中国部分省市糖尿病足调查及神经病变分析  

A multicenter survey on the diabetic foot and its neuropathy in China

作　　者：林少达[1] 林楚佳[1] 王爱红[2] 赵湜[3] 严励[4] 王鹏华[5] 杜玉茗[6] 王战建[7] 肖正华[8] 马学毅[9] 陈国昌[10] 周迎生[11] 李强[12] 卞茸文[13] 毛季萍[14] 许樟荣[2] 

机构地区：[1]广东汕头大学医学院第一附属医院内分泌科,515041 [2]中国人民解放军第306医院 [3]武汉市中心医院内分泌科 [4]中山大学第二附属医院内分泌科 [5]天津医科大学代谢病医院足病科 [6]吉林省人民医院内分泌科 [7]河北医科大学第三附属医院内分泌科 [8]广州市第一人民医院内分泌科 [9]中国人民解放军第304医院内分泌科 [10]第二炮兵总医院内分泌科 [11]北京医院内分泌科 [12]哈尔滨医科大学第二附属医院内分泌科 [13]江苏省级机关医院内分泌科 [14]中南大学湘雅二医院内分泌科

出　　处：《中华医学杂志》2007年第18期1241-1244,共4页National Medical Journal of China

摘　　要：目的调查和分析糖尿病足神经病变特点及相关因素。方法对全国14家医院的2004年全年门诊和住院糖尿病足患者进行统一调查,包括病史回顾、体格检查、生化检查等,对足溃疡进行分类、分期、神经病变特点及相关因素分析。结果纳入统计糖尿病足患者530例,神经性溃疡患者337例(63.6%)其中单纯性足部神经性溃疡172例(32.5%),合并下肢血管病变的混合性溃疡165例(31.1%),缺血性足部溃疡193例(36.42%)。足溃疡诱因物理因素占62.4%～84.9%。神经性足溃疡患者病程3(1,60)个月明显短于缺血性足溃疡组5(1,96)个月(P<0.001)。混合性足溃疡患者病程12(1,108)个月长于神经溃疡患者及缺血性溃疡患者(P<0.001)。足部溃疡程度Wagner 分级与糖尿病病程、经济收入、足畸形、膝反射、踝反射、足部音叉振动觉、尼龙丝感觉点、踝肱指数(ABI)、足部动脉搏动、空腹血糖及糖化血红蛋白呈相关关系;显著相关的因素是左胫后 ABI、右足音叉振动觉及经济收入。结论糖尿病足溃疡患者中神经性溃疡较常见,神经性损害预后优于血管性因素糖尿病足;混合性糖尿病足预后较差。周围神经病变中尼龙丝感觉点、足部音叉振动觉和肌腱反射的检查最为简单实用。Objective To investigate the characteristics of diabetic foot with neuropathy and its related factors. Methods 530 out- and in-patients in 14 grade A class 3 comprehensive hospitals in China with foot problems were surveyed. 337 of the 500 patients （63.58%） suffered from neuropathy, 172 （32. 45% ） with diabetic foot with simple neuropathy and 165 （31.13%） with simple neuropathy combined with peripheral artery disease （PAD）. 193 of the 500 patients （36.42%） suffered from peripheral artery disease （PAD）. 77.7% of ulcer were caused by physical factors. Questionnaire survey was conducted to collect the demographic data, present and past history, history of the hyperglycemia and lipid disorders, classification and phases of the foot ulcers based on Wagner＂ system and Texas system, characteristics of neuropathy and other diabetic complications, and relative risk factors. Detailed physical examination was performed, including 10 g nylon filament sensation examination. Results The duration of diabetic foot of the patients with simple neuropathy was 3 （1,60） months, significantly shorter than that of the diabetic foot patients with PAD [5 （ 1,96） months, P 〈0. 001 ]. The Wagner degree of ulcer was related to the duration of diabetes, economic income, foot deformity, nerve reflection, diapason vibration sensation of foot, sensation point of 10 g nylon filament, ankle/brachial index （ABI）, foot artery pulse, fasting blood sugar （FBS） and glycated hemoglobin （HbAlc）. Stepwise regression analysis revealed that ABI of left posterior tibial artery, vibration detection threshold and economic income were the most significant influencing factors of the degree of ulcer. Conclusion Neuropathy ulcer is common in diabetic foot patients. The prognosis of healing in diabetic foot with neuropathy is prior to that of diabetic foot with PAD. The neuropathy and PAD of foot influence each other and aggravate the condition of diabetic foot. The examinations of diapason vibration sensation of foo

关 键 词：糖尿病足 糖尿病神经病变 糖尿病血管病 流行病学 

分 类 号：R587.2[医药卫生—内分泌]