中华糖尿病杂志
中華糖尿病雜誌
중화당뇨병잡지
CHINES JOURNAL OF DLABETES MELLITUS
2011年
4期
291-295
,共5页
糖尿病,2型%周围神经系统疾病%足底压力
糖尿病,2型%週圍神經繫統疾病%足底壓力
당뇨병,2형%주위신경계통질병%족저압력
Diabetes mellitus,type 2%Peripheral nervous system diseases%Plantar pressure
目的 了解2型糖尿病合并周围神经病变患者足底压力变化特点.方法 根据患者有无合并周围神经病变将2004年1月至2009年12月诊治的1103例2型糖尿病患者分为合并周围神经病变组(DPN组,n=301)和无周围神经病变组(DC组,n=802).记录患者一般资料;测定血脂谱、空腹血糖和糖化血红蛋白水平及尿蛋白排泄率;用足底压力测量仪一步法测量两脚各5次动态足底压力,计算足底压力参数值.对研究数据采用独立样本t检验或Mann-Whitney U检验进行统计分析.结果 相比DC组,DPN组患者年龄大、腰臀围比值大、收缩压高、空腹血糖和糖化血红蛋白水平高、尿白蛋白排泄率高(均P＜0.05).两组足底峰值压力差异无统计学意义(P＞0.05);但DPN组接触时间延长[分别为(1484±412)和(1241±281)ms,t=-9.414,P＜0.05],压力-时间积分[分别为(333±115)和(278±89)kPa·s,t=-7.446,P＜0.05]和应力-时间积分[分别为(628±187)和(536±149)N·s,t=-7.707,P＜0.05]增加.与DC组相比,DPN组足跟[分别为(396±101)和(411±105)kPa,t=2.163,P＜0.05]和第2跖骨头[分别为(240±87)和(269±95)kPa,t=4.563,P＜0.05]、第3跖骨头[分别为(241±75)和(262±77)kPa,t=4.046,P＜0.05]峰值压力降低,但足弓[分别为(122±48)和(115±31)kPa,t=-2.487,P＜0.05]和第5跖骨头[分别为(218±116)和(195±99)kPa,t=-3.131,P＜0.05]及第3～5趾区域[分别为(108±50)和(98±46)kPa,t=-3.315,P＜0.01]峰值压力增高.而与DC组相比,DPN组足跟[分别为(228±100)和(189±67)kPa·s,t=-6.201,P＜0.05]、足弓[分别为(82±45)和(66±26)kPa·s,t=-6.151,P＜0.05]及前足底各个区域的压力-时间积分均明显增高.结论糖尿病周围神经病变患者足底压力分布异常、承受压力时间延长;两种因素共同作用致足底压力-时间积分增高,后者可致糖尿病足压力性溃疡.
目的 瞭解2型糖尿病閤併週圍神經病變患者足底壓力變化特點.方法 根據患者有無閤併週圍神經病變將2004年1月至2009年12月診治的1103例2型糖尿病患者分為閤併週圍神經病變組(DPN組,n=301)和無週圍神經病變組(DC組,n=802).記錄患者一般資料;測定血脂譜、空腹血糖和糖化血紅蛋白水平及尿蛋白排洩率;用足底壓力測量儀一步法測量兩腳各5次動態足底壓力,計算足底壓力參數值.對研究數據採用獨立樣本t檢驗或Mann-Whitney U檢驗進行統計分析.結果 相比DC組,DPN組患者年齡大、腰臀圍比值大、收縮壓高、空腹血糖和糖化血紅蛋白水平高、尿白蛋白排洩率高(均P＜0.05).兩組足底峰值壓力差異無統計學意義(P＞0.05);但DPN組接觸時間延長[分彆為(1484±412)和(1241±281)ms,t=-9.414,P＜0.05],壓力-時間積分[分彆為(333±115)和(278±89)kPa·s,t=-7.446,P＜0.05]和應力-時間積分[分彆為(628±187)和(536±149)N·s,t=-7.707,P＜0.05]增加.與DC組相比,DPN組足跟[分彆為(396±101)和(411±105)kPa,t=2.163,P＜0.05]和第2蹠骨頭[分彆為(240±87)和(269±95)kPa,t=4.563,P＜0.05]、第3蹠骨頭[分彆為(241±75)和(262±77)kPa,t=4.046,P＜0.05]峰值壓力降低,但足弓[分彆為(122±48)和(115±31)kPa,t=-2.487,P＜0.05]和第5蹠骨頭[分彆為(218±116)和(195±99)kPa,t=-3.131,P＜0.05]及第3～5趾區域[分彆為(108±50)和(98±46)kPa,t=-3.315,P＜0.01]峰值壓力增高.而與DC組相比,DPN組足跟[分彆為(228±100)和(189±67)kPa·s,t=-6.201,P＜0.05]、足弓[分彆為(82±45)和(66±26)kPa·s,t=-6.151,P＜0.05]及前足底各箇區域的壓力-時間積分均明顯增高.結論糖尿病週圍神經病變患者足底壓力分佈異常、承受壓力時間延長;兩種因素共同作用緻足底壓力-時間積分增高,後者可緻糖尿病足壓力性潰瘍.
