糖尿病足患者足底压力参数变化与神经传导速度的关系

Relationship between plantar pressure parameters and nerve conduction velocity in diabetic foot patients

目的 探究糖尿病足(DF)患者足底压力参数变化与神经传导速度(NCV)的关系。方法 回顾性选取DF患者108例,根据NCV检测结果将其分为NCV正常组(62例)和NCV异常组(46例)。收集所有患者的一般临床资料、实验室检查指标、NCV及足底压力参数并分组进行比较。采用多因素logistic回归分析评估DF患者NCV异常的影响因素;采用受试者工作特征(ROC)曲线分析足底压力参数对DF患者NCV异常的预测价值;构建DF患者NCV异常的列线图预测模型,采用ROC曲线、校准曲线和临床决策曲线评价模型效能。结果 NCV异常组患者年龄、糖尿病病程、空腹血糖(FPG)、糖化血红蛋白(HbAlc)、甘油三酯(TG)、肿瘤坏死因子(TNF)-α水平均显著高于NCV正常组(P<0.05)。NCV异常组患者平均接触地面面积、峰值压力(PP)及压力-时间积分(PTI)均明显高于NCV正常组(P<0.05)。多因素logistic回归分析结果显示,年龄、糖尿病病程、HbAlc、FPG、TNF-α、PP、PTI是DF患者NCV异常的独立危险因素(P<0.05)。ROC曲线分析结果显示,PP、PTI联合预测NCV异常的曲线下面积(AUC)0.873,远大于各因素单独预测的AUC值。基于7项独立预测因素建立的列线图模型验证结果显示,经内部验证Nomogram预测模型的一致性(C-index)指数为0.816;Hosmer-Lemeshow拟合优度检验显示出较好的拟合度(P=0.386);ROC曲线分析结果显示,该列线图模型预测AUC为0.828;临床决策曲线提示模型净获益值较高。结论 DF患者PP、PTI对NCV异常的发生具有一定的诊断价值,且两者联合诊断效能更高,临床检测足底压力参数有助于NCV异常的防治。

Objective To explore the relationship between plantar pressure parameters and nerve conduction velocity(NCV) in patients with diabetic foot(DF).Methods A total of 108 DF patients were retrospectively selected and divided into normal NCV group(62 cases) and abnormal NCV group(46 cases) according to NCV test results.General clinical data,laboratory indicators,NCV and plantar pressure parameters of all patients were collected and compared in groups.Multivariate logistic regression analysis was used to evaluate the influencing factors of abnormal NCV in DF patients;Receiver operating characteristic(ROC) curve was used to analyze the predictive value of plantar pressure parameters for NCV abnormalities in DF patients;A nomogram prediction model for NCV abnormalities in DF patients was constructed,and the model efficiency was evaluated by using ROC curve,calibration curve and clinical decision curve.Results Age,duration of diabetes,fasting plasma glucose(FPG),glycosylated hemoglobin(HbAlc),Triglycerides(TG) and tumor necrosis factor(TNF)-α levels in abnormal NCV group were significantly higher than those in normal NCV group(P<0.05).Average ground contact area,peak pressure(PP) and pressure time integral(PTI) in abnormal NCV group were significantly higher than those in normal NCV group(P<0.05).Multiariable logistic regression analysis results showed that age,duration of diabetes,HbAlc,FPG,TNF-α,PP,PTI were independent risk factors for NCV abnormalities in DF patients(P<0.05).ROC curve analysis results show that PP,PTI combined forecasting NCV anomaly area under curve(AUC) 0.873,separately predict the AUC value was greater than the indicators.The validation results of the Nomogram model based on 7 independent predictors showed that after internal verification,the consistency(C-index) index of the Nomogram prediction model was 0.816.Hosmer-Lemeshow goodness of fit test showed a good degree of fit(P=0.386).ROC curve analysis showed that according to the results of the nomogram model predict AUC was 0.828;Clinical decision curve showed that the model had high net benefit value.Conclusion PP and PTI have certain diagnostic value for the occurrence of abnormal NCV in DF patients,and the combined diagnosis efficiency of the two is higher.Clinical detection of plantar pressure parameters is helpful to the prevention and treatment of abnormal NCV.