踝肱指数在糖尿病周围血管病变中的应用

踝肱指数是一种简单、有效的评估周围血管疾病的指标,可通过观察下肢血管的血流量,快捷、非侵入性的筛选早期动脉粥样硬化.近年来广泛用于糖尿病患者外周血管病变的诊断和预后分析,对糖尿病患者下肢动脉病变的筛查、随访以及预防坏疽有重要的临床价值.本文从踝肱指数测量、诊断标准、影响因素、临床运用等方面作一综述.     

糖尿病患者外周血管病变的特征

目的观察糖尿病患者的外周动脉的病变特征。方法采用彩色多普勒超声技术对糖尿病（DM）患者及非糖尿病（N-DM）患者的外周动脉粥样硬化斑块、狭窄以及闭塞性病变特征进行观察。结果与N-DM组比较,DM组外周动脉的内-中膜厚度（IMT）、狭窄血管大小、血管闭塞率、闭塞血管大小及闭塞血管回声差异无统计学意义,但斑块总面积显著增加（P〈0.05）,斑块回声积分显著减小（P〈0.01）,血管狭窄率显著增加（P〈0.01）。结论糖尿病可使患者的外周动脉粥样硬化病变更严重,使中型动脉的狭窄几率更高,但闭塞性病变与非糖尿病患者无差异。     

踝臂血压比值在心血管疾病和糖尿病中的应用价值

糖尿病合并外周血管病变发生率较高,且严重,其病理学基础是动脉粥样硬化,但因其早期无症状,临床表现不如心、脑血管病变突出,而易被医务人员和病人所忽视,从而丧失早期诊断和干预的机会。近年来血管超声成像、CT和MRI成像等影像学方法的快速发展,使外周血管病变的诊断长期依赖于动脉造影方法的状况成为历史,但由于其造价昂贵、技术要求较高,而影响了其在基层单位的使用。通过测量上臂与踝部血压,计算踝臂血压比值,即ABI(Ankle-Brachial In-dex),是一种简便、迅速,非侵入性的血管检查方法,其在临床实践中得到了越来越广泛的应用。一、A…     

彩超用于早期诊断糖尿病患者下肢血管病变的临床价值

目的探讨彩色多普勒超声用于早期诊断糖尿病下肢血管病变的临床价值。方法随机选择2014年1月—2015年6月到大安市第一医院就诊的90例糖尿病患者和90例非糖尿病患者为研究对象,两组患者均行彩色多普勒超声检查,比较分析两组的检查结果。结果糖尿病患者中,65例患者出现动脉粥样硬化,76例患者出现动脉斑块,69例患者出现管腔狭窄或闭塞,下肢动脉血流流速为(34.24±3.78)cm/s,血流量为(27.41±9.79)mL/min,下肢血管病变诊断0~3级的患者数量分别为23、37、18和12例;非糖尿病患者中,7例患者出现动脉粥样硬化,23例患者出现动脉斑块,15例患者出现管腔狭窄或闭塞,下肢动脉血流流速为(43.61±3.87)cm/s,血流量为(47.39±10.12)mL/min,下肢血管病变诊断0~3级的患者数量分别为75、11、4和0例,两组之间的差异均具有统计学意义(P0.05或0.01)。结论彩色多普勒超声能够早期诊断糖尿病下肢血管病变,具有较高的临床价值,可以推广应用。     

老年高血压患者外周血管动脉粥样硬化相关危险因素分析

目的探讨老年高血压患者外周血管动脉粥样硬化相关危险因素及治疗情况。方法选取我院干部病房212例≥75岁的原发性高血压3级住院患者,依据原始病历记载情况,将212例高血压患者分为外周血管动脉粥样硬化组118例及非外周血管动脉粥样硬化组94例,对两组基线资料及治疗前后动脉参数情况进行χ2或t检验,比较分析两组之间的差异。同时,进一步对两组基线资料进行Logistic回归分析,探讨老年高血压外周血管动脉粥样硬化的高度危险因素。结果外周血管动脉粥样硬化组与非外周血管动脉粥样硬化组年龄、病程、合并高脂血症、糖尿病、IGR及高尿酸血症比例有明显统计学差异(P<0.05),而吸烟、肥胖在两组之间无统计学意义。多因素非条件Logistic回归分析结果显示年龄、高脂血症、糖尿病及IGR是高血压合并外周血管动脉粥样硬化的高度危险因素(P<0.01)。结论积极防治,早期强化降压、降糖、调脂治疗及生活方式的干预对于高血压的治疗尤为必要。     