목적 료해2형당뇨병합병주위신경병변환자족저압력변화특점.방법 근거환자유무합병주위신경병변장2004년1월지2009년12월진치적1103례2형당뇨병환자분위합병주위신경병변조(DPN조,n=301)화무주위신경병변조(DC조,n=802).기록환자일반자료;측정혈지보、공복혈당화당화혈홍단백수평급뇨단백배설솔;용족저압력측량의일보법측량량각각5차동태족저압력,계산족저압력삼수치.대연구수거채용독립양본t검험혹Mann-Whitney U검험진행통계분석.결과 상비DC조,DPN조환자년령대、요둔위비치대、수축압고、공복혈당화당화혈홍단백수평고、뇨백단백배설솔고(균P＜0.05).량조족저봉치압력차이무통계학의의(P＞0.05);단DPN조접촉시간연장[분별위(1484±412)화(1241±281)ms,t=-9.414,P＜0.05],압력-시간적분[분별위(333±115)화(278±89)kPa·s,t=-7.446,P＜0.05]화응력-시간적분[분별위(628±187)화(536±149)N·s,t=-7.707,P＜0.05]증가.여DC조상비,DPN조족근[분별위(396±101)화(411±105)kPa,t=2.163,P＜0.05]화제2척골두[분별위(240±87)화(269±95)kPa,t=4.563,P＜0.05]、제3척골두[분별위(241±75)화(262±77)kPa,t=4.046,P＜0.05]봉치압력강저,단족궁[분별위(122±48)화(115±31)kPa,t=-2.487,P＜0.05]화제5척골두[분별위(218±116)화(195±99)kPa,t=-3.131,P＜0.05]급제3～5지구역[분별위(108±50)화(98±46)kPa,t=-3.315,P＜0.01]봉치압력증고.이여DC조상비,DPN조족근[분별위(228±100)화(189±67)kPa·s,t=-6.201,P＜0.05]、족궁[분별위(82±45)화(66±26)kPa·s,t=-6.151,P＜0.05]급전족저각개구역적압력-시간적분균명현증고.결론당뇨병주위신경병변환자족저압력분포이상、승수압력시간연장;량충인소공동작용치족저압력-시간적분증고,후자가치당뇨병족압력성궤양.
Objective To investigate the plantar pressure distribution changes in type 2 diabetic patients with peripheral neuropathy.Methods From January 2004 to December 2009, a total of 1103 patients with type 2 diabetes were enrolled and divided into diabetic peripheral neuropathy (DPN) group ( n= 301 ) or diabetic control (DC group, without DPN) group (n = 802).Demographic characteristics were recorded.The lipid profile, fasting plasma glucose (FPG), hemoglobin Alc (HbAlc) and urinary albumin excretion rate (AER) were measured.Plantar pressure was recorded with the EMED-AT system by the "First Step Approach", and the parameters were calculated by EMED software.Independent t-test or Mann-Whitney U test was applied in the data analysis.Results The patients in the DPN group had statistically higher age, waist-to-hip ratio, systolic blood pressure, FPG, HbAlc and urinary AER as compared with those in DC group ( all P ＜ 0.05 ).There was no significant differences in the plantar peak pressure (PP)between the two groups (P ＞ 0.05).However, the contact time (CT) ( ( 1484 ± 412) vs ( 1241 ± 281 ) ms,increased significantly in DPN group in comparison with those in DC group.Compared to DC group, the peak pressure in heel (rear foot) ( (396 ± 101 ) vs (411 ± 105) kPa, t =2.163, P ＜0.05), the second metatarsal ((240±87) vs (269 ±95) kPa, t =4.563, P ＜0.05)or third metatarsal ((241 ±75) vs (262 ± 77) kPa, t = 4.046, P ＜ 0.05 ) decreased, while the peak pressure in foot arch (midfoot) ( ( 122 ±48 ) vs ( 115 ± 31 ) kPa, t = - 2.487, P ＜ 0.05 ), the fifth metatarsal ( ( 218 ± 116 ) vs ( 195 ± 99 ) kPa,t = - 3.131, P ＜ 0.05 ), and the third-to-fifth toes ( ( 108 ± 50) vs (98 ± 46) kPa, t = - 3.315, P ＜forefoot plantar were higher in DNP group than those in DC group.Conclusions DNP patient has an abnormal plantar pressure distribution and a longer contact time.Increasing of PTIs, induced by a synergistic effect of both plantar pressure and contact time, may play a key role in the development of diabetic foot ulcer.
