糖尿病足溃疡的性质及好发部位分析  

An approach of diabetic foot ulcers nature and its predilection site

作　　者：李青[1] 刘芳[1] 赵俊功[1] 赵珺[1] 曾辉[1] 董杨[1] 贾伟平[1] 

机构地区：[1]上海交通大学附属第六人民医院内分泌代谢科-上海市糖尿病临床医学中心足病防治协作组,上海200233

出　　处：《复旦学报（医学版）》2009年第4期465-468,共4页Fudan University Journal of Medical Sciences

摘　　要：目的探讨糖尿病足溃疡的性质及其相关的病理生理机制,同时对糖尿病足溃疡的好发部位作初步分析。方法分析糖尿病足病门诊121例患者的溃疡诱因等基本情况,测量溃疡面积。通过浅感觉、腱反射、肌电图或振动感觉阈值(vibration perception threshold,VPT)检查周围神经病变(diabetic peripheral neuropathy,DPN);通过症状、下肢血管超声或磁共振显像判断有无周围血管病变。根据病变基础将溃疡分为神经性溃疡组(n=33)、缺血性溃疡组(n=27)和混合型溃疡组(n=61)。结果121例患者中97例(80.2%)溃疡发病部位为足趾与足底。神经性溃疡组中,48.5%病变部位于足底,30.3%位于足背,21.2%位于足趾。缺血性溃疡组中,溃疡位于足趾59.3%,足背29.6%,足底11.1%。混合性溃疡组的溃疡49.2%位于足趾,41%位于足底,9.8%位于足背。3组的溃疡分布差异有显著性统计学意义(P<0.01)。3组中以混合型溃疡组患者年龄最大,糖尿病病程最长(P<0.05),诊断时溃疡面积最大,而缺血组的BMI与血压则较其余两组高(P>0.05)。结论病变发病基础不同可导致糖尿病足患病部位的不同,拇趾和足底为糖尿病足的高发部位。Objective To investigate the feature of diabetic foot ulcer and the relative mechanism, and to analyze its predilection site. Methods The precipitating factors and the areas of ulcer were analyzed in 121 diabetic patients with foot ulcer. The peripheral neuropathy was diagnosed by measuring the skin sensation, tendon reflex, electromyogram or vibration perception threshold （VPT）. The diabetic peripheral neuropathy （DPN） was evaluated by positive symptoms, ultrasound or magnetic resonance angiography. According to morbid changes, the patients were divided into neuropathic ulcer group （n = 33）, ischemic ulcer group （17 = 27）, and mixed type ulcer group （n = 61）. Results The ulcers of 97 cases （80. 2%） were distributed in digital pedis and plantar pedis. In neurogenic ulcer group, there were 48.5 % lesion at planta pedis, 30. 3 % at dorsum pedis, and 21.2 % at digiti pedi. In ischemic ulcer group, there were 59.3% at digiti pedis, 29.6 % at dorsum pedis, and li. 1% at planta pedis. In mixed type ulcer group,there were 49.2% at digiti pedis, 410 at planta pedis, and 9.8 % at dorsum pedis. The difference of ulcer distribution was apparent in these groups. Among these three groups, patients in mixed type ulcer group was the oldest, and had the longest duration of diabetes （P〈0.05） and the largest area of ulcer at diagnosis. However, the BMI and blood pressure in ischemic ulcer group were higher than those of the other groups （P〉0. 05）. Conclusions The difference of lesion basis affects the position of diabetic foot ulcer, and the thumbs and plantar pedis are the predilection area of diabetic foot.

关 键 词：糖尿病足 溃疡分型 好发部位 

分 类 号：R587.2[医药卫生—内分泌]