Leenstra Bernard, de Kleijn Robert, Kuppens Geoffrey, Verhoeven Bart Arnoldus Nicolaas, Hinnen Jan Willem, de Borst Gert J
Department of Vascular Surgery, UMC Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ 's-Hertogenbosch, The Netherlands.
J Clin Med. 2020 Oct 14;9(10):3291. doi: 10.3390/jcm9103291.
Currently, transcutaneous oxygen tension measurement (TCpO2) is the most favorable non-invasive test for diabetic foot ulcer (DFU) healing prognosis. Photo-optical TCpO2 is novel, less time-consuming and more practical in use compared to regular electro-chemical TCpO2. We prospectively investigated the clinical value of photo-optical TCpO2 to predict DFU healing. Patients with suspected DFU undergoing conservative treatment underwent an ankle pressure, toe-pressure and photo-optical TCpO2 test. The primary endpoint was DFU wound healing at 12 months. Based on their clinical outcome, patients were divided into a DFU healing and DFU non-healing group. Healing was defined as fully healed ulcers and non-healing as ulcers that deteriorated under conservative treatment or that required surgical amputation. Differences between groups were analyzed and an optimal TCpO2 cut-off value was determined. In total, 103 patients were included, of which 68 patients (66%) were classified as DFU healing. The remaining 35 patients (34%) had deteriorated ulcers, of which 29 (83%) eventually required surgical amputation. An optimal TCpO2 cut-off value of 43 mmHg provided a sensitivity, specificity and odds ratio of 0.78, 0.56 and 4.4, respectively. Photo-optical TCpO2 is an adequate alternative tool to validate the vascular status of the lower extremity indicating healing prognosis in patients with DFU. Therefore, we recommend that photo-optical TCpO2 can be safely coapplied in clinical practice to assist in DFU treatment strategy.
目前，经皮氧分压测量（TCpO2）是评估糖尿病足溃疡（DFU）愈合预后最理想的非侵入性检测方法。与传统的电化学TCpO2相比，光光学TCpO2是一种新型检测方法，耗时更短且使用更便捷。我们前瞻性地研究了光光学TCpO2在预测DFU愈合方面的临床价值。对接受保守治疗的疑似DFU患者进行了踝部压力、趾部压力和光光学TCpO2检测。主要终点是12个月时DFU伤口愈合情况。根据临床结果，将患者分为DFU愈合组和DFU未愈合组。愈合定义为溃疡完全愈合，未愈合定义为在保守治疗下溃疡恶化或需要手术截肢的情况。分析了两组之间的差异，并确定了最佳的TCpO2临界值。总共纳入了103例患者，其中68例（66%）被归类为DFU愈合。其余35例患者（34%）溃疡恶化，其中29例（83%）最终需要手术截肢。最佳的TCpO2临界值为43 mmHg，其敏感性、特异性和优势比分别为0.78、0.56和4.4。光光学TCpO2是一种合适的替代工具，可用于评估下肢血管状况，提示DFU患者的愈合预后。因此，我们建议光光学TCpO2可安全地应用于临床实践，以辅助DFU治疗策略。
