ABI、PWV与冠心病危险因素关系的研究

目的:综合评价ABI、PWV与冠心病危险因素的关系.方法:对我院因冠心病住院并行冠状动脉造影的心脏病患者的ABI、PWV及相关危险因素进行回顾性分析.结果:经冠脉造影证实657例患者中冠心病患者为506例;吸烟或曾经吸烟5年以上者、高血压、糖尿病、脂代谢异常冠心病患者明显高于非冠心病患者(P＜0.01);肥胖冠心病患者高于非冠心病患者(P＜0.05);有吸烟、高血压、糖尿病、脂质代谢异常、肥胖患者的ABI数值有明显下降趋势,PWV数值有明显增高趋势(P＜0.05);严重冠心病患者(双支以上病变且血管狭窄≥70%)共186例,其ABI、PWV值与非冠心病患者差异有显著统计学意义(P＜0.01).结论:吸烟、高血压、糖尿病、血脂异常、肥胖均可影响冠心病的发生发展,ABI、PWV可以表现各种危险因素对冠状动脉所造成的综合影响.     

Prospective randomized controlled study of a Chinese herbal medicine compound Tangzu Yuyang Ointment for chronic diabetic foot ulcers: a preliminary report

Aim of the study

The purpose of this study was to evaluate the efficacy and safety of a topical Chinese herbal medicine (CHM) compound Tangzu Yuyang Ointment (TYO) for treatment of chronic diabetic foot ulcers.

Materials and methods

This multi-center, prospective, randomized, controlled and add-on clinical trial was conducted at seven centers in the China mainland. Fifty-seven patients with chronic diabetic foot ulcers of Wagner's ulcer grade 1-3 were enrolled in this study. Patients who were randomly assigned to the control group (n = 28) received standard wound therapy (SWT), whereas those randomized to the treatment group (n = 28) received SWT plus topical TYO. Only 48 patients who finished 24 weeks of observations were entered for data analysis.

Results

The TYO and SWT groups were comparable for baseline characteristics. Ulcer improvement was 79.2% in the TYO group and 41.7% in the SWT group (P = 0.017) at 12 weeks, and 91.7% vs. 62.5% (P = 0.036) at 24 weeks. The number of ulcers that were completely healed at 4, 12 and 24 weeks was similar in both groups, as were the numbers of adverse events. Healing time was 96 ± 56 days (n = 19) in the TYO group and 75 ± 53 days (n = 14) in the SWT group (P = 0.271).

Conclusion

TYO plus SWT is more effective than SWT in the management of chronic diabetic foot ulcers and has few side-effects.     

Pseudoexfoliation as a risk factor for peripheral vascular disease: a case-control study

Aim

To determine the association between pseudoexfoliation (PEX) and peripheral vascular disease (PVD) among age-related cataract.

Setting

Iladevi Cataract and IOL Research Center, Ahmedabad, India.

Material and methods

An observational age-matched case-control study of 160 patients over 60 years of age with age-related cataract. A total of 40 subjects with PEX (cases) were compared with 120 subjects with cataract but without PEX (controls). A detailed medical history, including hypertension, diabetes mellitus, cerebrovascular stroke and ischaemic heart disease, was recorded. Ankle brachial index (ABI) was used to determine the risk of PVD among age-related cataract patients. Color Doppler imaging was performed on the brachial and dorsalis pedis artery to measure ABI and detect PVD. Least mean ABI was the main outcome measure, as low ABI indicates higher risk for PVD. The lowest mean ABI was measured for each subject. An ABI ratio of <0.90 was considered abnormal. The Mann–Whitney U-test and logistic regression were used for analysis.

Results

The lowest mean ABI in the controls was 0.98±0.03 (SD; a range of 0.86–1.08) as compared with 0.88±0.02 (SD) among the cases (a range of 0.79–0.92; P<0.001). When compared with controls, cases had a lower ABI (P<0.001) irrespective of the presence or absence of systemic illness. On multiple regression analysis adjusting for systemic illness, the presence of PEX increased the odds of a low ABI group 150 times (P<0.001).