2型糖尿病并高脂血症患者足背动脉的超声评价探讨

目的总结2型糖尿病并高脂血症(糖尿病组)患者足背动脉的超声检测方法以及应用价值。方法选取该院在2016年1月—2017年1月所接诊的47例2型糖尿病并高脂血症患者资料实施回顾性分析,所选47例患者全部接受二维和彩色多普勒超声检查,同期选取43例非2型糖尿病并高脂血症(非糖尿病组)患者资料进行对比。结果糖尿病组患者足背动脉粥样硬化病变、动脉狭窄以及闭塞的出现几率显著高于非糖尿病组;糖尿病组患者足背动脉收缩期血流峰值速度(PSV)显著低于非糖尿病组患者,两组比较差异有统计学意义(P0.05)。结论临床中开展超声检测足背动脉能够有效反应患者下肢远端小动脉粥样硬化,属于评估2型糖尿病周围血管病变程度的重要方式,能够为2型糖尿病患者肢端血管病变的早期诊断与治疗提供可靠的临床数据。     

2型糖尿病患者下肢动脉粥样硬化性闭塞症的超声表现及危险因素分析

2型糖尿病合并下肢动脉粥样硬化是糖尿病常见的并发症之一,是导致下肢截肢的主要原因〔1〕。超声检查能较临床症状更早地诊断下肢动脉病变,已得到广泛认可,但对于下肢动脉病变形成的相关危险因素仍未完全确定。本研究应用彩色多普勒超声对糖尿病患者下肢血管动脉粥样硬化的发生     

超声在诊断糖尿病并发肾病患者中的应用

目的对临床糖尿病肾病患者采用超声检查技术的诊断效果进行比较分析,探讨超声结果对患者临床诊断效果的影响。方法分析采用各项超声检查对糖尿病肾病患者诊断效果的差异。结果糖尿病肾病患者早期血、尿检查结果正常时,可根据超声检查结果确定肾脏体积及血流变化。结论超声在动态监测糖尿病肾病患者早期诊断及病程进展等方面的准确度明显高于其它方法,特别是三维超声技术和超声弹性成像准确度更高。     

“动脉粥样硬化临床前期病变干预研究”的课题设计

当前动脉粥样硬化性疾病严重威胁人类健康已成为人们的共识。既往多基于危险因素及是否已经发生冠心病、卒中糖尿病等疾病对高危患者进行干预。然而,约半数心肌梗死和卒中发生于表面健康且低密度脂蛋白胆固醇（LDL—C）无明显升高者¨。,如何在传统心血管疾病危险因素之外进行动脉粥样硬化性疾病高危患者的早期诊断、早期干预至关重要,因此人们开始重视动脉粥样硬化性疾病临床前期病变（preclinical atherosclerosis,PCA）的研究。PCA通常指已有客观的动脉硬化证据,而尚无重要动脉血管（如冠状动脉、脑动脉、肾动脉以及外周动脉）严重粥样硬化狭窄而导致明确相应临床症状的情况,也有人称为亚临床动脉粥样硬化病变（subclinical atherosclerosis）。     

彩色多普勒超声在2型糖尿病外周血管病变早期诊断中的价值

目的对彩色多普勒超声在2型糖尿病外周血管病变早期诊断中的价值进行分析。方法选择2014年1月-2015年12月间,我院收治的获得临床明确诊断的2型糖尿病患者56例作为观察组,另取同期健康体检者60例作为对照组,对这两组受试者展开彩色多普勒超声检查,对外周血管情况进行探析。结果观察组患者中内-中膜厚度不足1.0mm者所占比例低于健康对照组(P0.05);内-中膜厚度超过1.0mm者所占比例显著高于健康对照组(P0.05);出现粥样斑块者所占比例明显较健康对照组高(P0.05)。结论经彩色多普勒超声检查可对2型糖尿病外周血管病变做出准确的判断,为临床诊疗提供可靠的参考依据,值得关注并推广。     

