振动觉阈值对糖尿病足溃疡风险的预测价值及其危险因素研究

Value of the vibration perception thresholds in forecasting diabetic foot ulceration and its risk factors

目的探讨振动觉阈值(vibration perception thresholds,VPT)对糖尿病足溃疡风险的预测价值及其危险因素。方法采用美国振动感觉定量检查仪测定60例未发生足溃疡的2型糖尿病患者及30例正常人双足第1跖骨关节头的VPT。结果糖尿病患者的VPT显著高于年龄匹配的正常人(P<0.001)。60例糖尿病患者中VPT升高46例(76.7%),其中低度风险8例(17.4%),中度风险23例(50.0%),高度风险15例(32.6%),有糖尿病周围神经病变(diabetic peripheral polyneuropathy,DPN)症状31例(67.4%),无症状15例(32.6%)。<65岁年龄组,以低中度风险为主,≥65岁年龄组,以高度风险为主,差异有统计学意义(P<0.001)。<5年病程组,以低中度风险为主,≥5年病程组,以高度风险为主,差异有统计学意义(P<0.01)。VPT升高组与正常组比较,前者的年龄较大(P<0.001),病程较长(P<0.005)。二组性别、体重指数(BMI)、空腹血糖(FBS)、糖化血红蛋白(HbA1c)、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白蛋固醇(LDL-C)、糖尿病视网膜病变合并率、心电图缺血性改变合并率、高血压合并率、吸烟率和饮酒率差异无统计学意义(P>0.05)。多元线性回归分析显示,年龄、病程是影响VPT的独立危险因素。结论VPT是一项花费小、简单无创的预测糖尿病足溃疡风险的可靠指标。增龄、病程长可促进糖尿病足溃疡的发生。

Objective To explore the forecast value of the vibration perception thresholds （VPT） to risks of diabetic foot ulceration and dangerous factors. Methods American vibratory perception rational detector was adopted to measure the VPT from 60 eases of patients without foot ulceration of Type 2 diabetes, and 39 eases of people on the metatarsal joints of both feet. Results The VPT of the patients with diabetes were much higher than those of normal people at the same age （ P 〈 0. 001 ）. Tbe VPT of 46 cases （76.7 % ） among the 60 patients had risen, among which there were 8 cases （ 17.4% ） of low risk,23 eases （50.0%） of moderate risk, and 15 eases （32.6%） of high risk,31 eases （67.4%） with diabetic peripheral polyneuropatby （ DPN）, 15 cases （32.6%） without symptom. At 〈 65 years old group, basically the risk was low and moderate;≥65 years old, the risk was higher（ P 〈0. 001 ）. At the disease course 〈 5 years group, the risk was mainly low and moderate ; ≥5 years, the risk was high （ P 〈 0.01 ）. Compared to the VPT of the normal group, the age in the group of risen VPT was older （ P 〈 0. 001 ） ,with the disease course longer （ P 〈 0. 005 ）. There were no distinct difference （ P 〉 0.05 ） between the two groups in genders, body mass index（BMI） , fasting blood sugar（FBS） , HbAlc, blood urea nitrogen（BUN） ,ereatinine（Cr） , uric acid（UA） , total eholesterol（TC）, triglyeeride（ TG）, high density lipoprotein cholesterol（ HDLC ）, low density lipoprotein cholesterol （LDLC）, combination rate of diabetic retinopathy, combination rate of ECG ischemie changes ,combination rate of hypertension, smoking rate and rate of drinking wine. Multiple linear recursive analysis showed that age and disease course were the separate dangerous factors affecting the VPT. Conclusions The VPT is a reliable index in measuring diabetic foot ulceration risks with little cost,and it was simple and without injury. Age increasing and long disease course would cause diabetic foot ulceration.