Can ultrasound measures of intrinsic foot muscles and plantar soft tissues predict future diabetes-related foot disease? A systematic review.
Can ultrasound measures of intrinsic foot muscles and plantar soft tissues predict future diabetes-related foot disease? A systematic review.
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DOI：
10.1371/journal.pone.0199055
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Thoirs K
中科院分区：
文献类型：
--
作者：
Morrison T;Jones S;Causby RS;Thoirs K
糖尿病（DM）与高血糖和晚期糖基化终产物有关。在足部，慢性或不受控制的糖尿病的后果是微血管和大血管疾病、神经病变、关节活动度降低以及结构和软组织变化，这些变化增加了溃疡发展和截肢的风险。糖尿病足评估目前包括全面的病史、神经和血管评估以及侧重于皮肤和肌肉骨骼异常的检查。虽然这些评估有助于预测溃疡风险，但缺乏能够进行早期治疗干预的直接标识符。本综述的目的是确定B型超声是否可以在临床上应用于识别糖尿病足的结构变化，并用作溃疡风险的早期预测因子。系统检索了原始数据库和灰色文献来源。选择标准是研究包括糖尿病样本，并使用B型超声评估足部的软组织结构（足底皮肤、足底脂肪垫或内在肌肉）。确定了15项研究纳入（合并773例糖尿病样本）。超声显示，与非糖尿病患者相比，糖尿病患者第一（p = 0.01）和第二（p = 0.03）跖骨头下的组织厚度减少，但第三跖骨头下的组织厚度没有减少（p = 0.24）。跖骨头4/5（I2 65%，81%）下超声厚度测量的统计异质性较高，足底皮肤（I2 98%）、足跟垫（I2 76%）和内在肌（I2 91%，81%）的统计异质性非常高。与健康对照组相比，糖尿病患者的趾短伸肌（EDB）超声测量值在所有维度上均显着较薄，但一项研究除外，该研究报告EDB厚度无显着差异。没有发现直接证据表明B型超声测量可以预测糖尿病患者足底软组织的变化，尽管低水平研究表明超声有可能识别结构变化。临床、方法学和统计学异质性限制了结果的适用性。这篇综述强调了需要强大的前瞻性纵向研究，以检查这种方法的预测有效性。
Diabetes mellitus (DM) is associated with hyperglycaemia and advanced glycosylation end-products. In the foot, the consequences of chronic or uncontrolled diabetes are micro and macrovascular disease, neuropathy, reduced joint mobility and structural and soft tissue changes that increase the risk of ulcer development and amputation. Diabetes foot assessment currently includes a comprehensive history, neurological and vascular assessments and examination focussed on dermatological and musculoskeletal abnormalities. Whilst these assessments are helpful for predicting ulceration risk, direct identifiers that enable early therapeutic intervention are lacking. The intention of this review was to ascertain if B-mode ultrasound could be clinically applied to identify structural change in the diabetic foot and be utilised as an early predictor of ulceration risk. Primary databases and grey literature sources were systematically searched. Selection criteria were that the study included a diabetic sample and used B-mode ultrasound to assess soft tissue structures of the foot (plantar skin, plantar fat pad or intrinsic muscles). Fifteen studies were identified for inclusion (combined diabetic sample of 773). Ultrasound demonstrated reductions in tissue thickness in diabetics compared to non-diabetics under first (p = 0.01) and second (p = 0.03) metatarsal heads, but not the third (p = 0.24). Statistical heterogeneity was high for ultrasound thickness measures under metatarsal heads four/five (I2 65%, 81%) and very high for plantar skin (I2 98%), heel pad (I2 76%) and intrinsic muscles (I2 91%, 81%). Extensor digitorum brevis (EDB) ultrasound measures were significantly thinner in diabetics for all dimension measures compared to healthy controls except one study, which reported no significant differences in EDB thickness. No direct evidence was found to indicate B-mode ultrasound measures can predict soft tissue changes in the plantar foot in diabetes, although low level studies indicate ultrasound has the potential to identify structural change. Clinical, methodological and statistical heterogeneity limit result applicability. This review highlights the need for robust prospective longitudinal research to examine the predictive validity of this method.
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