2型糖尿病患者趾臂指数(TBI)与动脉粥样硬化的相关性研究

目的 研究踝臂指数(ABI)正常的2型糖尿病患者趾臂指数(TBI)与动脉粥样硬化的相关性.方法 瑞金医院内分泌代谢病科门诊收集的945例ABI正常(0.9≤ABI＜1.3)患者,根据TBI分为正常组(TBI≥0.6,n=893)和降低组(TBI＜0.6,n=52).分析TBI与颈动脉内中膜厚度(IMT)的相关性,以及TBI降低与动脉粥样硬化之间的关系.结果 TBI降低组的年龄及HbA1C明显高于TBI正常组.TBI与IMT显著负相关,回归系数β=-0.217(P＜0.01).按照TBI＜0.6,0.6≤TBI＜0.8,0.8≤TBI＜1.0,TBI≥1.0分为4组,以TBI等级变量为自变量,是否发生动脉粥样硬化为因变量,进行多元logistic回归分析,TBI降低是动脉粥样硬化的独立危险因素(OR=1.30,95% CI 1.01～1.69,P＜0.05).结论 在2型糖尿病中,TBI的降低是动脉粥样硬化的独立危险因素,有必要在糖尿病患者中早期检测TBI,以便检测到ABI不能发现的动脉硬化及狭窄,及早进行干预,降低糖尿病动脉粥样硬化的风险.

Association between toe brachial index and atherosclerosis in patients with type 2 diabetes mellitus

Objective Measurement of ankle brachial index (ABI) is a simple method of assessing lower limb arterial blood supply,while measurement of toe brachial index (TBI)has only been advocated as an alternative.The aim of this study was to obtain information about whether TBI should be taken in type 2 diabetes,even when ABI is normal,and to evaluate the relationship between TBI and atherosclerosis.Methods In a crosssection study,ABI,TBI,and carotid intimal-medial thickness (IMT) were measured on 979 outpatients with type 2 diabetes in Ruijin Hospital.Those with normal ABI (0.9 ≤ABI ＜ 1.3,n = 945) were divided into two groupsnormal TBI group(TBI≥0.6,n=893) and low TBI group(TBI＜0.6,n=52),and then the clinical and laboratory data were compared between these two groups.Furthermore,the relationship between TBI and atherosclerosis was investigated.Atherosclerosis was defined as the maximum IMT ≥ 1.1 mm.Results Low ABI and low TBI were detected in 1.3% and 6.6% of the patients,respectively.Comparison of the clinical and laboratory data between the two groups showed that age and HbA1C values were significantly higher in the low TBI group.Furthermore,TBI was inversely associated with IMT(β=-0.217,P＜0.01),an indicator for atherosclerosis of the carotid artery.Multiple logistic regression analysis revealed that decline of TBI was an independent risk factor of atherosclerosis (OR=1.30,95% CI 1.01-1.69,P＜0.05).Conclusion In type 2 diabetes,the decline of TBI is associated with atherosclerosis,indicating the necessity for diabetic patients to detect TBI,even when ABI is within normal range,in order to detect peripheral artery disease in early stage,and reduce the risk for atherosclerosis.