踝肱指数与糖尿病下肢动脉血管病变缺血程度的关系探讨

目的探讨踝肱指数(ABI)与糖尿病下肢动脉血管病变缺血程度的差异.方法采用多普勒流速仪对44例糖尿病下肢动脉血管病变患者进行踝肱指数的测定.结果踝肱指数(0.78±0.13)分16例,提示有下肢动脉阻塞;(0.48±0.92)分19例,提示患者下肢缺血程度严重;(0.28士0.04)分9例,均发生下肢溃疡或坏死.结论测定糖尿病患者踝肱指数可客观评价其下肢外周血管功能状况,为临床治疗提供可靠依据.     

踝肱指数与2型糖尿病患者下肢血管病变症状的关系

目的：通过踝肱指数（ABI）检查,探讨ABI与糖尿病下肢血管病变临床症状的关系。方法：检测522例门诊2型糖尿病患者的ABI,按其结果分为：A组（ABI≥0.9）、B组（ABI〈0.9且≥0.7）、C组（ABI〈0.7且≥0.4）、D组（ABI〈0.4）,比较各组临床症状及生化指标,分析ABI与症状的关系及其影响因素。结果：522例2型糖尿病患者中,有血管病变症状者占46.74%,ABI异常者（〈0.9,B、C、D组）占17.24%;ABI正常者（≥0.9,A组）与C组患者的症状表现形式差异有统计学意义（P〈0.01）,C组间歇性跛行47.83%、疼痛23.91%、皮肤发凉17.39%、溃疡26.09%、坏疽4.35%,A组分别为9.95%、24.31%、14.58%、5.56%、0。4组年龄、病程、运动强度、糖化血红蛋白、糖化血清蛋白间差异有统计学意义（P〈0.05）;而性别、吸烟、饮食控制、静脉血糖、血脂差异无统计学意义（P〉0.05）。相关分析显示ABI与年龄、病程、糖化血红蛋白、糖化血清蛋白呈负相关,回归分析表明,病程及年龄是ABI的独立影响因素。结论：ABI对于无症状性血管病变筛查有良好作用;但ABI正常（≥0.9）人群中,仍有部分有血管病变症状表现,对于病程长、高龄或高糖化血红蛋白患者应当重视,应进一步进行血管评估。     

自体外周血干细胞移植治疗下肢缺血性疾病的早期报告

目的探讨自体外周血干细胞移植治疗下肢缺血性疾病的早期效果. 方法扩增、分离外周血干细胞,多点注射于缺血的患肢肌肉内. 结果随访5～16周,3例下肢疼痛症状减轻,跛行距离延长,6条肢体中5条踝肱比(ankle/brachial index, ABI)升高,1条下降. 结论自体外周血干细胞移植对于改善下肢缺血、缓解缺血症状有一定作用.     

糖尿病与非糖尿病患者下肢动脉旁路移植术后移植血管闭塞原因分析

目的 探讨下肢动脉旁路移植术后血管闭塞的原因.方法 回顾性分析2002年1月至2006年4月收治的49例下肢动脉旁路移植后移植血管闭塞患者的临床资料.49例患者中,糖尿病下肢缺血者23例,占46.9%;非糖尿病下肢缺血26例,占53.1%.结果 在术后13～24个月移植的血管容易闭塞,本组占36.8%(18/49);其次是6个月以内的血管也容易闭塞,占26.5%(13/49);而在6～12个月和25～48个月期间进入一个比较平稳的阶段.糖尿病组与非糖尿病组移植血管闭塞时间比较,差异无统计学意义(P＞0.05).在吻合口内膜增生导致的血管闭塞原因和在使用抗凝药方面,糖尿病组和非糖尿病组比较,差异无统计学意义(P＞0.05);在移植血管近、远段动脉病变方面,糖尿病组与非糖尿病组相比,差异有统计学意义(P＜0.05).结论 下肢动脉旁路移植后血管闭塞除了内膜增生外,动脉硬化进一步发展,使移植血管近段或远段闭塞也是导致移植血管闭塞的重要原因,尤其是糖尿病患者更容易发生.     

