背景:糖尿病与软组织结构和功能的改变有关。然而,这种变化的方向性以及组织厚度或僵硬对糖尿病相关足部溃疡发病机制的影响程度尚不清楚.因此,本系统综述旨在总结糖尿病患者和非糖尿病患者足部软组织结构差异的现有证据。
方法:符合MOOSE和PRISMA指南,AMED,CINAHL,MEDLINE,ProQuest健康与医疗收藏,ProQuest护理和相关健康数据库,和WebofScience电子数据库被系统地搜索从数据库开始到2020年10月1日发表的研究[ProsperoCRD42020166614]。进一步筛选纳入研究的参考列表。使用麦克马斯特大学开发的用于定量研究的改良关键评估工具评估了方法学质量。
结果:总共有35项非随机观察性研究适合纳入。在这些之内,20项研究评估了足底组织厚度,19项研究评估了足底组织硬度,9项研究评估了跟腱厚度,5项研究评估了跟腱刚度结果。在55%的研究(11/20)中,有和没有糖尿病的人之间足底组织厚度没有发现显著差异,而在47%的研究中发现糖尿病患者足底组织硬度显著增加(9/19)。在44%的研究中(4/9),糖尿病患者的跟腱厚度显着增加,而在60%的研究(3/5)中,糖尿病患者和非糖尿病患者的跟腱硬度没有显著差异。
结论:本系统综述发现了一些糖尿病患者和非糖尿病患者之间软组织结构差异的证据。然而,这些差异是否独立导致糖尿病相关足部溃疡仍存在不确定性.方法学方法的异质性使得难以在不同研究中进行比较,方法学质量普遍不足。需要在明确定义的人群中使用标准化和验证的评估技术进行高质量的研究,以更充分地确定结构组织特性在糖尿病相关足部溃疡发病机理中的作用。
BACKGROUND: Diabetes mellitus is associated with changes in soft tissue structure and function. However, the directionality of this change and the extent to which either tissue thickness or stiffness contributes to the pathogenesis of diabetes-related foot ulcerations is unclear. Hence, this systematic
review aims to summarise the existing evidence for soft tissue structural differences in the feet of people with and without diabetes.
METHODS: In compliance with MOOSE and PRISMA guidelines, AMED, CINAHL, MEDLINE, ProQuest Health & Medical Collection, ProQuest Nursing & Allied Health Database, and Web of Science electronic databases were systematically searched for studies published from database inception until 1st October 2020 [Prospero CRD42020166614]. Reference lists of included studies were further screened. Methodological quality was appraised using a modified critical appraisal tool for quantitative studies developed by McMaster University.
RESULTS: A total of 35 non-randomised observational studies were suitable for inclusion. Within these, 20 studies evaluated plantar tissue thickness, 19 studies evaluated plantar tissue stiffness, 9 studies evaluated Achilles tendon thickness and 5 studies evaluated Achilles tendon stiffness outcomes. No significant differences in plantar tissue thickness were found between people with and without diabetes in 55% of studies (11/20), while significantly increased plantar tissue stiffness was found in people with diabetes in 47% of studies (9/19). Significantly increased Achilles tendon thickness was found in people with diabetes in 44% of studies (4/9), while no significant differences in Achilles tendon stiffness were found between people with and without diabetes in 60% of studies (3/5).
CONCLUSIONS: This systematic
review found some evidence of soft tissue structural differences between people with and without diabetes. However, uncertainty remains whether these differences independently contribute to diabetes-related foot ulcerations. The heterogeneity of methodological approaches made it difficult to compare across studies and methodological quality was generally inadequate. High-quality studies using standardised and validated assessment techniques in well-defined populations are required to determine more fully the role of structural tissue properties in the pathogenesis of diabetes-related foot ulcerations.