Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia.
Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia; Department of Endocrinology and Diabetes, Townsville University Hospital, Douglas, Queensland, Australia.
Wounds. 2021 Jul;33(7):192-196. doi: 10.25270/wnds/2021.192196.
Infected diabetic foot is the leading cause of hospital admissions for people with diabetes mellitus. Diabetic foot osteomyelitis (DFO) causes high morbidity and significant mortality. Current diagnostic tests for DFO are either expensive, invasive, or of low diagnostic yield.
The objective of the study was to determine whether serum levels of procalcitonin (PCT), an inflammatory marker, differ between DFO and diabetic foot ulcers without osteomyelitis (ie, cellulitis) as controls. The authors also aimed to assess the usefulness of PCT in diagnosing DFO.
A case-control study was designed comparing DFO with diabetic foot cellulitis as the control. Patients were classified as having osteomyelitis and cellulitis based on the International Working Group on the Diabetic Foot diagnostic criteria. Serum inflammatory markers PCT, adiponectin, C-reactive protein-1, osteoprotegerin (OPG), osteopontin (OPN), and interleukin 6 (IL-6) were analyzed in patients with DFO and controls.
The median serum procalcitonin was significantly higher in the DFO group 108.5 pg/mL (range, 65.0-124.0 pg/mL) compared with 57.0 pg/mL (range, 37.2-77.0 pg/mL) controls (P = .02). Procalcitonin had a sensitivity of 79% compared with 50%, 63%, 66%, and 75% for adiponectin, OPG, OPN, and IL-6, respectively. Procalcitonin had a specificity of 70% compared with 50%, 71%, 70%, and 64%. Receiver operator characteristic curves showed a value of area under the curve of 0.73 and 0.77 for PCT and IL-6 compared with 0.4, 0.6, and 0.6 for adiponectin, OPG, and OPN, respectively.
In this study, procalcitonin was a useful diagnostic test for DFOs and provided distinct diagnostic discrimination between DFO from cellulitis. It may serve as a useful marker for diagnosing DFO. Further studies in a larger population are needed to verify the findings.
感染性糖尿病足是导致糖尿病患者住院的主要原因。糖尿病足骨髓炎（DFO）会导致高发病率和显著的死亡率。目前用于诊断 DFO 的检测方法要么昂贵，要么具有侵入性，要么诊断效果不佳。
本研究旨在确定降钙素原（PCT）等炎症标志物在 DFO 与无骨髓炎（即蜂窝织炎）的糖尿病足溃疡之间是否存在差异，DFO 为病例组，糖尿病足蜂窝织炎为对照组。作者还旨在评估 PCT 在诊断 DFO 中的作用。
本研究采用病例对照设计，将 DFO 与糖尿病足蜂窝织炎作为对照组进行比较。根据国际糖尿病足工作组的诊断标准，将患者分为骨髓炎和蜂窝织炎。分析 DFO 患者和对照组患者的血清炎症标志物 PCT、脂联素、C 反应蛋白 1、骨保护素（OPG）、骨桥蛋白（OPN）和白细胞介素 6（IL-6）。
DFO 组的血清降钙素原中位数为 108.5pg/ml（范围 65.0-124.0pg/ml），明显高于对照组的 57.0pg/ml（范围 37.2-77.0pg/ml）（P=0.02）。降钙素原的敏感性为 79%，而脂联素、OPG、OPN 和 IL-6 的敏感性分别为 50%、63%、66%和 75%。降钙素原的特异性为 70%，而脂联素、OPG、OPN 和 IL-6 的特异性分别为 50%、71%、70%和 64%。受试者工作特征曲线显示，降钙素原和白细胞介素 6 的曲线下面积分别为 0.73 和 0.77，而脂联素、OPG 和 OPN 的曲线下面积分别为 0.4、0.6 和 0.6。
在这项研究中，降钙素原是一种有用的 DFO 诊断检测方法，可在 DFO 与蜂窝织炎之间进行明确的诊断区分。它可能是诊断 DFO 的有用标志物。需要在更大的人群中进行进一步的研究来验证这些发现。
