Holewski J J, Stess R M, Graf P M, Grunfeld C
Rehabilitation Research and Development Department, Veterans Administration Medical Center, San Francisco, California 94121.
J Rehabil Res Dev. 1988 Spring;25(2):1-10.
The Semmes-Weinstein pressure aesthesiometer, which measures cutaneous pressure sensation, was used for quantifying sensory loss in diabetic peripheral neuropathy. Eighty subjects comprising four groups were tested: nondiabetic controls (Group C); non-neuropathic, diabetic controls (Group DC); diabetic subjects with neuropathy and without a history of pedal ulcerations (Group DN); and, diabetic subjects with a history of or active pedal ulceration (Group DU). Cutaneous pressure sensation of 10 dorsal and plantar sites on the foot were tested, using a method of interval comparison modeled after the two-alternative forced choice algorithm. The sensitivity threshold level was defined as the lightest probe in which the subject accurately chose the correct interval in at least 2 out of 3 trials. The mean sensitivity threshold level for Group DC was not significantly increased (p greater than .05) compared to Group C. In contrast, patients with neuropathy (Group DN or DU) showed a significantly higher mean sensitivity threshold (p less than .001) than either Group C or DC. In addition, this technique demonstrated that patients in Group DU had a mean sensitivity threshold that was statistically higher (p less than .001) than Group DN, although both groups of patients had symptomatic neuropathy. This study provides a direct demonstration that decreased sensation of pressure occurs in the feet of diabetic patients with a history of ulceration. The best discrimination between groups is obtained by requiring that three of the six plantar forefoot sites have a sensitivity threshold level of greater than 5.07 log (0.1 mg) force as the risk discriminator level. Semmes-Weinstein aesthesiometry should now be tested in a prospective study to demonstrate its effectiveness in determining those patients at great risk of developing foot ulcers.
用于测量皮肤压力觉的Semmes-Weinstein压力觉测量仪，被用于量化糖尿病周围神经病变中的感觉丧失。对包括四组的80名受试者进行了测试：非糖尿病对照组（C组）；无神经病变的糖尿病对照组（DC组）；有神经病变且无足部溃疡病史的糖尿病受试者（DN组）；以及有足部溃疡病史或活动性足部溃疡的糖尿病受试者（DU组）。采用基于二项必选法算法的区间比较法，测试了足部10个背侧和跖侧部位的皮肤压力觉。敏感性阈值水平被定义为受试者在至少3次试验中的2次准确选择正确区间的最轻探针。与C组相比，DC组的平均敏感性阈值水平没有显著升高（p大于0.05）。相比之下，有神经病变的患者（DN组或DU组）的平均敏感性阈值显著高于C组或DC组（p小于0.001）。此外，该技术表明，尽管两组患者都有症状性神经病变，但DU组患者的平均敏感性阈值在统计学上高于DN组（p小于0.001）。这项研究直接证明，有溃疡病史的糖尿病患者足部会出现压力觉减退。通过要求跖侧前足六个部位中的三个部位的敏感性阈值水平大于5.07 log（0.1毫克）力作为风险判别水平，可以实现组间的最佳区分。现在应该在前瞻性研究中对Semmes-Weinstein触觉测量法进行测试，以证明其在确定那些有发生足部溃疡高风险患者方面的有效性。
