Kaiser Permanente, Southern California Pasadena, CA, United States of America.
Kaiser Permanente, Southern California Pasadena, CA, United States of America.
J Diabetes Complications. 2020 Sep;34(9):107624. doi: 10.1016/j.jdiacomp.2020.107624. Epub 2020 May 19.
Annually, up to 4% of people with diabetes present with a chronic foot ulcer. Quantitative real-time testing to identify patients at risk for ulceration can guide preventative care. Here, we assess whether a non-invasive optical imaging technique, Spatial Frequency Domain Imaging (SFDI), can identify patients at the highest risk for ulceration and predict ulcer onset.
We imaged 252 subjects with diabetes at Kaiser Permanente, Southern California. SFDI derived tissue biomarkers of microcirculation were compared between subjects with and without a history of ulceration, and subjects who did or did not develop ulcers after 1 year.
Feet of subjects at the highest risk (i.e. history of ulceration) had significantly lower hemoglobin in the papillary dermis (HbT), along with higher oxygenation (StO) due to poor extraction. These subjects also had more homogeneous hemoglobin spread in the reticular dermis (HbT) and tissue scattering (related to skin structure). Prediction based on HbT and tissue scattering identified new ulcerations and performed with sensitivity/specificity of 68.8%/64.8% and 75.0%/69.1%, respectively.
These results show that SFDI hemoglobin distribution and oxygenation biomarkers provide a quantitative basis for ulcer risk stratification and ulcer onset prediction.
每年，高达 4%的糖尿病患者会出现慢性足部溃疡。定量实时检测以识别有溃疡风险的患者可以指导预防护理。在这里，我们评估一种非侵入性光学成像技术，空间域频成像（SFDI），是否可以识别溃疡风险最高的患者，并预测溃疡的发生。
我们对加利福尼亚州南部凯泽永久医疗集团的 252 名糖尿病患者进行了成像。比较了有和无溃疡史的受试者以及 1 年后发生和未发生溃疡的受试者之间的 SFDI 衍生的微循环组织生物标志物。
处于最高风险（即有溃疡史）的受试者的乳头真皮中的血红蛋白（HbT）明显较低，同时由于提取不良，氧合（StO）较高。这些受试者的网状真皮（HbT）和组织散射（与皮肤结构有关）中的血红蛋白分布也更均匀。基于 HbT 和组织散射的预测可以识别新的溃疡，其敏感性/特异性分别为 68.8%/64.8%和 75.0%/69.1%。
这些结果表明，SFDI 血红蛋白分布和氧合生物标志物为溃疡风险分层和溃疡发生预测提供了定量依据。