早期2型糖尿病患者内皮依赖性血管舒张功能改变的研究

目的　探讨早期 2型糖尿病患者内皮功能的变化。方法　选择 5 0例无血管并发症的 2型糖尿病患者 ,和 2 5例年龄、性别匹配的健康个体。采用高分辨血管外超声法检测肱动脉血流介导的内皮依赖性血管舒张功能和硝酸甘油 (GNT)介导的内皮非依赖性血管舒张功能。结果　2型糖尿病组血流介导的血管舒张功能为 3 .62 % ,明显低于对照组的 4.68% (P <0 .0 5 )。基础血管内径、基础血流、GNT介导的血管舒张功能在 2组间无明显差异 (P >0 .0 5 )。结论　早期 2型糖尿病患者内皮依赖性血管舒张功能降低。     

A truncated ultrasound screening procedure for atheroma of the cervical arteries in asymptomatic diabetic patients: Evidence from a retrospective study

AIM: To demonstrate that ultrasound screening of diabetic patients presenting with no cerebrovascular symptoms for evaluation of atheroma of the cervical arteries can be limited to the carotid arteries. METHODS: We retrospectively analyzed the results of cervical artery ultrasound imaging of diabetic patients with no cerebrovascular symptoms. This diabetic population was divided into two subpopulations according to whether or not the vertebral and subclavian artery findings were normal or abnormal. RESULTS: Of the 760 patients who fulfilled the criteria for study inclusion, the ultrasound imaging findings of the vertebral and subclavian arteries were normal in 712 cases. Review of the files of the 48 remaining patients showed that findings for either the vertebral or subclavian arteries did not lead to any changes in patient management because of associated risk factors, carotid atheroma or peripheral arterial disease. CONCLUSION: A vascular risk evaluation in diabetic patients could include ultrasound imaging assessment for cervical artery atheroma and our data suggest that such an evaluation could be focused solely on the carotid arteries.     

基质金属蛋白酶-9、C反应蛋白与2型糖尿病患者颈动脉粥样硬化的相关性研究

目的:探讨基质金属蛋白酶-9(MMP-9)、C反应蛋白(CRP)与2型糖尿病颈动脉粥样硬化的关系, 方法:用酶联免疫法测定50例单纯2型糖尿病患者(A组)及50例2型糖尿病合并颈动脉粥样硬化患者(B 组)的血清MMP-9、CRP水平,通过彩色多普勒超声测量颈动脉内中膜厚度、斑块及血管狭窄情况判断颈动脉粥样硬化。结果:B组血清MMP-9、CRP水平分别为600.30 ng/ml、5.98 mg/L,较A组血清MMP-9、CRP水平284.05 ng/ml、3.46 mg/L明显增高,两组相比均有极显著性差异(P<0.01)。调整混杂因素后B组血清MMP一9、CRP水平仍较A组高(369.52 ng/ml比153.16 n/ml及4.03 mg/ml比2.19 mg/L),且两组相比有极显著性差异(P<0.01)。结论:MMP-9、CRP在2型糖尿病大血管病变的发生发展中起着重要作用。     

Commentary: SGLT inhibitors in type 1 diabetes: Place in therapy and a risk mitigation strategy for preventing diabetic ketoacidosis - the STOP DKA protocol

In the accompanying article, Goldenberg et al. review the promotion of diabetic ketoacidosis by SGLT2 inihibitors. They have carried out a metanalysis showing a 3.5-fold increase in the risk of diabetic ketoacidosis (DKA) in patients with type 1 diabetes under treatment with SGLT2 inhibitors. They make a number of suggestions for attempting to mitigate the risk of DKA in these patients, notably including blood ketone monitoring and the use of supplemental carbohydrates with additional insulin when ketones suggest incipient DKA. Their proposal merits evaluation in a clinical trial involving type 1 diabetes, which should also assess the possible cardiorenal benefits demonstrated with treatment with SGLT2 inhibitors in type 2 diabetes.     

