【摘要】 目的 探讨糖尿病足骨髓炎（DFO）磁共振成像（MRI）及其与血浆动脉粥样硬化指数（AIP）的相关性。方法 选取2016年1月至2022年12月于我院内分泌科治疗的DF患者96例，根据是否发生DFO分为单纯DF组（n=52）、DFO组（n=44），比较两组年龄、性别、DM病程、AIP等。Logistic回归分析DFO的影响因素，受试者工作特征（ROC）曲线分析AIP与常见临床指标预测DFO的效能。结果 MRI成像显示，96例DF患者均表现为足部软组织蜂窝织炎，其中50例表现为脓肿（52%）,48例表现为骨髓炎（50%）,45例表现为窦道（46.8%）,12例表现为夏科氏关节（12.5%）。48例骨髓炎患者中，4例骨穿刺活检证实为假阳性，13例有骨组织暴露，14例行骨穿刺活检证实，17例骨病原菌培养阳性中，有革兰氏阳性菌9例（5例金黄色葡萄球菌、3例表皮葡萄球菌、1例溶血葡萄球菌）、革兰氏阴性菌5例（3例铜绿假单胞菌、1例奇异变形菌、1例肺炎克雷伯菌）及混合感染3例。与DF组比较，DFO组BMI、AIP、超敏C反应蛋白及吸烟率升高（P<0.05）。Logistic回归分析显示，AIP及吸烟史是DFO的影响因素。ROC曲线显示，AIP预测DM患者DFO的ROC曲线下面积为0.738，敏感度是72.7%，特异度是73.1%，截断值为0.19。Delong检验结果显示，AIP预测DFO具有优势（P<0.05）。结论 MRI能较好显示DFO足部软组织及骨关节的受累情况，AIP和吸烟是DFO的影响因素，其可作为DFO防治的监测指标。更多还原

【Abstract】 Objective To study the MRI features of diabetic foot osteomyelitis(DFO) and its correlation with the atherogenic index of plasma(AIP). Methods The clinical data of 96 DF patients who were treated in the our hospital from January 2016 to December 2022 were collected. According to whether DFO occurs,the patients were divided into two groups:DF group(n=52) and DFO group(n=44). The differences of age,sex,course of diabetes,AIP and other clinical indicators between the two groups were compared. Logistic regression was used to analyze the influencing factors of DFO,and receiver operating characteristic(ROC) curve was used to analyze the efficacy of AIP and common clinical indicators in predicting DFO. Results The main manifestations of DFO on MRI were soft tissue cellulitis,abscess(50/96),osteomyelitis(48/96),sinus(45/96),and Charcot’s joint(12/96). Among 48 cases of osteomyelitis,4 cases were confirmed as false positive by bone puncture biopsy,13(13/44) cases had exposed bone tissue,14(14/44) cases were confirmed by bone puncture biopsyand17(17/44) cases were positive for bone pathogen culturewhichincluding 9 cases of Gram-positive bacteria(5 cases of Staphylococcus aureus,3 cases of Staphylococcus epidermidis,and 1 case of Staphylococcus hemolysis);5 cases of Gram-negative bacteria(3 cases of Pseudomonas aeruginosa,1 case of Proteus mirabilis,and 1 case of Klebsiella pneumoniae)and 3 cases were mixed bacterial infections. Compared with the DF group,the BMI,AIP,High sensitivity C reactive protein,and smoking rate of patients in the DFO group increased(P<0. 05). Binary logistic regression analysis showed that AIP and smoking were the influencing factors of DFO. The ROC curve analysis showed that the area under the ROC curve of AIP predicting DFO in DM patients was 0. 738,with a sensitivity of 72. 7%,a specificity of 73. 1%,and an optimal cutoff value of 0. 19. The Delong test showed that AIP has an advantage in predicting DFO(P<0. 05). Conclusions MRI can better display the involvement of soft tissue and bone joints in DFO feet. AIP and smoking are influencing factors of DFO. AIP is a monitoring indicator for the prevention and treatment of DFO.更多还原