Abstract: Background　In recent years，the prevalence of diabetes is rising rapidly in China. Diabetic foot（DF）is one of the most severe chronic complications of diabetes. About 25% of patients with diabetes may have DF. Many factors affect the occurrence and development of DF. Lower limb artery occlusion and microcirculation dysfunction are mainly responsible for its prolonged treatment. As one method for detecting vascular lesions，transcutaneous oxygen measurement（TcPO2）can diagnose lower extremity arterial disease and evaluate microcirculation state. Objective　To investigate the value of TcPO2 in predicting healing of DF．Methods　A total of 102 patients with DF admitted in the Department of Endocrinology，Air Force General Hospital，PLA from February to June 2017 were enrolled.All subjects were divided into severe ischemia group （24 cases，TcPO2≤20 mm Hg），mild-to-moderate ischemia group （42 cases，20 mm Hg<TcPO2<40 mm Hg） and non-ischemia group （36 cases，TcPO2≥40 mm Hg）．The general data and laboratory indexes of patients were collected.Ankle brachial index （ABI） of dorsum pedis and posterior tibia，toe-brachial index （TBI） and dorsal pedal artery blood flow were recorded.TcPO2 was detected and the healing was recorded after 12 weeks of follow-up.Results　Age and HbA1c levels in severe ischemia group were higher than those in non-ischemia group，triacylglycerol （TG），ABI of dorsum pedis and TBI were lower than those in non-ischemia group，the percentage of lower extremity arterial occlusion was higher than that of mild-to-moderate ischemia group，and ABI of dorsum pedis was lower than those of mild-to-moderate ischemia group （P<0.05）；the level of HbA1c in mild-to-moderate ischemia group was higher than that of non-ischemia group，and TBI of affected limb was lower than those of non-ischemia group （P<0.05）．After 12-week follow-up，1 case （4.2%） healed in severe ischemia group，12 cases （28.6%） in mild-to-moderate ischemia group，and 31 cases （86.1%） in non-ischemia group.The healing rate after 12 weeks of severe ischemia group and mild-to-moderate ischemia group was lower than that of non-ischemic group （P<0.017）．Receiver operating characteristics （ROC） curve showed that the area under ROC curve （AUC） of TcPO2 and ABI of dorsum pedis and posterior tibia  predicting DF healing were 0.874，0.691 and 0.650，respectively. When the optimal critical value of TcPO2 was 38.5 mm Hg，Youden index was 0.687，sensitivity was 77.3%，and specificity was 91.4%. Age and HbA1c were negatively correlated to TcPO2 level （P<0.05），TG，ABI of posterior tibia，TBI，blood flow of dorsalis pedis artery were positively correlated to TcPO2 level （P<0.05），12-week healing rate was correlated to TcPO2 level （P<0.05）．Conclusion　TcPO2 is better in predicting DF healing.The higher the level of TcPO2，the more likely DF is to heal.

Key words: Diabetic foot；Blood gas monitoring, transcutaneous；Forecasting；Healing

摘要： 背景　近年来糖尿病（DM）患病率明显上升，糖尿病足（DF）是DM的严重慢性并发症之一，约25%的DM患者会发生DF。多种因素影响着DF的发生、发展，其中下肢动脉闭塞及微循环障碍引起的下肢缺血缺氧是导致DF治疗周期长的主要原因。经皮氧分压（TcPO2）是检测血管病变的技术之一，可以评价肢体的微血管功能状态。目的　探讨足背TcPO2预测DF愈合的价值。方法　选取2017年2—6月空军总医院内分泌科住院的DF患者102例，根据患肢足背TcPO2将其分为重度缺血组24例（TcPO2≤20 mm Hg）、轻中度缺血组42例（20 mm Hg<TcPO2<40 mm Hg）及无缺血组36例（TcPO2≥40 mm Hg）。收集患者一般资料及实验室指标，记录患肢足背、胫后踝肱指数（ABI）、趾臂指数（TBI）、足背动脉血流量，检测TcPO2，并随访12周记录愈合情况。结果　重度缺血组年龄、糖化血红蛋白（HbA1c）水平均高于无缺血组，三酰甘油（TG）、患肢足背ABI、患肢TBI均低于无缺血组，下肢动脉闭塞率高于轻中度缺血组，患肢足背ABI低于轻中度缺血组（P<0.05）；轻中度缺血组HbA1c水平高于无缺血组，患肢TBI低于无缺血组（P<0.05）。随访12周后，重度缺血组愈合1例（4.2%），轻中度缺血组愈合12例（28.6%），无缺血组愈合31例（86.1%）。重度缺血组、轻中度缺血组的12周愈合率均低于无缺血组（P<0.017）。受试者工作特征（ROC）曲线显示，TcPO2、患肢足背ABI、患肢胫后ABI预测DF愈合的ROC曲线下面积（AUC）由大到小依次为0.874、0.691、0.650。当TcPO2的最佳临界值为38.5 mm Hg时，Youden指数为0.687，灵敏度为77.3%，特异度为91.4%。年龄、HbA1c与TcPO2水平均呈负相关（P<0.05）；TG、患肢足背ABI、患肢TBI、患肢足背动脉血流量与TcPO2水平均呈正相关；12周愈合情况与TcPO2水平存在相关关系（P<0.05）。结论　TcPO2对DF愈合有较好的预测价值，TcPO2越高，DF愈合的可能性越大。

关键词: 糖尿病足；血气监测, 经皮；预测；愈合