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目的调查和分析糖尿病足神经病变特点及相关因素。方法对全国14家医院的2004年全年门诊和住院糖尿病足患者进行统一调查,包括病史回顾、体格检查、生化检查等,对足溃疡进行分类、分期、神经病变特点及相关因素分析。结果纳入统计糖尿病足患者530例,神经性溃疡患者337例(63.6%)其中单纯性足部神经性溃疡172例(32.5%),合并下肢血管病变的混合性溃疡165例(31.1%),缺血性足部溃疡193例(36.42%)。足溃疡诱因物理因素占62.4%～84.9%。神经性足溃疡患者病程3(1,60)个月明显短于缺血性足溃疡组5(1,96)个月(P<0.001)。混合性足溃疡患者病程12(1,108)个月长于神经溃疡患者及缺血性溃疡患者(P<0.001)。足部溃疡程度Wagner 分级与糖尿病病程、经济收入、足畸形、膝反射、踝反射、足部音叉振动觉、尼龙丝感觉点、踝肱指数(ABI)、足部动脉搏动、空腹血糖及糖化血红蛋白呈相关关系;显著相关的因素是左胫后 ABI、右足音叉振动觉及经济收入。结论糖尿病足溃疡患者中神经性溃疡较常见,神经性损害预后优于血管性因素糖尿病足;混合性糖尿病足预后较差。周围神经病变中尼龙丝感觉点、足部音叉振动觉和肌腱反射的检查最为简单实用。
Objective To investigate and analyze the characteristics and related factors of diabetic foot neuropathy. Methods A total of 14 hospital outpatients and inpatients with diabetic foot in 2004 were surveyed, including history review, physical examination and biochemical examination. The classification, staging, neuropathy and related factors of foot ulcer were analyzed. Results Among 530 patients with diabetic foot disease, 337 patients (63.6%) had neurogenic ulcer, of which 172 (32.5%) had simple foot neuropathic ulcer, 165 (31.1%) had mixed ulcer with lower extremity vascular disease, Bloody foot ulcer in 193 cases (36.42%). The physical causes of foot ulcer inducement accounted for 62.4% ~ 84.9%. The duration of neuropathic foot ulcer patients was significantly shorter than that of ischemic foot ulcers for 3 (1,60) months and 3 (1,60) months (P <0.001). Patients with mixed foot ulcer had a duration of 12 (1,108) months longer than patients with neurogenic ulcers and ischemic ulcers (P <0.001). Foot ulcer degree Wagner classification and duration of diabetes, economic income, foot deformity, knee reflex, ankle reflex, foot tuning fork vibration sensation, nylon wire sensory points, ankle brachial index (ABI), foot artery pulse, fasting blood glucose and glycosylated hemoglobin The correlation was significant. The significant related factors were the ABI of the left tibia and the vibrational sensation of the right foot and the economic income. Conclusions Neuropathic ulcer is more common in patients with diabetic foot ulcer and the prognosis of neurological damage is better than that of vascular factor diabetic foot. Mixed diabetic foot is poor prognosis. Peripheral neuropathy in the feeling of nylon wire, foot tuning fork vibration and tendon reflex check the most simple and practical.