糖尿病对血管重建治疗慢性重症下肢缺血的影响

目的评价糖尿病对血管重建(腔内及手术)治疗慢性重症下肢缺血的影响。方法回顾性分析3年间北京朝阳医院因慢性重症下肢缺血行下肢血管重建治疗的121例患者(130条肢体)的临床资料。其中,糖尿病组(DM组)55例(60条肢体),行动脉转流手术27条肢体,单纯经皮动脉球囊扩张(PTA)9条肢体,PTA+支架20条肢体,转流手术+腔内治疗杂交手术4条肢体;非糖尿病组(NDM组)66例(70条肢体),行动脉转流手术28条肢体,单纯PTA 10条肢体,PTA+支架24条肢体,转流手术+腔内治疗杂交8条肢体。随访3~36个月,比较两组患者的围手术期病死率、术后1年生存率及保肢率。结果围手术期病死率DM组为9.1%,NDM组为6.1%,两组差异无统计学意义(P>0.05);术后1年生存率DM组为88.1%,NDM组为93.1%,两组差异亦无统计学意义(P>0.05);术后1年保肢率DM组为81.6%,NDM组为83.4%,两组差异亦无统计学意义(P>0.05)。结论对于因慢性重症下肢缺血行下肢血管重建的患者,糖尿病并不增加其围手术期病死率,也不降低其远期生存率及保肢率。笔者认为,对于糖尿病慢性重症下肢缺血患者应积极进行血管重建...     

下肢动脉硬化闭塞症的外科治疗

下肢动脉硬化闭塞症(lowerextremityatheroscleroticocclu sivedisease,LEAOD)是血管外科常见病,是导致慢性下肢缺血的主要原因,其发病率随年龄增大而增加,Criqui统计65岁以上的男性约10%患有LEAOD,而75岁以上则有20%的发病率[1];北美60岁以上的高血压患者中有近25%患有慢性下肢缺血[2]。LEAOD是全身动脉硬化的局部表现。在我们的一组158例严重多节段动脉硬化闭塞症患者中,50%以上合并有心脑血管疾病,25%以上合并有糖尿病。严重的合并症是导致临床治疗效果欠佳和死亡率高的主要原因之一。因此,在下肢缺血的治疗中,不仅要注重肢体血管…     

下肢动脉缺血性患者假性高压的鉴别及临床意义

Objective To evaluate the diagnosis of and management for pseudo-high blood pressure in patients with lower limb ischemia. Methods From March 2006 to March 2007, 182 cases with lower limb ischemia were admitted, and they were divided into three groups. In group 1 pseudo-high blood pressure did not exist, in group 2, patients had pseudo-high blood pressure with ABI<1.3, in group 3, patients had pseudo-high blood pressure and with ABI≥1.3. ABI and TBI were compared with color Doppler, angiography, MRA and CTA. Results In all those 182 patients, there were 102(56.0%)cases having no pseudo-high blood pressure, and 27.5% with concomitant diabetes. Seventy-two cases(39.6%) had pseudo-high blood pressure (ABI<1.3) with 44.4% having diabetes. Eight cases (4.4%) (ABI≥ 1.3) manifested pseudo-high blood pressure with the ratio concomitant diabetes being 75%. Conclusions In diabetic patients with lower limb's ischemia there is increased ratio of pseudo-high blood pressure.     

下肢动脉缺血性患者假性高压的鉴别及临床意义

Objective To evaluate the diagnosis of and management for pseudo-high blood pressure in patients with lower limb ischemia. Methods From March 2006 to March 2007, 182 cases with lower limb ischemia were admitted, and they were divided into three groups. In group 1 pseudo-high blood pressure did not exist, in group 2, patients had pseudo-high blood pressure with ABI<1.3, in group 3, patients had pseudo-high blood pressure and with ABI≥1.3. ABI and TBI were compared with color Doppler, angiography, MRA and CTA. Results In all those 182 patients, there were 102(56.0%)cases having no pseudo-high blood pressure, and 27.5% with concomitant diabetes. Seventy-two cases(39.6%) had pseudo-high blood pressure (ABI<1.3) with 44.4% having diabetes. Eight cases (4.4%) (ABI≥ 1.3) manifested pseudo-high blood pressure with the ratio concomitant diabetes being 75%. Conclusions In diabetic patients with lower limb's ischemia there is increased ratio of pseudo-high blood pressure.     