糖尿病足动脉血管早期病变行彩色多普勒超声诊断对定位准确、无创性的价值研究

目的分析探讨给予糖尿病足动脉血管早期病变患者彩色多普勒超声诊断取得的临床应用价值,分析探究其定位准确以及无创价值。方法选取2018年1月—2020年8月该院收治的糖尿病足动脉血管早期病变患者作为研究对象,确诊患者共计112例,在诊断过程中均采取彩色多普勒超声诊断、超声造影检查,同时将X线数字减影血管造影的诊断结果作为金标准,评估分析应用彩色多普勒超声诊断、超声造影检查取得的诊断效果。结果彩色多普勒超声诊断的确诊率为98.21%,误诊率为1.79%,和超声造影检查结果、金标准进行比较,差异无统计学意义(χ²=4.073,P>0.05);对比分析采取3种诊断措施以后患者血管病变状况,差异无统计学意义(Z=0.500,P>0.05)。对比分析超声造影以及彩色多普勒超声应用后脉搏波传导速度以及踝肱指数、脉压指数,差异有统计学意义(t=12.027、11.685、25.017,P<0.05)。结论给予糖尿病足动脉血管早期病变患者彩色多普勒超声诊断措施对于准确分析血管病变情况具有积极意义,具有较高的定位准确以及无创价值。     

2型糖尿病脂肪肝的筛查及相关因素分析

目的　探讨2 型糖尿病(T2DM)伴脂肪肝的患病率与相关因素。　方法　对400 例T2DM患者进行临床、生化、瘦素、C肽与肝脏超声检查。　结果　T2DM患者脂肪肝的患病率为46%,该组的体质指数(BMI)、舒张压显著高于无脂肪肝组(P<0.05),甘油三酯(TG)、1 h与2 h C肽、瘦素水平显著高于无脂肪肝组(P<0.01);Logistic逐步回归分析显示1 h C肽、瘦素、TG水平升高,与脂肪肝的发生呈正相关关系。　结论　T2DM患者脂肪肝患病率明显升高,且与BMI、TG、C肽、瘦素水平呈正相关。     

Diabetic retinopathy: A predictor of coronary artery disease

BackgroundDiabetes mellitus is a vascular disease with many microvascular manifestations as retinopathy and macrovascular complications as coronary artery disease. A large number of diabetics with retinopathy may have unidentified coronary artery disease.ObjectiveEvaluate whether diabetic retinopathy is a valid predictor of coronary artery disease.Study designCross section study.Patients and methodsThe study included 60 male patients chosen randomly from diabetic and ophthalmologic outpatient clinics. Twenty patients had type 2 diabetes mellitus with nonproliferative retinopathy, 20 patients with proliferative diabetic retinopathy and 20 patients with type 2 diabetes mellitus without retinopathy. All studied cases were not previously identified as coronary artery disease. Clinical examination stressed on conventional cardiovascular risk factors; duration, degree of control of hyperglycemia and erectile failure. Lipogram, urinary albumin excretion, resting, exercise ECG and echocardiography were carried out. All patients were subjected to fundus examination for evaluation of diabetic retinopathy and duplex ultrasound to assess carotid intimal medial thickness. Coronary angiography was undertaken for all cases.ResultsThere was no significant difference regarding age, BMI and blood pressure between the groups. However, duration of diabetes, erectile dysfunction and neuropathy revealed significant difference between different groups particularly the proliferative in relation to the nonproliferative diabetic group. Hypertriglyceridimia, urinary albumin excretion and serum cholesterol differ significantly between the studied groups. The ECG, echocardiography showed insignificant differences. Carotid intima media thickness showed an insignificant difference when comparing the three studied groups, however diabetic retinopathy group with coronary artery stenosis revealed a significant increase in carotid media thickness. Evidence of coronary artery stenosis was present in 80% of the proliferative diabetic retinopathy group and in 70% of the nonproliferative diabetic retinopathy group but was not present in nonretinopathic diabetic group. The stenotic lesions were involving one or two vessels. No one had left main disease.ConclusionDiabetic retinopathy is a good predictor of coronary artery disease that exceeds the conventional risk factors. Diabetics with retinopathy would benefit from early coronary angiography and diabetic retinocoronary clinics are warranted.     

