CAJ | 학술논문

目的分析糖尿病周围神经病变与糖尿病患者足型及静态足底压力的关系.方法 2007年8月20日至2008年10月14日从华西医院内分泌科门诊及住院患者中整群抽取540例糖尿病患者(糖尿病组),其中男227例,女313例,平均年龄(59±12)岁,体质指数(24±4)kg/m2;另从成都市武侯区纳入年龄、性别、体质指数匹配的健康者231名(健康对照组),其中男84名,女147名,平均年龄(64±11)岁,体质指数(23±4) kg/m2.由专人使用密西根神经病变筛查量表(MNSI量表)对糖尿病组患者进行周围神经病变评估.使用足底图像扫描仪及足底压力测量仪测定研究对象足型、足底各部位静态相对压力峰值.采用t检验或卡方检验进行数据统计.结果 2组参试者足底静态平均压力峰值(36±21 vs 36±22,t=-0.544,P=0.587)及足底各部位静态压力峰值无明显差异.糖尿病患者据MNSI评分分成A组(MNSI评分0～4分)、B组(MNSI评分4.5 ～6.5分)、C组(MNSI评分7分以上),3组人群体质量及体质指数与健康对照组无差异.3组人群静态足底平均压力峰值与健康对照组比较无明显差异(A组为36±20,B组为35±20,C组为35±20,健康对照组为36±22).各组足底各部位静态相对压力峰值与健康对照组比较差异亦无统计学意义(均P＞0.05).糖尿病组锤状趾的发生率明显高于健康对照组[8.7％ (47/540)vs 4.3％( 10/231),x2=3.966,P=0.029].糖尿病组锤状趾和扁平足患者MNSI评分[(6.2±2.0)分vs(5.4±1.2)分,=2.145,P=0.032;(6.6±2.1)分vs(5.4±1.2)分,t=2.339,P=0.02]高于糖尿病患者.结论 MNSI评分不能预测糖尿病患者足底静态压力的变化;糖尿病周围神经病变是足部畸形发生的危险因素;伴足底压力升高或足部畸形的糖尿病周围神经病变患者是糖尿病足的高危人群.
목적 분석당뇨병주위신경병변여당뇨병환자족형급정태족저압력적관계.방법 2007년8월20일지2008년10월14일종화서의원내분비과문진급주원환자중정군추취540례당뇨병환자(당뇨병조),기중남227례,녀313례,평균년령(59±12)세,체질지수(24±4)kg/m2;령종성도시무후구납입년령、성별、체질지수필배적건강자231명(건강대조조),기중남84명,녀147명,평균년령(64±11)세,체질지수(23±4) kg/m2.유전인사용밀서근신경병변사사량표(MNSI량표)대당뇨병조환자진행주위신경병변평고.사용족저도상소묘의급족저압력측량의측정연구대상족형、족저각부위정태상대압력봉치.채용t검험혹잡방검험진행수거통계.결과 2조삼시자족저정태평균압력봉치(36±21 vs 36±22,t=-0.544,P=0.587)급족저각부위정태압력봉치무명현차이.당뇨병환자거MNSI평분분성A조(MNSI평분0～4분)、B조(MNSI평분4.5 ～6.5분)、C조(MNSI평분7분이상),3조인군체질량급체질지수여건강대조조무차이.3조인군정태족저평균압력봉치여건강대조조비교무명현차이(A조위36±20,B조위35±20,C조위35±20,건강대조조위36±22).각조족저각부위정태상대압력봉치여건강대조조비교차이역무통계학의의(균P＞0.05).당뇨병조추상지적발생솔명현고우건강대조조[8.7％ (47/540)vs 4.3％( 10/231),x2=3.966,P=0.029].당뇨병조추상지화편평족환자MNSI평분[(6.2±2.0)분vs(5.4±1.2)분,=2.145,P=0.032;(6.6±2.1)분vs(5.4±1.2)분,t=2.339,P=0.02]고우당뇨병환자.결론 MNSI평분불능예측당뇨병환자족저정태압력적변화;당뇨병주위신경병변시족부기형발생적위험인소;반족저압력승고혹족부기형적당뇨병주위신경병변환자시당뇨병족적고위인군.
Objective To investigate the relation of plantar pressure or foot type with diabetic peripheral neuropathy.Methods A total of 540 diabetic inpatients and outpatients ( DM group,male 227,female 313,average age (59 ± 12) years old,body mass index (BMI) (24 ±4) kg/m2) from Endocrinology Department of West China Hospital were enrolled with cluster sampling and examined by using Michigan Neuropathy Screening Instrument ( MNSI ).Matched healthy subjects ( control group,male 84,female 147,average age (64 ± 11 ) years old,BMI (23 ±4) kg/m2) were also enrolled in this study.All of the subjects were measured for foot type and relative peak plantar pressure in static state by plantar image scanner and plantar pressure measurement instrument.Chi-square test or t test was used for data analysis.Result There was no difference in mean relative peak plantar pressure (36 ±21 vs 36 ±22,t =-0.544,P =0.587 ) and relative peak plantar pressure of every site in static state between the two groups ( P ＞0.05 ).Body weight and BM1 were matched among three diabetic groups (the MNSI scores of group A were below 4; the MNSI scores of group B were between 4.5 and 6.5 ; the MNSI scores of group C were above 7)and the normal group.Compared to the control group,there was no difference in the relative average peak plantar pressure and relative peak plantar pressure of every site in static state ( P ＞ 0.05 ).In the diabetic group,the incidence of hammer toes was twice as it in the control group (8.7％ (47/540) vs 4.3％ ( 10/231 ) ).The mean MNSI scores of the diabetics with hammer toes (6.2 ±2.0 vs 5.4 ± 1.2,t =2.145,P =0.032) and the diabetics with platypodia ( 6.6 ± 2.1 vs 5.4 ± 1.2,t =2.339,P =0.02 ) were higher,when compared to all of the diabetics.Conclusions MNSI shows little value in predicting plantar pressure;diabetics with hammer toes and platypodia may have higher MNSI scores.Patients who suffer from diabetic peripheral neuropathy and foot deformity or high plantar pressure are at higher risk of developing diabetic foot.