下肢动脉缺血性患者假性高压的鉴别及临床意义

Objective To evaluate the diagnosis of and management for pseudo-high blood pressure in patients with lower limb ischemia. Methods From March 2006 to March 2007, 182 cases with lower limb ischemia were admitted, and they were divided into three groups. In group 1 pseudo-high blood pressure did not exist, in group 2, patients had pseudo-high blood pressure with ABI<1.3, in group 3, patients had pseudo-high blood pressure and with ABI≥1.3. ABI and TBI were compared with color Doppler, angiography, MRA and CTA. Results In all those 182 patients, there were 102(56.0%)cases having no pseudo-high blood pressure, and 27.5% with concomitant diabetes. Seventy-two cases(39.6%) had pseudo-high blood pressure (ABI<1.3) with 44.4% having diabetes. Eight cases (4.4%) (ABI≥ 1.3) manifested pseudo-high blood pressure with the ratio concomitant diabetes being 75%. Conclusions In diabetic patients with lower limb's ischemia there is increased ratio of pseudo-high blood pressure.     

下肢动脉缺血性患者假性高压的鉴别及临床意义

Objective To evaluate the diagnosis of and management for pseudo-high blood pressure in patients with lower limb ischemia. Methods From March 2006 to March 2007, 182 cases with lower limb ischemia were admitted, and they were divided into three groups. In group 1 pseudo-high blood pressure did not exist, in group 2, patients had pseudo-high blood pressure with ABI<1.3, in group 3, patients had pseudo-high blood pressure and with ABI≥1.3. ABI and TBI were compared with color Doppler, angiography, MRA and CTA. Results In all those 182 patients, there were 102(56.0%)cases having no pseudo-high blood pressure, and 27.5% with concomitant diabetes. Seventy-two cases(39.6%) had pseudo-high blood pressure (ABI<1.3) with 44.4% having diabetes. Eight cases (4.4%) (ABI≥ 1.3) manifested pseudo-high blood pressure with the ratio concomitant diabetes being 75%. Conclusions In diabetic patients with lower limb's ischemia there is increased ratio of pseudo-high blood pressure.     

Prevalence of Ischemia in Diabetic Foot Infection

Foot infection is a common problem affecting diabetics. In addition to neuropathy, ischemia is a major factor contributing to the progress and morbidity of the disease. The aim of this study was to determine the prevalence of lower limb ischemia in patients with diabetic foot infection by prospectively measuring the ankle-brachial pressure index (ABI). Over a 21-month period 60 patients were treated in the general surgical ward of Princess Basma Teaching Hospital. Ischemia was present in 35 of the 60 patients (58.4%). Among them 27 had moderate ischemia (ABI 0.5–0.9) and were treated successfully before further vascular workup. The other 8 patients had severe ischemia (ABI < 0.5) and required below-knee amputation because their feet were severely infected and not salvageable. This study confirmed the recommendation for early detection of lower limb ischemia in diabetics, especially those with foot infection, as it should improve the outcome of treatment. In addition to patient education and periodic foot examinations, estimating the ABI is an easy. reliable way to determine foot blood flow and to detect patients who require further vascular workup and treatment.     

Natural history of limbs with arterial insufficiency and chronic ulceration treated without revascularization

