1型糖尿病患者的足底压力变化及其相关因素分析

目的分析1型糖尿病（type 1 diabetes mellitus，T1DM）患者足底压力的变化及相关因素。 方法T1DM患者40例，检测入组时及2年后足底10个区域的足底压力，记录相关临床资料。 结果经过2年时间，T1DM患者第2、3跖骨头部位的多项足底压力增加，足跟内、外侧的冲量和足跟外侧的压强-时间积分降低。患者第2、3跖骨头及足跟内、外侧的足底压力增加与血清总胆固醇水平增加有关（β=0.366~0.495，P＜0.05）；第2、3跖骨头部位的足底压力增加与研究期间出现足底胼胝有关（β=0.259~0.448，P＜0.05）；第2跖骨头的足底压力增加与糖化血红蛋白增加有关（β=0.248~0.320，P＜0.05）；第3跖骨头最大压力增加与感觉神经传导速度变化有关（β=-0.327，P=0.026）。 结论随着病程延长，T1DM患者第2、3跖骨头部位足底压力增高。足底压力的变化与总胆固醇、糖化血红蛋白、感觉神经传导速度及研究期间足底胼胝的出现相关。

Plantar pressure changes and correlating factors in the patients with type 1 diabetes

ObjectiveTo assess the plantar pressure changes and correlating risk factors in the patients with type 1 diabetes(T1DM).MethodsA total of 40 patients with T1DM were recruited in this study. Plantar pressure was obtained from 10 foot regions at enrollment and two years later. Additionally, some relevant clinical data were recorded.ResultsOver the course of 2 years, significant plantar pressure increase in the second and third metatarsal heads was found(P＜0.05). Decrease of impulse under the medial and lateral side of the heel and pressure time integral under the lateral side of the heel were also identified(P＜0.05). The increase of plantar pressure in the second and third metatarsal heads and under the medial and lateral side of the heel was correlated with increased serum total cholesterol(TC)(β=0.336-0.495， P＜0.05). The increase of plantar pressure in the second and third metatarsal heads was correlated with the appearance of calluses during the study period(β=0.259-0.448， P＜0.05). In addition, the increase of plantar pressure in the second metatarsal head was correlated with the change of hemoglobin A1c(β=0.248-0.320， P＜0.05). The increase of maximum pressure in the second metatarsal head was correlated with the change of sensory nerve conduction velocities(SCV) (β=-0.327， P=0.026).ConclusionWith the prolongation of the disease course, the plantar pressure of the second and third metatarsal heads among the patients with T1DM was increased significantly. The increase of plantar pressure was correlated with the changes of serum TC level, hemoglobin A1c, SCV and the appearance of calluses.