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50岁以上糖尿病人群周围动脉闭塞性疾病相关因素分析
作者姓名:Guan H  Liu ZM  Li GW  Guo XH  Xu ZR  Zou DJ  Xing HL  Liu W  Sheng ZY  Tian HM  Zhu DL  Yu DM  Zhuang WT  Chen LL  Weng JP
作者单位:1. 100730,中国医学科学院,中国协和医科大学,北京协和医院血管外科
2. 第二军医大学长征医院
3. 中日友好医院
4. 北京大学第一医院
5. 解放军306医院
6. 第二军医大学长海医院
7. 上海第二医科大学附属新华医院
8. 上海第二医科大学附属仁济医院
9. 上海交通大学附属第一人民医院
10. 四川大学华西医院
11. 南京鼓楼医院
12. 天津代谢病医院
13. 福建省立医院
14. 武汉协和医院
15. 中山医科大学附属第一医院
摘    要:目的 调查了解我国周围动脉闭塞性疾病(PAD)现患率及其相关影响因素。方法 在我国7个大中城市15家三级甲等医院整群抽样入选50岁以上伴有一个以上危险因素的糖尿病患者以踝肱比(ABI)〈0.9及脉波传导速度(PWV)〉1400cm/s诊断PAD,进行多因素回归分析其危险因素。结果 调查的1397人中PAD的现患率为19.47%,其中男性占18.3%(122/664),女性占20.4%(150/733)。70岁以上PAD患病率上升到31.9%。PAD与年龄、吸烟、收缩压、糖尿病病程及糖化血红蛋白均呈显著正相关。结论 我国50岁以上糖尿病人群近五分之一患有PAD。年龄、糖尿病病程、血糖水平和收缩期血压是PAD的危险因素。ABI、PWV不仅是诊断PAD的手段,也可作为脑血管病(CVD)的预警指标。

关 键 词:动脉闭塞性疾病  危险因素  糖尿病  流行病学因索
修稿时间:2006-04-20

Analysis of peripheral arterial obstructive disease related factors among diabetic population aged > or = 50
Guan H,Liu ZM,Li GW,Guo XH,Xu ZR,Zou DJ,Xing HL,Liu W,Sheng ZY,Tian HM,Zhu DL,Yu DM,Zhuang WT,Chen LL,Weng JP.Analysis of peripheral arterial obstructive disease related factors among diabetic population aged > or = 50[J].National Medical Journal of China,2007,87(1):23-27.
Authors:Guan Heng  Liu Zhi-Min  Li Guang-Wei  Guo Xiao-Hui  Xu Zhang-Rong  Zou Da-Jin  Xing Hui-Li  Liu Wei  Sheng Zheng-Yan  Tian Hao-Ming  Zhu Da-Long  Yu De-Min  Zhuang Wei-Te  Chen Lu-Lu  Weng Jian-Ping
Institution:Department of Vascular Surgery, Peking Union Medical College Hospital, CAMS&PUMC, Beijing, China.
Abstract:OBJECTIVE: To analyze the peripheral arterial obstructive disease (PAD) related factors among diabetic population aged > or = 50 in China. METHODS: The clinical data of 1397 diabetic patients aged > or = 50 with at least one of the following risk factors: smoking, hypertension, and hyperlipidemia, from 15 Class III Grade A hospitals in 7 major cities of China were collected. Diagnosis of PAD was based on the ankle brachial index (ABI) < 0.9, and diagnosis of arteriosclerosis was based on pulse wave velocity (PWV) > 1400 cm/s. Regression studies were made to analyze the relations among PAD and various risk factors: age, sex, body mass index (BMI), smoking, hypertension, hyperlipidemia, history of cerebral vascular disease (CVD), history of ischemia heart disease (IHD) etc. RESULTS: The current prevalence rate of PAD was 19.47% among the 1397 patients, 18.3% (122/664) among the male patients, and 20.4% (150/733) among the female patients. The prevalence of PAD in the patients aged > or = 70 was as high as 31.9%. The duration of diabetes course was positively correlated with the prevalence of PAD (chi2 = 11.9, P = 0.0026). The ABI abnormality rate was 15.78% among those with a diabetic course of 5 years and was 23.84% among those with a diabetic course of 10 years. The abnormal ABI rate of the patients with CVD was 30.57%, significantly higher than that of hose without CVD (17.29%, chi2 = 21.49, P < 0.0001). The abnormal ABI rate of the patients with IHD was 24.64%, significantly higher than that of the patients without IHD (18.20%, chi2 = 5.85, P = 0.0155). The HbA1c value of the PAD patients was significantly higher than that of the patients without PAD (chi2 = 5.10, P = 0.0239) Odd risk analysis showed that age increase of 10 years increased the PAD risk by 1.64 times (OR = 1.6444, P = 0.0001). The PAD risk of the smokers was 1.68 times higher than that of the non-smokers (OR = 1.6852, P = 0.0001). Increase of 10 mm Hg in systolic blood pressure (SBP) increased the PAD risk by 1.19 times (OR = 1.1926, P = 0.01). The PAD risk of the patients with abnormal HbAlc was 2.44 times higher than that of the patients with normal HbA1c (OR = 2.4473, P = 0.0001). One-year's increase of the hypertension course increased the PAD risk by 1.02 times (OR = 1.0194, P = 0.03). Logistic analysis indicated that the relations among PWV and the risk factors were almost the same among ABI abnormality and the risk factors. CONCLUSION: Approximately one fifth of diabetic patients aged > or = 50 in China suffer from PAD. Age, course of diabetes, blood glucose level, SBP, IHD, and CVD are risk factors for PAD. Early intervention and treatment of hypertension and hyperglycemia, and quitting smoking are important in reducing the occurrence of PAD. ABI and PWV are not only diagnostic means for PAD, but also alarm guide indexes for cerebral vascular disease (CVD).
Keywords:Arterial occlusive diseases  Risk factors  Diabetes  Epidemiologic factors
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