Abbott C A, Vileikyte L, Williamson S, Carrington A L, Boulton A J
Department of Medicine, Manchester Royal Infirmary, U.K.
Diabetes Care. 1998 Jul;21(7):1071-5. doi: 10.2337/diacare.21.7.1071.
To investigate longitudinally prognostic factors for foot ulceration in a large population of diabetic patients with established neuropathy.
A double-blind multicenter study of a potential new agent for diabetic neuropathy provided the opportunity for this 1-year investigation since intervention demonstrated no efficacy in the condition. A total of 1,035 patients with NIDDM and IDDM were included. Inclusion criteria were vibration perception threshold (VPT) at the great toe > or = 25 V in at least one foot and < or = 50 V in both feet, normal peripheral circulation, and no previous foot ulceration. VPT and clinical components of the Michigan diabetic polyneuropathy (DPN) score were assessed at baseline and subsequent visits.
After 1 year, the incidence of first foot ulcers for the total population was 7.2%. Neuropathy parameters were the same between the treatment and placebo groups at baseline and were unchanged at 1 year; therefore, baseline data were combined for multiple regression analysis. VPT, age, and Michigan DPN scores for muscle strength and reflexes were significant independent predictors for first foot ulceration (P < 0.01). For each 1-U increase in VPT values at baseline, the hazard of the first foot ulcer increased by 5.6%. Similarly, for each 1-U increase in muscle strength and reflex components of the Michigan DPN scores, the hazard of the first foot ulcer increased by 5.0%.
Tests of VPT and Michigan DPN scores for muscle strength and reflexes are useful clinical predictors for foot ulceration in diabetic patients with established neuropathy. The rate of subsequent ulceration in the following year was alarmingly high, however, despite standardized foot care education at baseline and regular follow-up visits.
纵向研究大量已确诊神经病变的糖尿病患者足部溃疡的预后因素。
一项关于糖尿病神经病变潜在新药的双盲多中心研究为这项为期1年的调查提供了机会，因为干预措施在该疾病中未显示出疗效。共纳入1035例非胰岛素依赖型糖尿病（NIDDM）和胰岛素依赖型糖尿病（IDDM）患者。纳入标准为至少一只脚的大脚趾振动觉阈值（VPT）≥25V且双脚≤50V、外周循环正常且既往无足部溃疡。在基线和后续随访时评估VPT以及密歇根糖尿病多发性神经病变（DPN）评分的临床指标。
1年后，总体人群中首次发生足部溃疡的发生率为7.2%。治疗组和安慰剂组在基线时的神经病变参数相同，1年后也未改变；因此，将基线数据合并进行多元回归分析。VPT、年龄以及密歇根DPN评分中肌肉力量和反射部分是首次足部溃疡的显著独立预测因素（P<0.01）。基线时VPT值每增加1U，首次足部溃疡的风险增加5.6%。同样，密歇根DPN评分中肌肉力量和反射部分每增加1U，首次足部溃疡的风险增加5.0%。
VPT检测以及密歇根DPN评分中肌肉力量和反射部分对已确诊神经病变的糖尿病患者足部溃疡是有用的临床预测指标。然而，尽管在基线时进行了标准化的足部护理教育并定期随访，但次年后续溃疡的发生率高得惊人。
