【摘要】 目的调查和分析糖尿病足神经病变特点及相关因素。方法对全国14家医院的2004年全年门诊和住院糖尿病足患者进行统一调查,包括病史回顾、体格检查、生化检查等,对足溃疡进行分类、分期、神经病变特点及相关因素分析。结果纳入统计糖尿病足患者530例,神经性溃疡患者337例(63.6%)其中单纯性足部神经性溃疡172例(32.5%),合并下肢血管病变的混合性溃疡165例(31.1%),缺血性足部溃疡193例(36.42%)。足溃疡诱因物理因素占62.4%～84.9%。神经性足溃疡患者病程3(1,60)个月明显短于缺血性足溃疡组5(1,96)个月(P<0.001)。混合性足溃疡患者病程12(1,108)个月长于神经溃疡患者及缺血性溃疡患者(P<0.001)。足部溃疡程度Wagner 分级与糖尿病病程、经济收入、足畸形、膝反射、踝反射、足部音叉振动觉、尼龙丝感觉点、踝肱指数(ABI)、足部动脉搏动、空腹血糖及糖化血红蛋白呈相关关系;显著相关的因素是左胫后 ABI、右足音叉振动觉及经济收入。结论糖尿病足溃疡患者中神经性溃疡较常见,神经性损害预后优于血管性因素糖尿病足;混合性糖尿病足预后较差。周围神经病变中尼龙丝感觉点、足部音叉振动觉和肌腱反射的检查最为简单实用。更多还原

【Abstract】 Objective To investigate the characteristics of diabetic foot with neuropathy and its related factors.Methods 530 out-and in-patients in 14 grade A class 3 comprehensive hospitals in China with foot problems were surveyed.337 of the 500 patients (63.58%) suffered from neuropathy,172 (32.45%) with diabetic foot with simple neuropathy and 165 (31.13%) with simple neuropathy combined with peripheral artery disease (PAD).193 of the 500 patients (36.42%) suffered from peripheral artery disease (PAD).77.7% of ulcer were caused by physical factors.Questionnaire survey was conducted to collect the demographic data,present and past history,history of the hyperglycemia and lipid disorders, classification and phases of the foot ulcers based on Wagner system and Texas system,characteristics of neuropathy and other diabetic complications,and relative risk factors.Detailed physical examination was performed,including 10 g nylon filament sensation examination.Results The duration of diabetic foot of the patients with simple neuropathy was 3 (1,60) months,significantly shorter than that of the diabetic foot patients with PAD [5(1,96) months,P<0.001].The Wagner degree of ulcer was related to the duration of diabetes,economic income,foot deformity,nerve reflection,diapason vibration sensation of foot, sensation point of 10 g nylon filament,ankle/brachial index (ABI),foot artery pulse,fasting blood sugar (FBS) and glycated hemoglobin (HbA1c).Stepwise regression analysis revealed that ABI of left posterior tlbial artery,vibration detection threshold and economic income were the most significant influencing factors of the degree of ulcer.Conclusion Neuropathy ulcer is common in diabetic foot patients.The prognosis of healing in diabetic foot with neuropathy is prior to that of diabetic foot with PAD.The neuropathy and PAD of foot influence each other and aggravate the condition of diabetic foot.The examinations of diapason vibration sensation of foot,sensation point of 10 g nylon filament,and Achilles tendon reflex are simple and practical, and are worth recommending.更多还原