OBJECTIVES: The natural history of limbs affected by ischemic ulceration is poorly understood. In this report, we describe the outcome of limbs with stable chronic leg ulcers and arterial insufficiency that were treated with wound-healing techniques in patients who were not candidates for revascularization. METHODS: A prospectively maintained database of limb ulcers treated at a comprehensive wound center was used to identify patients with arterial insufficiency, defined as an ankle-brachial index (ABI) <0.7 or a toe pressure <50 mm Hg. Patients were treated without revascularization when medical comorbidity or anatomic considerations did not allow revascularization with acceptable risk. Ulcers were treated with a protocol emphasizing pressure relief, débridement, infection control, and moist wound healing. Risk factors analyzed for their affect on healing and amputation risk included age, gender, diabetes mellitus, chronic renal insufficiency (serum creatinine > 2.5 mg/dL), severity of ischemia measured by ABI or toe pressure, wound grade, wound size, and wound location. RESULTS: Between January 1999 and March 2005, 142 patients with 169 limbs having arterial insufficiency and full-thickness ulceration were treated without revascularization. Mean patient age was 70.8 +/- 4.5. Diabetes mellitus was present in 70.4% of limbs and chronic renal insufficiency in 27.8%. Toe amputations or other foot-sparing procedures were performed in 28% of limbs. Overall, limb loss occurred in 37 patients. By life-table analysis, 19% of limbs required amputation < or =6 months of initial treatment and 23% at 12 months. Complete wound closure was achieved in 25% by 6 months and in 52% by 12 months. Statistical analysis showed a correlation between ABI and the risk of limb loss. In patients with an ABI <0.5, 28% and 34% of limbs experienced limb loss at 6 and 12 months, respectively, compared with 10% and 15% of limbs in patients with an ABI >0.5 (P = .01). The only risk factor associated with wound closure was initial wound size (P < .005). CONCLUSIONS: Limb salvage can be achieved in most patients with arterial insufficiency and uncomplicated chronic nonhealing limb ulcers using a program of wound management without revascularization. Healing proceeds slowly, however, requiring more than a year in many cases. Patients with an ABI <0.5 are more likely to require amputation. Interventions designed to improve outcomes in critical limb ischemia should stratify outcomes based on hemodynamic data and should include a comparative control group given the natural history of ischemic ulcers treated in a dedicated wound program.     

大隐静脉原位转流术重建下肢血液循环

目的:评价大隐静脉原位转流术治疗下肢动脉硬化闭塞症的疗效.方法:运用自制瓣膜切除器开展大隐静脉原位转流术治疗下肢动脉硬化闭塞症38例共40例肢体.患者术前踝肱指数(ABI)为0-0.58(平均0.29),均经动脉造影证实.术后移植物均可扪及搏动,有28条肢体足背或胫后动脉搏动恢复,17例同时行输入输出道动脉重建术,溃疡清创术6例,4例于术后3天内出现移植物搏动消失,行第2次重建术,结果:ABI平均值同术前0.29上升至0.84,严惩缺血肢体挽救率为100%,经寿命表统计分析,1-5年的血管累积通畅率分别为92%,87%,82%,72%和65%,结论:大隐静脉原位转流术是治疗下肢动脉硬化闭塞症的理想方法之一,同时行输入功输出道动脉重建术,对保证移植血管的通畅有着重要的意义.     

自体骨髓干细胞和外周血干细胞移植治疗下肢缺血的对比研究

目的 比较自体骨髓干细胞和外周血干细胞移植治疗下肢缺血的临床疗效。方法 2004年12月～2005年12月,对42例下肢缺血患者分别采用骨髓干细胞移植（A组,n=21）和外周血干细胞移植（B组,n=21）。其中男32例,女10例;年龄34～80岁,平均65．6岁。糖尿病下肢缺血28例,血栓闭塞性脉管炎8例,单纯下肢动脉硬化闭塞症6例。缺血病程：3个月～5年,平均2．1年。治疗后4周,应用主观标准包括疼痛、冷感、麻木以及客观标准包括间歇性跛行距离、踝肱指数（ankle brachial index,ABI）、经皮氧分压、血管造影、截肢率和足部创面变化等一系列指标评价其疗效。结果 治疗后4周,A、B组疼痛缓解总有效率分别为88．2％和89．5％（P〉0．05）,冷感缓解改善率分别为94．4％和94．7％（P〉0．05）,麻木改善有效率分别为69．2％和66．7％（P〉0．05）。A、B组ABI分别增加38．1％和33．3％（P〉0．05）;经皮氧分压（TcPO2）有效率分别增加85．7％和90．5％（P〉0．05）;新生侧支血管评估：A、B组分别有12例和9例患者术后复查血管造影,A、B组总有效率分别为83．3％和77．8％（P〉0．05）;截肢率评价：两组截肢率均为9．1％（P〉0．05）;足部创面变化,A、B组有效率分别为60．0％和66．7％（P〉0．05）。40例患者获随访3～15个月,平均8个月。主观评价,A、B组有效率分别为75．0％和70．0％（P〉0．05）。客观评价：A、B组ABI较术前分别增加60．0％和65．0％;A、B组TcPOz较术前分别增加80．o％和75．0％;A、B组新生侧支血管总有效率分别为90．0％和84．6％;A、B组溃疡面除B组1处明显缩小外,其余均愈合,客观评价指标两组比较差异均无统计学意义（P〉0,05）。结论 无论是骨髓干细胞还是外周血干细胞移植治疗下肢缺血都是有效的方法;但对同时伴心脑血管病变的患者,进行自体干细胞移植,尤其是采用外周血干细胞移植需特别慎重。     

