糖尿病合并周围神经病变患者足底压力变化与神经传导及代谢指标的关系

Relationship between changes of plantar pressure and nerve conduction,metabolic indexes in patients with diabetes mellitus and peripheral neuropathy

目的探讨糖尿病合并周围神经病变患者足底压力变化与神经传导及代谢指标的关系。方法纳入2019年9月~2021年1月于本院就诊的糖尿病合并周围神经病变患者93例行回顾性分析,按照是否发生糖尿病足将发生糖尿病足的患者设为A组(n=43),将未发生糖尿病足的患者设为B组(n=50);另选择同期于本院行健康体检的45例正常人设为C组。比较3组足底不同区域[第一跖骨(M1)、第二跖骨(M2)、第三跖骨(M3)、第四跖骨(M4)、第五跖骨(M5)、足跟内侧(HM)、足跟外侧(HL)、足中部(MF)、第一脚趾(T1)、第二至第五脚趾(T2~T5)]峰值压力检测结果、正中神经、尺神经、腓总神经传导速率[运动神经传导速度(MNCV)、感觉神经传导速度(SNCV)]以及血糖[空腹血糖(FBG)、餐后2 h血糖(2hPBG)、糖化血红蛋白(HbA1c)]、血脂代谢指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]水平,采用Person相关系数分析糖尿病合并周围神经病变患者足底压力与神经传导及代谢指标的相关性。结果A组、B组左足及右足M1、M2、M3、M4、M5、HM、HL、T1~T5区域足底峰值压力均高于C组,其中A组各区域足底峰值压力均高于B组(P<0.05);A组正中神经、尺神经、腓总神经MNCV、SNCV均低于B组,B组神经传导速率均低于C组(P<0.05);A组、B组FBG、2 hPBG、HbA1c、TG水平均高于C组,其中A组FBG、2 hPBG、HbA1c、TG、LDL-C水平高于B组(P<0.05);Person相关性分析结果显示,糖尿病足患者左足、右足足底M1、M2、M3、M4、M5、HM、HL、T1~T5区域峰值压力均与神经传导速率呈负相关(P<0.05),糖尿病足患者左足、右足足底M1、M2、M3、M4、M5、HM、HL、T1~T5区域峰值压力均与FBG、2hPBG、HbA1c、TG、LDL-C呈正相关(P<0.05)。结论糖尿病合并周围神经病变的糖尿病足患者足底除足中部区域,大部分区域压力峰值均高于正常人,且与神经传导速率呈负相关,与血糖及TG、LDL-C等血脂代谢指标呈正相关。

Objective To study the relationship between changes of plantar pressure and nerve conduction,metabolic indexes in patients with diabetes mellitus and peripheral neuropathy.Methods A total of 93 patients with diabetes mellitus and peripheral neuropathy treated in the hospital were retrospectively enrolled from September 2019 to January 2021.According to presence or absence of diabetic foot(DF),they were divided into group A(n=43,DF)and group B(n=50,non-DF).Other 45 healthy controls during the same period were enrolled as group C.The peak pressure values of different plantar areas[first metatarsal(M1),second metatarsal(M2),third metatarsal(M3),fourth metatarsal(M4),fifth metatarsal(M5),medial heel(HM),lateral heel(HL),mid-foot(MF),first toe(T1),second to fifth toes(T2-T5)],conduction rates[motor nerve conduction velocity(MNCV),sensory nerve conduction velocity(SNCV)]of median nerve,ulnar nerve and common peroneal nerve,levels of blood glucose indexes[fasting blood glucose(FBG),2 h postprandial blood glucose(2 hPBG),hemoglobin A1 c(HbA1 c)]and blood lipid metabolism indexes[total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)]were compared among group A,B and C.The correlation between plantar pressure and nerve conduction,metabolic indexes in patients with diabetes mellitus and peripheral neuropathy was analyzed by Person correlation coefficients.Results The peak pressure values of left and right feet at M1,M2,M3,M4,M5,HM,HL and T1-T5 were the highest in group A,followed by group B and group C(P<0.05).MNCV and SNCV of median nerve,ulnar nerve and common peroneal nerve were the highest in group C,followed by group B and group A(P<0.05).The levels of FBG,2 hPBG,HbA1 c and TG in group A and group B were higher than those in group C.The levels of FBG,2 hPBG,HbA1 c,TG and LDL-C in group A were higher than those in group B(P<0.05).The results of Person correlation analysis showed that peak pressure values of left and right feet at M1,M2,M3,M4,M5,HM,HL and T1-T5 were negatively correlated with nerve conduction velocity(P<0.05),while positively correlated with FBG,2 hPBG,HbA1 c,TG and LDL-C(P<0.05).Conclusion Except for mid-foot,peak pressure values at most areas in patients with diabetes mellitus and peripheral neuropathy are higher than those in normal people,which are negatively correlated nerve conduction velocity,while positively correlated with blood glucose,TG,LDL-C and other blood lipid metabolism indexes.