人年龄、病程、吸烟、MNDS得分、餐后2 h血糖(2 h-PBG)、尿微量白蛋白/肌酐比值 (UALBU/Ucr)、血肌酐(Scr)及血尿素氮(BUN)比较差异有统计学意义(P<0.05)。DN组及DU组HM、HL、T1及M1~M4区域的PPP异常升高(P<0.05)。Logistic回归分析显示，病人发生糖尿病足底压力性溃疡的风险与病程、足部畸形、吸烟、合并周围神经病变、2 h~PBG、T1、M2、M3的PPP有关(P<0.05)。[结论]合并神经病变或者患有溃疡的糖尿病病人在前足及足跟均具有较高PPP，应给予针对性的干预。

关键词：足底压力峰值；糖尿病足溃疡；糖尿病；影响因素

Study on correlation between peak plantar pressure and diabetic plantar pressure ulcer in diabetes mellitus

Xie Cuihua,Zhang Qian,Fu Xiajun,et al

(South Hospital of Southern Medical University,Guangdong 510515 China)

AbstractObjective:To probe into correlation between abnormal peak plantar pressure (PPP) and diabetic plantar pressure ulcer,to analyze the risk factors of diabetic plantar pressure ulcer,in order to provide the evidences for the prevention of diabetes foot.Methods:A total of 453 diabetic patients were selected in a third grade A hospital in Guangzhou from May 2013 to September 2014,they were evaluated on peripheral neuropathy by using Modified neurological disability core(MNDS) ,and the patients were divided into 3 groups,211 cases in normal group (group DC),165 cases in neuropathy group (group DN) and 77 cases in diabetic pressure ulcer group (group DU);foots plantar pressure was measured based on footscan1m board produced by Belgian RS-SCAN company combined with plantar pressure analyzer,and the foot included heel medial (HM),heel lateral (HL),foot middle (MF),the first toe (T1),second toe to the fifth toe (T2~T5) and the first metatarsal bone to the fifth metatarsal (M1to M5) a total of 10 anatomical regions.based .Results:There was statistically significant difference in age,course of disease,smoking,MNDs score,2 h postprandial blood glucose (2 h-PBG) ,urine micro albumin /urine creatinine (UALBU/Ucr )，blood creatinine (SCR) and blood urea nitrogen (BUN) in DC group and DU group compared with DN group (P<0.05).The PPP in HM,HL,T1and M1~M4was abnormally increased in DN and DU group.Logistic regression analysis showed that the risk of the occurred diabetes foot pressure ulcer in patients showed significant positive correlation with duration,foot deformity,smoking，peripheral neuropathy,2 h-PBG,PPP of T1,M2,M3(P<0.05).Conclusion: Diabetic patients with neuropathy or ulcers had higher PPP level in the forefoot and heel which should be given targeted intervention.

Key wordsplantar pressure peak;diabetic foot ulcer;diabetes mellitus;risk factor

糖尿病足是糖尿病病人的主要慢性并发症之一，病人一旦发生足部溃疡，不仅延长住院时间，还给社会及家庭带来严重的经济负担，糖尿病足重在预防。目前，在糖尿病足检查及治疗中，足部生物力学评估是一项极其重要的因素。国外研究发现，足底压力是预测病人是否发生足底溃疡的重要指标[1]。因此，在临床工作中，发现糖尿病足底压力异常区域具有重要意义，根据客观数据进一步探讨足溃疡发生相关危险因素，为病人制作减压鞋垫、制定个性化护理提供指导。……