光体积描记法测量糖尿病患者趾血压和趾臂指数的同测者间和复测者间可靠性。
Interrater and intrarater reliability of photoplethysmography for measuring toe blood pressure and toe-brachial index in people with diabetes mellitus.
机构信息
Diabetes Service, Nepean Hospital, Nepean Blue Mountains Local Health Network, Level 3 West Block, Derby St Kingswood, NSW, 2747, Australia.
出版信息
J Foot Ankle Res. 2012 Jun 7;5:13. doi: 10.1186/1757-1146-5-13.
BACKGROUND
A reliable tool to measure arterial flow to the feet in people with diabetes is required given that they are particularly prone to peripheral arterial disease. Traditionally, the ankle brachial index (ABI) has been used to measure arterial circulation, but its application is limited due to calcification of larger arteries. More recently, toe pressure and the toe brachial index (TBI) has been suggested as superior to ABI measurements because they assess smaller digital arteries less prone to arterial calcification. However, reliability studies for the clinical use of photoplethysmography (PPG) in people with diabetes are lacking.
METHODS
Sixty people with diabetes mellitus (35 males and 25 females, mean age 59.6 yrs) consented to take part in the study. The majority (92%) had type 2 diabetes and 8% had type 1 diabetes. Forty-three percent were diagnosed as having peripheral neuropathy when tested using a biothesiometer and 15% were current smokers (10 - 40/day). A podiatrist and a diabetes educator measured toe and brachial blood pressure independently and in a random order using PPG. These measurements were repeated again seven days later, and subsequently analysed with intraclass correlation coefficients (ICC), 95% confidence intervals (CI) and standard error of measurement (SEM).
RESULTS
The intrarater reliability of measuring toe pressures was excellent (ICC3,1 =0.78-0.79, SEM 8 mmHg) and interrater reliability was also excellent (ICC2,2 = 0.93, SEM 4 mmHg). The intrarater reliability for measuring brachial pressures was generally poor (ICC3,1 = 0.40 - 0.42, SEM 19 mmHg) and interrater reliability was fair-good (ICC2,2. 0.65, SEM 14 mmHg). The TBI intrarater reliability was fair-good (ICC3,1 = 0.51-0.72, SEM 0.08), whilst the interrater reliability of TBI was excellent (ICC2,2 = 0.85, SEM 0.07).
CONCLUSIONS
Based on these results, interrater and intrarater reliability of PPG is excellent for measuring toe blood pressure, good for TBI and only fair for brachial pressures in people with diabetes mellitus.
背景
由于糖尿病患者特别容易患外周动脉疾病，因此需要一种可靠的工具来测量脚部的动脉血流量。传统上，踝臂指数 (ABI) 一直用于测量动脉循环，但由于较大动脉的钙化，其应用受到限制。最近，趾压和趾臂指数 (TBI) 已被认为优于 ABI 测量，因为它们评估较小的、不易发生动脉钙化的数字动脉。然而，缺乏用于糖尿病患者的光体积描记术 (PPG) 临床应用的可靠性研究。
方法
60 名糖尿病患者（35 名男性和 25 名女性，平均年龄 59.6 岁）同意参与研究。大多数（92%）患有 2 型糖尿病，8%患有 1 型糖尿病。43%的人在使用生物电阻抗仪测试时被诊断为患有周围神经病变，15%的人是当前吸烟者（每天 10-40 支）。足病医生和糖尿病教育者使用 PPG 独立且随机地测量趾部和臂部血压。这些测量值在七天后再次重复，并随后使用组内相关系数 (ICC)、95%置信区间 (CI) 和测量标准误差 (SEM) 进行分析。
结果
测量趾压的同一位评估者的可靠性非常好（ICC3,1 =0.78-0.79，SEM 8mmHg），两位评估者的可靠性也非常好（ICC2,2 =0.93，SEM 4mmHg）。测量臂部血压的同一位评估者的可靠性通常较差（ICC3,1 =0.40-0.42，SEM 19mmHg），而两位评估者的可靠性则较好（ICC2,2 =0.65，SEM 14mmHg）。TBI 的同一位评估者的可靠性为良好至极好（ICC3,1 =0.51-0.72，SEM 0.08），而 TBI 的两位评估者的可靠性为极好（ICC2,2 =0.85，SEM 0.07）。
结论
基于这些结果，在糖尿病患者中，PPG 测量趾部血压的同一位和两位评估者的可靠性均非常好，TBI 的可靠性较好，而测量臂部血压的可靠性仅为较好。
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