双足动态参数以及胰岛素抵抗指数对DNP患者发生足溃疡的预测价值

The predictive value of developing foot ulcers of DNP patients by bipedal dynamic parameters and insulin resistance index

目的探讨下肢震动感觉阈值(VPT)、最大足底压力以及胰岛素抵抗指数对糖尿病周围神经病变患者随访1年发生足溃疡的预测价值。方法纳入2020年5月至2022年5月在海南西部中心医院就诊的糖尿病合并周围神经病变患者112例,按随访1年内是否发生足溃疡分为糖尿病周围神经病变(DN)组57例(50.89%)和糖尿病周围神经病变伴足溃疡(DNFU)组55例(49.11%),比较两组患者一般临床资料以及双足动态参数,多因素logistic回归分析获得影响糖尿病周围神经病变患者随访1年内发生足溃疡的独立预测因素,重点分析VPT、最大足底压力以及胰岛素抵抗指数与糖尿病周围神经病变患者随访1年发生足溃疡的相关性,并绘制相关受试者工作特征(ROC)曲线和决策曲线,分析其预测效能和净收益率。结果DNFU组患者糖尿病病程[(7.93±2.21)年vs.(6.23±1.85)年,t=2.678,P=0.013]、糖化血红蛋白[(8.83±2.23)%vs.(7.23±2.12)%,t=4.725,P=0.000]、胰岛素抵抗指数(3.61±0.38 vs.2.87±0.34,t=4.882,P=0.000)明显高于DN组(P<0.05);DNFU组患者VPT[(12.56±3.22)v vs.(8.42±1.32)v,t=4.878,P=0.000]、最大足底压力[(2456.89±322.74)N vs.(2228.33±234.42)N,t=7.838,P=0.000]明显高于DN组(P<0.05);多因素logistic回归分析结果显示,胰岛素抵抗指数(OR=2.275,95%CI:1.226~3.452,P=0.028)、VPT(OR=2.594,95%CI:1.137~3.786,P=0.005)以及最大足底压力(OR=2.376,95%CI:1.342~3.567,P=0.017)3个指标为糖尿病周围神经病变患者随访1年内发生足溃疡的独立预测因素(P<0.05);ROC曲线分析显示,胰岛素抵抗指数、VPT以及最大足底压力预测糖尿病周围神经病变患者随访1年内发生足溃疡的曲线下面积(AUC)分别为0.765(95%CI:0.712~0.867)、0.834(95%CI:0.782~0.927)以及0.811(95%CI:0.775~0.878);决策曲线分析显示,VPT、最大足底压力、胰岛素抵抗指数预测糖尿病周围神经病变患者随访1年内发生足溃疡均具有良好的净收益率,并且3者联合预测的净收益率最高。结论VPT、最大足底压力以及胰岛素抵抗指数用于预测糖尿病周围神经病变患者随访1年发生足溃疡具有良好的预测效能和净收益率。

Objective To explore the predictive value of vibration perception threshold(VPT),maximum plantar pressure,and insulin resistance index for the development of foot ulcers in patients with diabetic peripheral neuropathy(DPN)over a one-year follow-up period.Methods The study included 112 patients with diabetic peripheral neuropathy who visited our hospital from May 2020 to May 2022.Patients were divided into two groups:DPN group(n=57,50.89%)and diabetic neuropathy with foot ulcer(DNFU)group(n=55,49.11%)based on whether foot ulcers developed during the one-year follow-up.General clinical data and dynamic foot parameters were compared between the groups.Multivariate logistic regression was used to identify independent predictors of foot ulcer development.The relation-ship between VPT,maximum plantar pressure,and insulin resistance index with the development of foot ulcers was analyzed,and ROC curves and decision curves were constructed to evaluate predictive performance and net benefit.Results The DNFU group had significantly higher diabetes duration(7.93±2.21 years us.6.23±1.85 years,t/P=2.678/0.013),HbAic levels(8.83±2.23%us.7.23±2.12%,t/P=4.725/0.000),and insulin resistance index(3.61±0.38 vs.2.87±0.34,t/P=4.882/0.000)than the DPN group(P<0.05).VPT(12.56±3.22 vs.8.42±1.32,t/P=4.878/0.000)and maximum plantar pressure(2456.89±322.74 N us.2228.33±234.42 N,t/P=7.838/0.000)were significantly higher in the DNFU group(P<0.05).Multivariate logistic regression analysis identified insulin resistance index(0R:2.275,95%CI:1.226-3.452,P=0.028),VPT(OR:2.594,95%CI:1.137-3.786,P=0.005),and maximum plantar pressure(0R:2.376,95%Cl:1.342-3.567,P=0.017)as independent predictors for foot ulcer development(P<0.05).ROC analysis showed that the area under the curve(AUC)for predicting foot ulcer development was 0.765(95%Cl:0.712-0.867)for insulin resistance index,0.834(95%Cl:0.782-0.927)for VPT,and 0.811(95%Cl:0.775-0.878)for maximum plantar pressure.Decision curve analysis indicated good net benefit for VPT,maximum plantar pressure,and insulin resistance index in predicting foot ulcer development,with the combined prediction model achieving the highest net benefit.Conclusion VPT,maximum plantar pressure,and insulin resistance index are effective predictors of foot ulcer development in diabetic peripheral neuropathy patients over a one-year follow-up period,demonstrating good predictive performance and net benefit.