Masson E A, Hay E M, Stockley I, Veves A, Betts R P, Boulton A J
Department of Medicine, Manchester Royal Infirmary, Sheffield, UK.
Diabet Med. 1989 Jul;6(5):426-8. doi: 10.1111/j.1464-5491.1989.tb01198.x.
Both rheumatoid arthritis and diabetes have been associated with the development of abnormally high pressures under the feet, and ulceration has been considered to be a problem in both conditions. In order to examine further the relationship between high foot pressure, neurological abnormalities, and ulceration, we have studied two groups of patients: (a) 38 diabetic patients and (b) 37 patients with rheumatoid arthritis who had similar clinical abnormalities of the feet. Thirty-two percent of diabetic patients had a history of plantar ulceration compared with none of the rheumatoid group (p less than 0.01). However, the diabetic group had considerably more severe neuropathy (peroneal nerve motor conduction velocity 35.4 +/- 4.8 m s-1 vs 44.4 +/- 5.2 m s-1 (mean +/- SD), p less than 0.001; vibration perception threshold 33.5 +/- 13.4 vs 16.9 +/- 10.9, p less than 0.001), with a similar frequency of elevated plantar pressures (51% vs 61%, NS). These data emphasize the importance of the loss of sensory awareness in the pathogenesis of diabetic foot ulceration, and suggest that high pressure alone is not a direct cause of ulceration.
类风湿性关节炎和糖尿病都与足部异常高压的形成有关，并且溃疡一直被认为是这两种病症都会出现的问题。为了进一步研究足部高压、神经功能异常与溃疡之间的关系，我们对两组患者进行了研究：（a）38名糖尿病患者和（b）37名患有足部类似临床异常的类风湿性关节炎患者。32%的糖尿病患者有足底溃疡病史，而类风湿组无一例有此病史（p<0.01）。然而，糖尿病组的神经病变要严重得多（腓总神经运动传导速度为35.4±4.8米/秒，而另一组为44.4±5.2米/秒（平均值±标准差），p<0.001；振动感觉阈值为33.5±13.4，而另一组为16.9±10.9，p<0.001），足底压力升高的频率相似（分别为51%和61%，无显著性差异）。这些数据强调了感觉功能丧失在糖尿病足溃疡发病机制中的重要性，并表明单纯的高压并非溃疡的直接病因。
