糖尿病周围神经病变与足型及足底压力的关系

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／m^2；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／m^2。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±21VS36±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）VS4．3％（10／231），X^2=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，t=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。

Relationship between diabetic peripheral neuropathy and foot type or plantar pressure

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.