Assessing peripheral arteries in South African black women with type 2 diabetes mellitus.

OBJECTIVES: To determine the value of ankle and toe blood pressure indices and pedal pulse palpation in the assessment of peripheral arterial disease in subjects with type 2 diabetes mellitus (DM). DESIGN: Cross-sectional study. SUBJECTS: A convenience sample of 85 female subjects with type 2 DM underwent a series of peripheral vascular assessments at the diabetes clinic of a community hospital. OUTCOME MEASURES: Palpation of the pedal pulses, Doppler-derived ankle brachial systolic blood pressure indices, photo plethysmographic-derived toe brachial systolic blood pressure indices and antero-posterior radiographs of both feet. RESULTS: Mean values were 1.15 (standard deviation (SD): 0.17) and 0.76 (SD: 0.17) for ankle brachial index (ABI) and toe brachial index (TBI) respectively. The differences between the two indices increased from 0.36 (95% confidence interval (CI): 0.32-0.41) to 0.58 (95% CI: 0.46-0.70) depending on whether ABI was less or greater than 1.3. The correlation coefficient for left versus right foot was 0.62 and 0.71 for ABI and TBI respectively. The relationship between ABI and TBI is non-linear with a cut point close to 1.3. Both ABI and TBI were significantly lower in subjects who had both pedal pulses absent on palpation. CONCLUSIONS: The relationship between ABI and TBI is linear below an ABI of 1.3. but with a wide 95% prediction interval. If both pedal pulses are absent the ABI is significantly diminished compared with when both pulses are present, even though not necessarily below 0.9.     

外周血干细胞移植治疗慢性下肢动脉缺血性疾病

目的 观察自体外周血干细胞移植治疗慢性下肢缺血性疾病的疗效.方法 应用自体外周血干细胞移植治疗46例慢性下肢缺血性疾病的患者.结果 42例小腿疼痛缓解,小腿冷、凉感觉消失;35例足部疼痛改善;29例足部冷、凉感消失;4例术后4周因为小腿中段以下出现坏死导致截肢.42例保肢病例,干细胞移植术后3个月,间歇性跛行距离由(87.45±41.22)m增加到(348.52±147.24)m,下肢皮温由(28.52±0.51)℃增加到(33.56±0.62)℃,踝肱指数(ABI)由(0.48±0.06)增加到(0.75±0.07),移植前后3项指标的差异均具有统计学意义(P＜0.05),移植后优于移植前.术后6个月和12个月下肢动脉影像学检查显示,37例均有不同程度的新生侧支血管形成.结论 自体外周血干细胞移植治疗下肢缺血性疾病是一种有效的方法,尤其对远端动脉流出道差的患者是一种较好的治疗手段.     

自体外周血单个核细胞移植治疗下肢缺血53例的临床研究

目的观察自体外周血单个核细胞移植治疗下肢缺血的有效性和安全性。方法2004年6月至2005年10月，采用自体外周血单个核细胞移植治疗53例（83条下肢）下肢严重缺血。病因为糖尿病性下肢缺血44例71条患肢（44／53，83．0％）；单纯性下肢动脉硬化5例6条患肢（5／53，9．4％）；血栓闭塞性脉管炎4例6条患肢（4／53，7．6％）。本组患者中80．7％（67／83）患肢有疼痛感，72．3％（60／83）肢体有冷感，67．5％（56／83）肢体有麻木感。移植后2个月评估其疗效。结果本组无死亡病例。移植后2个月总的疼痛缓解率为83．6％，总的冷感缓解率为91．7％，总的麻木缓解率为75．0％。有39．8％（33／83）患肢的ABI有所增加。89．2％（74／83）患者经皮测定的氧分压（TePO2）有不同程度的增加。29．2％患者的溃疡面有不同程度的缩小。有44．6％（23例37条）于术后行血管造影评估，其中72．9％患肢有不同程度的侧支血管形成。15条（18．1％）患肢最终行截肢，其中5条患肢降低了截肢平面。结论自体外周血单个核细胞移植治疗下肢缺血性疾病是一种简单、安全、有效的方法；在治疗过程中需要注意心脑血管并发症的发生。     

