| Objective:To investigate the clinical significance of combined measurement of vibration perception threshold(VPT)and ankle brachial index(ABI)in early diagnosis of diabetic foot,and analyze the risk factors for early intervention.Method:2545 patients with type 2 diabetes admitted in Department Endocrinology,Zhongda hospital from 2006 to 2013,including diabetic foot group(n=167)and non-diabetic foot group(n=2378).All subjects execute(pain sensation,cold-warm temperature,tactile sensation,vibration pressure threshold)and ankle brachial index ABI detection.Comparing the prevalence of(ankle brachial index)and(vibration pressure threshold)with difference classified group.The receiver operating characteristic curve(ROC curve)were also analyzed,calculating the value of Z,comparing area under ROC curve for different detections.The risk factors of diabetic DF(Diabetic,foot)were analyzed using univariate and multivariate logistic regression,and Spearman correlation analysis among the factors was carried out.Result:1.Characteristics of subjectsThe sex,age,duration of disease,ankle brachial index,sensory threshold were normal distribution,independent t test showed that the two groups were not statistically significant.The age of diabetic foot group and non-diabetic foot group was(69.23 ± 11.05)years and(60.64 ±12.77)years old respectively,the difference was statistically significant(p<0.01).The duration of diabetes in two group was(11.24 ± 8.34)years,(8.07 ± 7.42)years,the difference was statistically significant(p<0.01).The ankle brachial index of right foot in diabetic foot group and non-diabetic foot group was(0.85 ± 0.38)and(1.08 ± 0.26),and the left foot was(0.89 ± 0.32)and(18.10 ± 7.08)respectively,the difference was statistically significant(p<0.01).There was a significant difference in VPT between the Diabetic foot group and non-diabetic foot group at hallux,the second metatarsal head,and fifth metatarsal head of both feet.The comparison of VPT with right foot was(25.95 ± 5.93)V and(18.10 ± 7.08)V at hallux,(25.36±6.21)V and(17.28±6.65)V at the second metatarsal head,and(25.68 ± 6.00)V and(17.43±6.73)V at the fifth metatarsal head.The comparison of VPT with left foot was(25.44 ± 6.02)V and(17.69 ± 6.28)V at hallux,(25.00±5.90)V and(17.04±6.53)V at the second metatarsal head,and(24.97 ± 5.94)V and(17.11±6.60)V at the fifth metatarsal head..Superficial sensation(pain,touch,cool temperature)were abnormal distribution,using the rate(%),the chi square test showed that diabetic foot group and non-diabetic foot group,tactile(loss)accounted for 4(2.4%)and 40(0.2%),tactile(decline)accounted for 97(57.4%)and 690(29%),tactile(normal)accounted for 68(40.2%)and 1682(70.8%),the difference was statistically significant(p<0.01).Diabetic foot group and non-diabetic foot group,pain(loss)accounted for 11(6.5%)and 33(1.4%),pain(decline)accounted for 138(81.7%)and 1719(72.3%),pain(normal)accounted for 20(11.8%)and 624(26.3%),the difference was statistically significant(p<0.01).Diabetic foot group and non-diabetic foot group cooltemperature(loss)accounted for 6(3.5%)and 22(0.9%),cool temperature(decline)accounted for 102(60.4%)and 718(30.2%),cooltemperature(normal)accounted for 61(36.1%)and1636(68.9%)there were statistically significant differences(p<0.01).2.Different ankle brachial index and sensory threshold range,comparing diabetic foot prevalence,rate of n(%)Comparison of different ankle brachial index group,0.9<ABI<1.3 group prevalence rate was 4.2%,0.7<ABI<0.9 group prevalence rate was 14.9%,0.4<ABI<0.7 group prevalence rate was 51.9%,while the ABI is less than or equal to 0.4,the prevalence rate was 23.3%.The prevalence rate of groups were compared statistically significant difference(P<0.01).Comparison of different vibration perception threshold group,VPT<10 in normal group,the prevalence rate was 1.3%,10<VPT<15 group,the prevalence rate were 1.5%,15<VPT<25 group prevalence rate was 6.4%,and the prevalence rate was 20.1%in group VPT>25.3.Univariate and multivariate regression analysis of diabetic footSingle factor Logistic regression analysis:age,duration of diabetes,VPT,superficial sensation(tactile,pain,cool temperature)were disease risk factor for patients with diabetic foot,the ABI was a protective factor(P<0.05).multivariate Logistic regression analysis:Only ABI,VPT,pain and tactile taken into the regression equation.The ABI was a protective factor,and VPT,pain,tactile were risk factors(P<0.05).4.Correlation analysis among factorsSpearman rank correlation analysis,age was positively correlated with VPT,and negatively correlated with ABI(p<0.05).The duration of diabetes was negatively correlated with ABI and positively correlated with VPT(p<0.05).VPT and ABI were negatively related to each other(P>0.05),no statistical significance.5.Comparing the difference of the ROC curve area for detection methodsComparison of the area under the ROC curve VPT,(R1,R2,R5)AUC were 0.8146,0.8278,0.8275,VPT(L1,L2,L5)AUC were 0.8065,0.8197,0.8153,tactile,pain,cool temperature AUC were 0.654,0.592,0.662,ABI(R,L)AUC were 0.674 and 0.670.ROC(VPT +ABI)AUC was 0.881.From the above AUC,the maximum areas were VPT(R2)and the comprehensive method,AUC 0.828 and 0.881,respectively.The difference was statistically significant(p<0.05).6.Diabetic foot,diagnostic sensitivity,specificity analysisVPT(R1,R2,R5)sensitivity were 76.5%,74.7%,76.5%,the specificity was 73.3%,77.3%and 76.8%respectively;VPT(LI,L2,L5)sensitivity were 73.5%,71.7%,69.3%,the specificity was 76.2%,79.5%and 78.7%respectively.The sensitivity of ABI(R and L)was 40.9%and 40.2%,respectively,and the specificity was 93.6%and 93.4%respectively.The sensitivity and specificity of the combined measurement(ABI+VPT)were 84.8%and 79.3%.Conclusion:1.Patients with type 2 diabetes with abnormal sensory perception and ABI have higher risk of diabetic foot.Even if the ABI is at the normal value,there are still chances to suffer peripheral artery disease.Decrease of the diagnostic efficiency of ABIis related to certain clinical situations such as neuropathy、calcification or foot wounds.The diagnosis of Diabetic foot with single ABI or VPT would decrease the diagnostic efficiency.Combined measurement analysis can improve the diagnosis efficiency,and advantages to the screening of high-risk groups of diabetic foot,to achieve early intervention and treatment.2.The ROC curve shows that the comprehensive(ABI+VPT)has the largest AUC implies the combined diagnosis efficiency is high.Among the method of sensory detection,diagnostic efficiency of vibration perception threshold is superior to the superficial sensation(tactile,pain,cool,temperature),and vibration perception threshold of each toe(hallux,2nd metatarsal,5th metatarsal)is not significantly different.3.Associated factors of diabetic foot:Loss of sensation in pain,tactile and VPT(R2)increased were risk factors of diabetic foot,odd ratio(OR>1);ABI increased within the cutpoint of 1.3 was a protective factor,odd ratio(OR<1). |
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