糖尿病患者足底压力参数的改变及其影响因素

Study of foot plantar pressure in Chinese diabetic patients

目的探讨我国糖尿病(DM)患者足底压力参数、分布情况及影响因素。方法 1035例 DM 患者和1022例正常人均行一步法测量两脚各5次动态足底压力,将足底分10个区域(足跟,足弓,第一～五跖骨头,第一趾,第二趾,第三～五趾),计算平均足底最大峰值压力(MPP)和各部位平均最大压力。结果 DM 患者左右足 MPP 为(410±122)kPa 和(427±128)kPa,正常人为(415±113)kPa 和(428±116)kPa,两组差异无统计学意义。两组左右足 MPP 分布前3位均为:第一趾>第二跖骨>第三跖骨。不同糖尿病病程、性别、年龄、体重指数、腰臀比、有否溃疡史的 DM 患者 MPP差异无统计学意义。合并周围神经病变的 DM 患者左右足 MPP 高于正常人,前足的压力较正常人升高[左:(352±121)kPa or(338±117)kPa,右:(357±126)kPa or(335±116)kPa],尤以第二、第三跖骨头明显。但有无合并周围神经病变的 DM 患者间 MPP 差异无统计学意义。结论 DM 患者足底压力与正常人差异无统计学意义,但分布与正常人不同。合并周围神经病变可使 DM 患者足底压力增高。

Objective To investigate the difference and distribution of plantar pressure in normal Chinese population and diabetic patients and their influencing factors, Methods 1035 diabetic patients and 1022 normal subjects were evaluated by the ＂first step approach＂, Each trial included five acceptable separate barefoot walks across the EMED-AT system for each foot. Tbe whole foot was divided into ten ＂masks＂, including the heel, midfoot, the first, second, third, fourth, fifth metatarsals, hallux, second toe and the third-to-fifth toes, The mean of maximum peak pressure （MPP） of each mask as calculated. Results The MPP were 410 ± 122 and 427 ± 128 kPa in left and right foot of diabetics while 415 ± 113 and 428 ± 116 kPa in left and right foot of normal subjects with P 〉 0. 05. The top three places with the hight MPP value in the in diabetics and normal subjects were hallux 〉 the second metatarsal 〉 the third metatarsals in both left and right foot. The disease course, sex, age, BMI, WHR and history of foot ulcer had few influence on the plantar pressure in diabetics. The MPP in the diabetics with peripheral neuropathy（DPN） was higher than that of normal subjects, with no significant difference compared to that of non-DPN diabetics. Conclusion The plantar pressure in the diabetics is almost the same as that of the normal subjects, but with different distribution is different . Complication with DPN may lead to the increase of plantar pressure in the diabetic. But factors such as disease course, sex, age, BMI and WHR have few influence on MPP.