Vayssairat M, Le Dévéhat C
FAMA AP-HP de Pathologie Vasculaire, Hôpital Tenon, 4 rue de la Chine 75020 Paris.
J Mal Vasc. 2001 Apr;26(2):122-5.
Diabetes mellitus is the chief medical cause of amputation. The risk of amputation is 15-fold higher in diabetic subjects and 5 out of 6 amputees are diabetic. Among the three risk factors for amputation in diabetic patients-neuropathy, ischemia, and infection-ischemia is the most difficult to quantify. Thus, functional and/or distal foot arteriopathy may be present without any clinical symptoms long before trophic changes occur. Therefore additional vascular explorations, including measurement of systolic toe pressure, must be performed. Physical examination is sufficient to diagnose lower limb arterial disease when ankle pulses are missing, but severe foot ischemia may be present despite minimal clinical signs and normal ankle pulses. Mediacalcinosis alters ankle pressure. Toe pressure is the most reliable test for quantifying ischemia of the diabetic foot. Other investigations such as TcPO(2) measurement, laser-Doppler and capillaroscopy are useful for revealing early functional diabetic microangiopathy, but they can only be done and interpreted in specialized centers.
糖尿病是截肢的主要医学原因。糖尿病患者的截肢风险高出15倍，六分之五的截肢者患有糖尿病。在糖尿病患者截肢的三个风险因素——神经病变、缺血和感染中，缺血最难量化。因此，在营养改变发生之前很久，可能就已存在功能性和/或足部远端动脉病变，但无任何临床症状。因此，必须进行包括测量趾收缩压在内的额外血管检查。当踝脉搏缺失时，体格检查足以诊断下肢动脉疾病，但尽管临床体征轻微且踝脉搏正常，仍可能存在严重的足部缺血。血管钙化会改变踝压。趾压是量化糖尿病足缺血最可靠的检查。其他检查，如经皮氧分压（TcPO₂）测量、激光多普勒和毛细血管镜检查，有助于发现早期功能性糖尿病微血管病变，但这些检查只能在专业中心进行和解读。
