足底压力异常在糖尿病周围神经病变早期诊断中的意义  

Abnormal plantar pressure:the signal of diabetic peripheral neuropathy

作　　者：方芳[1] 王冬梅[2] 顾鸣宇[1] 严率[1] 李志欢[2] 吴艺捷[1] 

机构地区：[1]上海交通大学附属第一人民医院内分泌代谢科,上海200080 [2]上海交通大学机械与动力工程学院

出　　处：《上海医学》2013年第5期398-401,共4页Shanghai Medical Journal

基　　金：国家自然基金资助项目(81071234)

摘　　要：目的探讨糖尿病患者足底鞋内压力异常在周围神经病变(DNP)中的诊断意义。方法以神经传导速度为金标准,将36例2型糖尿病患者分入两组:2型糖尿病无DPN组(无DPN组,25例,49个足底)、2型糖尿病DPN组(DPN组,11例,21个足底)。应用F-Scan压力鞋垫采集在平地匀速行走时患者的足底压力值,6次中间步态取平均值,分析足底区域压力特点。结果 DNP组吸烟、糖尿病视网膜病变的构成比均显著高于无DNP组(P值均<0.05)。与无DNP组比较,DNP组行走中与地面的接触时间显著延长(P<0.01),足底与地面的力度时间积分显著升高(P<0.01)。DPN组的中足与足跟力度比值(MID/REAR)、外侧足与内侧足力度比值(LTR/MED)、前外侧/前内侧足力度比值(FRT-LTR/FRT-MED)均显著高于无DPN组(P值分别<0.01、0.05)。LTR/MED比值与DNP呈正相关(r=0.309,P<0.01),采用受试者工作特征曲线求得LTR/MED曲线下面积为0.732(P<0.01),对DNP有一定诊断价值。结论 DNP患者存在足底压力分布异常,检测这种变化可能有助于DNP的早期诊断。Objective To explore the role of plantar pressure in the diagnoses of diabetic peripheral neuropathy （DPN）. Methods According to the nerve conduction velocity （NCV）, 36 patients with type 2 diabetes mellitus were divided into DPN group （ 11 cases, 21 planta perils） and non-DPN group （25 cases, 49 planta pedis）. All subjects were requested to walk on F-Scan insole with an uniform speed （ 1 km/h） and an uniform slope （0°）. Six middle stances per foot were collected and used for analysis. Results The proportions of the patients with smoking and diabetic retinopathy in DPN group were significantly higher than that in non-DPN group （both P〈O. 05）. The contact time and force-time-integral in DPN group were significantly longer than those in non-DPN group （both P〈0. 01）. The force ratios of mesopedes to calcar pedis （MID/REAR）, lateral-foot to internal-foot （LTR/MED） and front lateral-foot to front internal-foot （FRT-LTR/FRT-MED） in DPN group were significantly higher than those in non-DPN group（ P〈0. 01 or P〈0. 05）. LTR/MED was positively correlated with DPN （r = 0. 309, P〈0. 01）. The area under LTR/MED curve using receiver operating characteristic curve （ROC） was 0. 732 （P〈0.01）. Conclusion Abnormal plantar pressure is found in DPN patients. Detection of these changes may contribute to the early diagnosis of DPN.

关 键 词：糖尿病 糖尿病周围神经病变 足底压力 

分 类 号：R587.2[医药卫生—内分泌]