Ozdemir Baris A, Brownrigg Jack R, Jones Keith G, Thompson Matt M, Hinchliffe Robert J
St. George's Vascular Institute St. George's Healthcare NHS Trust London, United Kingdom.
Surg Technol Int. 2013 Sep;23:51-8.
Diabetes-related foot complications are a major cause of amputation. The presence of peripheral arterial disease (PAD) identifies those at increased risk of ulceration, failure to heal an ulcer, and amputation. This systematic review assesses the ability of noninvasive screening tests to detect PAD in patients with diabetes mellitus. A database search was performed using the OVIDSP Web site, from 1946 to June 30, 2012 (MEDLINE®), and from 1974 to June 30, 2012 (EMBASE), to identify studies assessing the utility of screening tests in detecting PAD or predicting clinical outcomes in patients with diabetes mellitus. Thirteen studies were identified that reported sensitivity and specificity data on screening tests. No single screening test was reliable in identifying or excluding peripheral arterial disease in patients with diabetes. Although the evidence base is limited, transcutaneous oxygen measurements appear to be predictive of ulcer or surgical wound healing. The diagnosis of PAD (and the decision to revascularize) in patients with diabetes is unreliable using screening tests. Therefore, all patients with diabetes-related foot ulceration should be assessed by a multidisciplinary diabetes foot team that has access to a vascular specialist. A low threshold for noninvasive diagnostic imaging seems appropriate in patients with diabetes-related foot ulceration.
糖尿病相关足部并发症是截肢的主要原因。外周动脉疾病（PAD）的存在表明患者发生溃疡、溃疡不愈合以及截肢的风险增加。本系统评价评估了非侵入性筛查试验检测糖尿病患者PAD的能力。通过使用OVIDSP网站进行数据库检索，检索时间范围为1946年至2012年6月30日（MEDLINE®）以及1974年至2012年6月30日（EMBASE），以识别评估筛查试验在检测糖尿病患者PAD或预测临床结局方面效用的研究。共识别出13项报告了筛查试验敏感性和特异性数据的研究。没有单一的筛查试验能够可靠地识别或排除糖尿病患者的外周动脉疾病。尽管证据基础有限，但经皮氧测量似乎可预测溃疡或手术伤口愈合情况。使用筛查试验对糖尿病患者进行PAD诊断（以及决定是否进行血管重建）并不可靠。因此，所有糖尿病相关足部溃疡患者均应由能够获得血管专科医生帮助的多学科糖尿病足团队进行评估。对于糖尿病相关足部溃疡患者，采用低门槛的非侵入性诊断成像似乎是合适的。
