2型糖尿病合并下肢动脉病变患者颈动脉、椎动脉、锁骨下动脉及肾动脉造影特点分析

目的探讨2型糖尿病合并下肢动脉病变患者颈动脉、椎动脉、锁骨下动脉、肾动脉造影特点。方法纳入104例2型糖尿病合并下肢动脉病变,且接受动脉造影(DSA)检查者。其中50例患者同时进行双下肢踝肱指数(ABI)测定。根据DSA测量的椎动脉、锁骨下动脉、肾动脉狭窄程度分为正常组(血管狭窄程度≤50%)和病变组(血管狭窄程度>50%或完全闭塞),比较两组ABI平均值水平及ABI<0.9时各段动脉病变发生率差异。分析各段狭窄病变与ABI关系,并讨论病变特点的临床意义。结果 104例患者DSA结果显示各段动脉病变主要以斑块为主,51%～74%和75%～99%程度的狭窄病变在肾动脉中发生率最高,分别为22.1%和5.8%,而闭塞病变在椎动脉中发生率最高,达到27.9%。任一动脉存在狭窄或闭塞病变组(n=30)ABI平均值水平较正常组(n=20)低(P=0.000),椎动脉和肾动脉病变组(各17例)平均ABI值较正常组(各33例)低(P分别为0.003,0.02),且ABI<0.9时,病变发生率较高(P分别为0.008,0.047),锁骨下动脉病变组(8例)与正常组(42例)比较,平均ABI值差异无统计学意义。结论 2型糖尿病合并下肢动脉病变患者可以同时合并全身多处动脉病变,主要以斑块形成、狭窄或闭塞病变为主。ABI<0.9时,应注意同时存在全身多处动脉狭窄或闭塞病变可能。

Digital Subtract Arteriographic Characteristics of Carotid Artery, Vertebral Artery, Subclavian Artery and RenalArtery in Type 2 Diabetic Patients with Lower Extremities Peripheral Arterial Disease

Objective To investigate angiographical characteristics of carotid,vertebral,subclavian,and renal arteries in the type 2 diabetic patients with lower extremities peripheral arterial disease(LEPAD).Methods There were 104 type 2 diabetic patients with LEPAD recruited in this study,who received digital subtract arteriography(DSA).Ankle-brachial index(ABI) assessment was also performed in 50 participants.Dependent upon the stenosis degree of vertebral artery,subclavian artery and renal artery measured by DSA,the patients were divided into normal group(stenosis≤50%) or pathological group(stenosis >50% or blocked lesions).The angiographic features of carotid,vertebral,subclavian,and renal arteries were analyzed and the relationship between arterial stenosis and ABI was explored.Results DSA results of 104 patients showed that the most common lesion in the arteries was plaque.The stenosis degrees of 51%-74% and 75%-99% were most commonly observed in renal artery,with incidence of 22.1% and 5.8%,respectively.Arterial occlusion was most commonly observed in vertebral artery,with incidence of 27.9%.The patients with stenosis or occlusion of arteries had lower ABI(P=0.000),and the patients with stenosis or occlusion of vertebral and renal arteries also had lower ABI(P=0.003 and 0.02,respectively),compared with those without stenosis.ABI<0.9 indicated higher risk of stenosis or occlusion of vertebral and renal arteries(P=0.008 and 0.047 respectively).Between the patients with subclavian arterial stenosis and those without this artery stenosis,there was no statistical significant difference observed in ABI level.Conclusion Type 2 diabetic patients with LEPAD can affect multiple arteries,showing plaque formation,multi-segmental stenosis and occlusion of arteries.The patients with ABI<0.9 have higher risk of multiple arterial stenosis or occlusion lesions.