糖尿病周围神经病变患者足底压力变化

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.

Plantar pressure distribution changes in patients with diabetic peripheral neuropathy

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.