Ultrasonographic evaluation of pes anserinus tendino-bursitis in patients with type 2 diabetes mellitus

OBJECTIVE: To assess musculoskeletal ultrasonographic (US) findings in patients with type 2 diabetes mellitus (DM) with and without pes anserinus (PA) tendinitis or bursitis syndrome; and to determine possible etiologic factors such as systemic diabetic microvascular disease complications in these patients. METHODS: The knee joints were examined with an ultrasound real-time scanner using a 10 MHz electronic linear transducer in 48 patients with type 2 DM and 25 controls. The presence of systemic diabetic microvascular disease complications was evaluated. RESULTS: On examination 23 (23.9%) knees of the 14 (29.1%) patients with type 2 DM were found to have PA tendinitis or bursitis syndrome. US revealed that only 4 (8.3%) of the diabetic patients with PA tendinitis or bursitis syndrome had PA tendonitis findings. There were no significant differences in the thickness of PA tendons between the diabetic patients with bilateral knee PA tendinitis or bursitis syndrome (9 patients) and controls, or between the asymptomatic and symptomatic knees in patients with unilateral PA tendinitis or bursitis syndrome (5 patients). The prevalence of morphologic changes of the medial meniscus, effusion and synovitis in the suprapatellar recess, popliteal cyst, and radiographic osteoarthritis (OA) in the diabetic patients with PA tendinitis or bursitis syndrome was found to be increased. CONCLUSION: The prevalence of PA tendinitis or bursitis syndrome is not uncommon on examination in patients with type 2 DM. However, patients with clinically diagnosed PA tendinitis or bursitis syndrome less frequently have morphologic US changes of the PA tendons. Our results also suggest that structural changes such as meniscus lesions that occur in consequence of OA might have a role in the etiology of medial knee pain in diabetic patients.     

Influence of long-term statin use in type 2 diabetic patients on thyroid nodularity in iodine-sufficient area

Statins have marked beneficial effects on lipid profile, but also have pleiotropic actions. A previous study in an iodine-deficient area suggested that statin use is associated with reduced thyroid volume and nodularity. We performed this study to investigate how long-term statin use in type 2 diabetic patients affects thyroid nodularity in iodine-sufficient area.We recruited euthyroid type 2 diabetic patients, receiving statin therapy continuously for at least 5 years (statin group) and, age and sex matched statin-naive type 2 diabetic patients (control group). Subjects with past history of cancer, thyroid disease or treatment with lithium or amiodarone; family history of thyroid cancer; palpable goiter or thyroid nodule, and/or positive thyroperoxidase antibody were excluded. The prevalence, number, and volume of thyroid nodules, size of thyroid were evaluated in all subjects by high resolution ultrasound.Prevalence of non-palpable thyroid nodules of statin group (n=70) and control group (n=98) were 51 and 53%, respectively. There was no difference of prevalence, number, and volume of non-palpable thyroid nodules and size of thyroid between statin and control group. But, the patients aged between 60 and 65 years from statin group showed lower prevalence of non-palpable thyroid nodules than the patients with same age interval from control group (4 out of 12 patients, 33%, statin group; 19 out of 27 patients, 70%, control group; P=0.04).Long-term statin use in elderly type 2 diabetic patients was associated with lesser prevalence of thyroid nodules in an iodine-sufficient area. Our data might support a possible antiproliferative effect of statins on thyroid in old type 2 diabetic patients. But, the effect was not as strong as that in an iodine-deficient area and further studies with enough numbers of subjects and revised design will be needed.     

血管回声跟踪技术检测2型糖尿病患者股动脉弹性

目的 应用血管同声跟踪(echo tracking,ET)技术评价2型糖尿病患者早期股动脉硬化.方法 选择60例2型糖尿病患者(糖尿病组)和60名体检结果正常者(对照组),以上对象均已行双侧股动脉常规高频超声检查排除斑块形成及狭窄,应用血管ET技术检测2组的双侧股动脉,比较2组的压力-应变弹性系数(Ep)、硬度指数(B)、顺应性(AC)及脉搏波传导速度(PWVβ).结果 糖尿病组的股动脉Ep、β、PWVβ均较对照组升高(均为P<0.01).AC较对照组降低(P<0.01).结论 血管ET技术能准确评价2型糖尿病患者早期股动脉弹性改变.为临床提供血管早期病变的诊断依据.