Armstrong David G, Lipsky Benjamin A, Polis Adam B, Abramson Murray A
Rosalind Franklin University, Chicago, IL, USA.
Int Wound J. 2006 Dec;3(4):302-7. doi: 10.1111/j.1742-481X.2006.00269.x.
The purpose of the study was to assess in patients with a diabetic foot infection (DFI), whether differences in skin temperature of the affected foot as compared to the corresponding site on the contralateral foot using dermal thermometry (DT) correlates with infection severity and clinical outcome. As part of the SIDESTEP DFI study, investigators took DT measurements at baseline and the discontinuation of intravenous therapy (DCIV) and performed a systematic evaluation of the infected limb to calculate a wound score. We compared the skin temperature differential between the limbs at the two assessments and determined the correlation between this value and surrogate markers of inflammation and the clinical response to treatment. Among patients enrolled in SIDESTEP, 332 were fully evaluable. The mean temperature differential between the limbs was 2.81 +/- 5.75 degrees F at baseline and 2.43 +/- 4.84 degrees F at DCIV (mean change: -0.37; 95% confidence interval (CI): -0.98, 0.23; P= 0.225). Skin temperature differential at baseline did not correlate with white blood cell count, level of C-reactive protein or erythrocyte sedimentation rate or the infection severity score (r= 0.058, 0.148, -0.002, 0.067, respectively). We observed no overall trend between surface temperature differential at baseline and clinical outcome at DCIV, but patients with a skin temperature differential of > or =10 degrees F at baseline had a significantly lower clinical response than those whose differential was <10 degrees F (81.4% versus 94.3%; difference 12.9%; 95% CI: 3.5, 27.3%, P= 0.007). While there was no overall relationship between skin temperature and poor clinical outcome, there may be a threshold effect in DT (<10 degrees F versus >10 degrees F) between the limbs at baseline that predicts outcome of therapy.
本研究的目的是评估在糖尿病足感染（DFI）患者中，使用皮肤温度测量法（DT）测量患足与对侧足部相应部位的皮肤温度差异是否与感染严重程度及临床结局相关。作为SIDESTEP DFI研究的一部分，研究人员在基线期和静脉治疗终止时（DCIV）进行了DT测量，并对感染肢体进行了系统评估以计算伤口评分。我们比较了两次评估时两肢体间的皮肤温度差异，并确定该值与炎症替代标志物及治疗临床反应之间的相关性。在SIDESTEP研究纳入的患者中，332例可进行全面评估。两肢体间的平均温度差异在基线期为2.81±5.75华氏度，在DCIV时为2.43±4.84华氏度（平均变化：-0.37；95%置信区间（CI）：-0.98，0.23；P = 0.225）。基线期的皮肤温度差异与白细胞计数、C反应蛋白水平、红细胞沉降率或感染严重程度评分均无相关性（r分别为0.058、0.148、-0.002、0.067）。我们未观察到基线期表面温度差异与DCIV时临床结局之间的总体趋势，但基线期皮肤温度差异≥10华氏度的患者临床反应显著低于差异<10华氏度的患者（81.4%对94.3%；差异12.9%；95% CI：3.5，27.3%，P = 0.007）。虽然皮肤温度与不良临床结局之间没有总体关系，但基线期两肢体间DT可能存在阈值效应（<10华氏度对>≥10华氏度），可预测治疗结局。
