Bennett P J, Stocks A E, Whittam D J
School of Public Health, Queensland University of Technology, Australia.
J Am Podiatr Med Assoc. 1996 Mar;86(3):112-6. doi: 10.7547/87507315-86-3-112.
Diabetes mellitus affects about one in 25 Australians. Neuropathic foot ulceration is a frequent complication in persons with diabetes. This study evaluates the importance of different risk factors for the development of this condition. The role of nonenzymatic glycosylation and pressure beneath the sole of the foot in the pathogenesis of neuropathic foot ulcers was investigated. Twenty-seven subjects with diabetes with a recent history of neuropathic foot ulceration were matched by age and sex with a group of 50 control subjects without neuropathy or history of foot ulceration. The degree of nonenzymatic glycosylation was assessed by analyzing the average level of glycosylated hemoglobin in the 3 years prior to the development of the foot ulcer and a goniometer assessment of peripheral joint (hand and ankle) flexibility. Dynamic pressure of the plantar aspect of the foot was recorded using a Musgrave Footprint System pedobarograph during a normal gait cycle. There was no significant difference in age, sex, body mass index, and duration or type of diabetes between the ulcer and control groups. The pressure of the plantar aspect of the foot was significantly elevated (p < 0.01). Ankle joint flexibility was reduced (p < 0.01) in cases with neuropathic foot ulceration compared with the control group. There was a trend toward elevation of glycosylated hemoglobin (HbA1c fraction) or HbA1c in the ulcer group (p = 0.06). The results suggested that nonenzymatic glycosylation occurs at a more significant level in patients with diabetes with a history of neuropathic foot ulceration.
糖尿病影响着约每25名澳大利亚人中的1人。神经性足部溃疡是糖尿病患者常见的并发症。本研究评估了导致这种情况发生的不同风险因素的重要性。研究了非酶糖基化和足底压力在神经性足部溃疡发病机制中的作用。27名近期有神经性足部溃疡病史的糖尿病患者，按年龄和性别与50名无神经病变或足部溃疡病史的对照组受试者进行匹配。通过分析足部溃疡发生前3年糖化血红蛋白的平均水平以及用测角仪评估外周关节（手和脚踝）的灵活性来评估非酶糖基化程度。在正常步态周期中，使用Musgrave Footprint System足压计记录足底的动态压力。溃疡组和对照组在年龄、性别、体重指数、糖尿病病程或类型方面无显著差异。足底压力显著升高（p < 0.01）。与对照组相比，神经性足部溃疡患者的踝关节灵活性降低（p < 0.01）。溃疡组糖化血红蛋白（HbA1c组分）或HbA1c有升高趋势（p = 0.06）。结果表明，有神经性足部溃疡病史的糖尿病患者非酶糖基化水平更高。