膝下动脉球囊血管成形术治疗重症下肢缺血的临床研究

目的 评价膝下动脉闭塞首选球囊血管成形术的临床治疗效果.方法 2005年12月至2009年5月,对于连续收治且符合手术指征的54例(61条肢体)膝下动脉重度狭窄或闭塞的重症下肢缺血患者,采用膝下动脉球囊血管成形术进行治疗.其中男性37例,女性17例,平均年龄66岁.术前踝肱指数平均0.43±0.27.根据病变部位选择手术方法,膝下动脉病变首选球囊血管成形术,合并髂股动脉病变同时进行血管重建(支架置入或动脉旁路术).结果 髂股动脉重建(28条肢体行支架置入,5条肢体行动脉旁路术)均一期成功.膝下动脉球囊血管成形术57条肢体获得一期成功,技术成功率93.4%.围手术期主要并发症为小腿血肿3例(4.9%),膝下截肢2例(3.3%).术后踝肱指数增加至0.86±0.21,与术前相比差异有统计学意义(P<0.01).本组平均随访时间(16±11)个月,一期通畅率61.1%,21条肢体发生再狭窄(38.9%),其中10条肢体再次接受外科干预,二期通畅率75.9%.截肢3条肢体,总的救肢率91.8%.结论 球囊血管成形术是治疗重症下肢缺血安全有效的方法,可以作为膝下动脉病变首选的外科干预手段.     

Change in ankle-brachial index over time and mortality in diabetics with proteinuria

Peripheral arterial disease is common in diabetic chronic kidney disease (CKD) and is characterized either by abnormally low or high ankle-brachial index (ABI). Whether low or high ABI carries similar prognostic value is unknown. The association of baseline ABI with all-cause mortality over 40 ± 21 months (mean ± SD) was ascertained in 167 proteinuric diabetics (age 57 ± 7 years; median urine protein-creatinine, 2.5 mg/mg). Association of change in ABI with all-cause mortality was determined in 75 subjects with normal ABI (0.9 - 1.3) at baseline. Among 167 participants, 41% had an abnormal ABI: < 0.9, 18%; and > 1.3 or non-compressible arteries, 23%. Only individuals with low ABI had a significantly higher risk for all-cause mortality (hazards ratio (95% confidence interval), HR: 2.23 (1.07, 4.65)). In subjects with normal ABI at baseline with follow-up measurement (n = 75), vascular disease worsened in 39% over 23 ± 6 months: 17% had either a decrease in ABI by ≥ 0.1 or a final ABI < 0.9, and 21% had a final ABI > 1.3 or noncompressible arteries. Only individuals who had a decrease in ABI over time had a significantly higher risk for death (adjusted HR, 7.41 (1.63, 33.65)). Peripheral arterial disease is not uncommon and progresses rapidly in individuals with diabetes and proteinuria. Low or declining ABI is a strong predictor of all-cause mortality. Routine measurement of ABI is a simple bed-side procedure that may permit easy risk-stratification in diabetic CKD patients.     

膝下动脉血管成形术治疗糖尿病足

目的:研究小口径球囊(2～4mm)扩张膝下血管对糖尿病导致的下肢严重缺血(critica llimb ischaemia)的疗效。方法:对120例糖尿病导致的下肢严重缺血患者使用小口径球囊进行扩张。结果:成功地对110例患者进行了扩张,无严重并发症发生,成功率91.6%。踝肱指数平均0.85%。结论:小球囊扩张膝下血管对糖尿病导致的下肢严重缺血疗效显著,近期结果满意。