Conclusion

Subjects with cataract and PEX had a significantly lower ABI as compared with controls (cataracts without PEX). PEX is associated with and may be a risk factor for PVD.     

Tissue plasminogen activator (tPA) activity is a novel and early marker of asymptomatic LEAD in type 2 diabetes

Introduction

Lower extremity arterial disease (LEAD) is often one of the first signs of a generalized atherosclerotic disease in type 1 and type 2 diabetic subjects.

Materials and methods

We studied 143 diabetic subjects at 30-70 years of age, M/F 69/74, 74 with type 1 and 69 with type 2 diabetes, without previously known or suspected lower extremity arterial disease. The relationship between early asymptomatic lower extremity arterial disease and blood levels of HbA1c, lipids and fibrinolysis markers (tPA-activity, tPA mass, PAI-1 activity, tPA-PAI-1 complex) was assessed. In parallel, a group with non-diabetic subjects (n = 80) was studied.

Results

35 (24%) diabetic subjects were classified as having sign(s) of LEAD, defined as having at least one reduced peripheral blood pressure measurement, 28% in type 1 vs 20% in type 2 diabetic subjects (p = NS). In univariate logistic regression analyses age, glycemic level (HbA1c), male gender (only in type 1 diabetic subjects), hypertension and tPA activity (only in type 2 diabetic subjects) were positively associated with LEAD. When markers of fibrinolysis were entered into a multivariate model adjusting for age, hypertension, and HbA1c, only tPA activity remained independently associated with LEAD (p = 0.01) and this was also found in type 2 diabetic subjects (p = 0.05). In type 1 diabetic subjects the increase in odds ratio was non-significant.

Conclusions

Tissue plasminogen activator (tPA) activity may be an independent and early marker for asymptomatic lower extremity arterial disease in diabetic subjects, particularly in type 2 diabetes. Thus an altered fibrinolytic activity could be an early marker of atherosclerosis development in the lower extremities but the cause-effect relationship remains unclear.     

某区2型糖尿病视网膜病变不同分期与踝肱指数ABI的关系

目的观察2型糖尿病患者视网膜微血管病变不同分期与踝肱指数ABI之间的相互关系。方法收集我院内分泌科2010年6月至2012年9月经确诊的203例2型糖尿病住院患者,经踝肱比值(ABI)测定,将其分为ABI正常组(1.0<ABI<1.3),ABI异常组ABI<1.0或ABI>1.3),观察糖尿病视网膜病变(DR)不同分期情况下与ABI之间的关系。结果 ABI异常组的2型糖尿病患者中,DR检出率为94.1%,约是正常组的1.6倍,两者比较差异有显著性(P=0.000);单因素Logistic回归分析显示,DR I期(P=0.01,OR=0.04,95%CI:0.00～0.38);DR II期(P=0.22,OR=0.28,95%CI:0.04～2.18);DR III期(P=0.91,OR=0.89,95%CI:0.11～6.93)。结论 DR I期对ABI来说,是其微弱的保护因素(95%CI<1),DR II-III期与ABI之间无统计学差异(P值>0.05),即DR II、III期不是ABI的危险因素(尽管III期时95%CI>1)。尽管本实验,未能发现2型糖尿病视网膜病变不同分期与ABI之间有直接线性关系,但在2TDM患者中DR的检出率仍偏高,建议行ABI检测的糖尿病患者,尽早行眼底病变筛查,这对预防糖尿病大血管及微血管并发症均有重要意义。     

