Screening techniques to identify people at high risk for diabetic foot ulceration - A prospective multicenter trial
Screening techniques to identify people at high risk for diabetic foot ulceration - A prospective multicenter trial
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DOI：
10.2337/diacare.23.5.606
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发表时间：
2000-05-01
期刊：
影响因子：
16.2
通讯作者：
Veves, A
中科院分区：
文献类型：
--
作者：
Pham, H;Harkless, LB;Veves, A
目的-糖尿病足溃疡是一种可预防的糖尿病长期并发症。一个多中心的前瞻性后续研究进行，以确定在足部筛查的风险因素有一个高关联的发展foot ulctionation.Research设计和方法-共248例患者从3个大型糖尿病足中心参加了一项前瞻性研究。在研究开始时，对所有患者的神经病变症状评分、神经病变残疾评分（NDS）、振动感知阈值（VPT）、Semmes-Weinstein单丝（SWFs）、关节活动度、足底峰值压力和血管状态进行评价。患者每6个月随访一次，平均30个月（范围6-40），记录所有新发足部溃疡。每个危险因素的敏感性，特异性和阳性预测值进行了evaluated.RESULTS -足部溃疡95英尺（19%）或73例（29%）在研究期间。发生足部溃疡的患者多为男性，糖尿病持续时间较长，足部脉搏不可触及，关节活动度降低，NDS高，VPT高，无法感觉到5.07 SWE NDS单独具有最佳灵敏度，而NDS和无法感觉到5.07 SWE的组合灵敏度达到99%。另一方面，单一因素的最佳特异性由足压提供，最佳组合是NDS和足压。单变量逻辑回归分析得出了性别、种族、糖尿病病程、可触脉、足部溃疡史、高NDS、高VPT、高SWF和高足部压力的统计学显著优势比（OR）。此外，95只溃疡足中有94只（99%）具有高NDS和/或NDS;这导致最高OR为26.2（95% CI 3.6-190）。此外，在多变量逻辑回归分析，只有显着的因素是高NDS，VPT，SWFs，和foot pressure.CONCLUSIONS -临床检查和5.07 μ m的测试是两个最敏感的测试，在确定患者的足部溃疡的风险，特别是当测试是相互结合使用。VPT测量也很有帮助，可以作为一种替代方法。最后，足部压力测量提供了相当高的特异性，并可用作筛选后测试结合提供适当的鞋类。
OBJECTIVE - Diabetic foot ulceration is a preventable long-term complication of diabetes. A multicenter prospective follow-up study was conducted to determine which risk factors in foot screening have a high association with the development of foot ulceration.RESEARCH DESIGN AND METHODS - A total of 248 patients from 3 large diabetic foot centers were enrolled in a prospective study. Neuropathy symptom score, neuropathy disability score (NDS), vibration perception threshold (VPT), Semmes-Weinstein monofilaments (SWFs),joint mobility, peak plantar foot pressures, and vascular status were evaluated in all patients at the beginning of the study Patients were followed-up every 6 months for a mean period of 30 months (range 6-40), and all new foot ulcers were recorded. The sensitivity, specificity, and positive predictive value of each risk factor were evaluated.RESULTS - Foot ulcers developed in 95 feet (19%) or 73 patients (29%) during the study. Patients who developed foot ulcers were more frequently men, had diabetes for a longer duration, had nonpalpable pedal pulses, had reduced joint mobility, had a high NDS, had a high VPT and had an inability to feel a 5.07 SWE NDS alone had the best sensitivity, whereas the combination of the NDS and the inability to feel a 5.07 SWF reached a sensitivity of 99%. On the other hand, the best specificity for a single factor was offered by foot pressures, and the best combination was that of NDS and foot pressures. Univariate logistical regression analysis yielded a statistically significant odds ratio (OR) for sex, race, duration of diabetes, palpable pulses, history of foot ulceration, high NDSs, high VPTs, high SWFs, and high foot pressures. In addition, 94 (99%) of the 95 ulcerated feet had a high NDS and/or SWF; which resulted in the highest OR of 26.2 (95% CI 3.6-190). Furthermore, in multivariate logistical regression analysis, the only significant factors were high NDSs, VPTs, SWFs, and foot pressures.CONCLUSIONS - Clinical examination and a 5.07 SWF test are the two most sensitive tests in identifying patients at risk for foot ulceration, especially when the tests are used in conjunction with each other. VPT measurements are also helpful and can be used as an alternative. Finally, foot pressure measurements offer a substantially higher specificity and can be used as a postscreening test in conjunction with providing appropriate footwear.