缺血型糖尿病足诊疗规律回顾性研究

[主要目的]分析缺血型糖尿病诊疗规律。[资料来源]在辽宁中医药大学附属第一医院病案室选取2012年6月至2013年10月缺血型糖尿病住院病历。[选择文献量及依据]①研究类型:临床观察。②研究对象:符合缺血型糖尿病足诊断标准;中医四诊资料齐全;同一患者反复入院症状发生变化时重复纳入,无明显变化时仅纳入第一次入院情况。③诊断分型:湿热毒盛、血脉瘀阻。④评价指标:临床症状、双下肢多普勒血流图和踝肱比(ABI)、Wagner分级、血流量(ABI所取动脉血管:π(血管内径/2)^2*血流速度,cm^3/s),等。⑤干预方法:常规西药、四妙勇安汤合仙方活命饮、当归四逆汤合桃红四物汤、清脉康熏洗、一效膏,等。共51例住院病历。[数据提炼规则及应用方法]临床症状、双下肢多普勒血流图和踝肱比(ABI)、Wagner分级、血流量。疗效判定:参照《中医病证诊断疗效标准》。采用SPSS19.0统计软件,计量资料采用均值±标准差(sx±)表示,组间比较用单因素方差分析和t检验。使用Microsoft Excel2013建立数据库,分析预后结果。[数据综合得出结果与结论]预后结果:治愈12例,有效35例,无效4例,总有效率92.16%。ABI两组均有改善(P0.05,P0.01),湿热毒盛改善优于血脉瘀阻(P0.05)。肢端缺血程度为影响治疗效果决定因素,是否存在感染不是影响治疗效果的主要因素。ABI不能反映下肢血流量,可能是因为侧支循环的形成,彩超测定血管内径和血流速度,计算得出每秒血流量更能反映下肢血流情况,因管腔狭窄而造成相同每秒血流量下血流速度相对加快,故不能采用血流速度,而采用每秒血流量能客观反映肢端有效供血量。[未来展望]扩大样本量,进一步调查研究,为缺血型糖尿病足的预防及辨证施治提供科学依据。     

糖尿病下肢血管病变踝肱指数与中医证型等相关性研究

目的:探讨ABI的影响因素及ABI与糖尿病中医证型、临床症状等的相关性,并以下肢血管彩超为诊断标准,探讨ABI用于早期诊断糖尿病下肢血管病变的临床意义.方法:为90例糖尿病患者测定踝肱指教(ABI),抽血查FBC、2hPBG、HbA1C、TC、TG、HDL-C、LDL-C等指标,进行临床症状评分、下肢血管彩超检查及中医辨证分型,采用SPSS10.0统计软件包进行统计分析.结果:双侧ABI与年龄、PBC、Hb A1c、SBP、DBP、LDL-C均呈负相关,与糖尿病病程、BMI、FBC、TG、HDL-C、TC无相关性.合并冠心病的糖尿病患者的ABI值较无冠心痛者降低.临床症状方面,随着症状的加重,ABI数值逐渐降低.中医证型方面,阴阳两虚组双侧ABI在糖尿病各证型中最低.以下肢血管彩超为诊断标准,踝肱指数≤0.9诊断符合率最高.结论:临床上可以把踝肱指数≤0.9作为糖尿病下肢血管病变的早期筛壹方法,同时ABI受年龄、PBG、HbA1c、SBP、DBP、LDL-C等因素的影响.     

Haemodynamic limitations and exercise performance in peripheral arterial disease

It has been frequently argued that haemodynamic limitations are poor predictors of exercise performance in people with peripheral arterial disease (PAD) and intermittent claudication. This review has tried to address this argument through a review of published data that appears to support or counterbalance it, brief consideration of some of the methodological limitations associated with these data, as well as some other considerations. The main argument rests primarily upon data about the resting ankle-brachial index (ABI) and/or blood flow after calf exercise or an ischaemic challenge; whereas the counter argument rests mainly on data about blood flow during walking or cyding exercise. Consideration of the limitations of all methods suggests that the measurement of blood flow during exercise has the greatest value in explaining differences in exercise performance amongst claudicants; whereas the other methods are relatively limited in their explanatory value. This strengthens the counter argument and undermines the main argument proposed by others. Consequently, asserting that haemodynamic limitations are poor predictors of exercise performance in claudicants is not justified in light of available evidence.