2型糖尿病患者踝肱指数临床分析

目的 研究踝肱动脉血压指数(ABI)在诊断2型糖尿病患者下肢动脉病变中临床意义与影响因素.方法 采用多普勒血流探测仪检测2型糖尿病患者足背动脉、胫后动脉与肱动脉血压的比值,以ABI＜0.9为切割点分成低ABI组与对照组,并分析比较两组代谢参数.结果 421例2型糖尿病患者中ABI＜0.9的63例,占总例数15%,低ABI组与对照组比较,其年龄、糖尿病病程、高血压病程、TC、LDL-C、uAlb、吸烟率明显增高,血管彩超显示病变率较高(P＜0.05),逐步回归分析显示,年龄、糖尿病病程、高血压病程、LDL-C为ABI独立影响因素.结论 ABI在诊断2型糖尿病下肢动脉病变中具有重要意义;年龄、病程、高LDL-C、高血糖、高血压为下肢动脉病变的主要危险因素.     

2型糖尿病下肢血管病变发生率及相关因素调查

目的调查2型糖尿病患者下肢血管病变发生率及其相关因素.方法于北京地区5所医院对随机选择所在医院随诊1年以上,发病年龄≥40岁,病程≥5年的2型糖尿病患者393例,进行病史回顾,体格检查,生化检查和下肢血管多普勒超声检查.结果393例患者中下肢坏疽8例(2.0%),间歇性跛行28例(7.1%).超声多普勒检查提示有不同程度下肢血管病变者357例(90.8%),其中以68例(17.8%)踝/肱动脉压比值＜1.0者与以下临床情况相关明显糖尿病肾病和视网膜病变发生率高(P＜0.05),FBS和HbAlc水平高(P＜0.05),HDL-ch水平低(P＜0.05),舒张压高0P＜0.01).且踝/肱比值与FBS、HbAlc、Tg、纤维蛋白原、血压呈负相关,与HDL-ch呈正相关0P＜0.05).结论 2型糖尿病患者下肢血管病变常见,与血糖、血脂、血压以及血凝多种因素有关.超声多普勒检查能较早地发现病变,而踝/肱比值是下肢血管病变的一种方便可行和可靠的检测指标.     

踝肱指数测量法在糖尿病足筛查及护理中的应用价值

目的探讨在糖尿病足筛查及护理中简单踝肱指数测量法的应用价值。方法选取2018年2—7月份在该院进行治疗的糖尿病患者60例作为研究对象,分别对其进行简单的踝肱指数测量和下肢血管彩超检查,比较两种方法对于糖尿病足筛查的一致性,并对踝肱指数值异常的患者进行糖尿病足护理。结果对60例糖尿病患者进行下肢血管彩超检查的结果显示,有24例(40.0%)患者并发有下肢血管病变,36例(60.0%)不并发有下肢血管病变,病变组的患者比起无病变组患者年龄较大,但是否患病与性别无明显关系(P0.05);如果以踝肱指数(ABI)≤0.9为判断下肢血管病变的标准,那么简单踝肱指数测量结果显示,下肢血管病变(ABI≤0.9)的有26例(43.3%),无病变(ABI0.9)的有34例(56.7%),以彩超检查结果为参考,则简单踝肱指数测量法判断下肢血管病变的灵敏度为87.3%,特异度为77.6%,准确诊断指数为64.5%,内部一致性系数为0.639,表明简单踝肱指数测量法与下肢血管彩超检查结果有较好的一致性。结论简单踝肱指数测量法与下肢血管彩超检查结果有较好的一致性,表明简单踝肱指数测量法对于糖尿病足患者的筛查有较高的应用价值,应用于糖尿病患者的护理中,可以及早地诊断和发现糖尿病足的发生,从而及时地采用有效的治疗和护理,对于糖尿病足的预防、诊断和治疗都是十分有意义的。     

前列地尔治疗糖尿病下肢动脉病变的临床研究

将48例糖尿病下肢病变患者随机分成前列地尔治疗组(治疗组24例),红花注射液治疗组(对照组24例),观察治疗前后病变下肢的症状改善程度、踝肱指数以及下肢神经传导速度的变化及下肢动脉血管的流速。结果治疗组症状改善、踝肱指数以及下肢动脉血管的流速、下肢神经传导速度的变化均优于对照组。结论前列地尔治疗糖尿病下肢病变安全性高、疗效明显。     

2型糖尿病下肢血管病变超声诊断的临床应用

目的评价2型糖尿病下肢血管病变超声诊断的临床应用价值。方法选取该院2014年3月—2015年3月收治的2型糖尿病患者100例,采用抽签法的形式将其分为实验组与对照组,每组50例,对照组行普通B超检查法,实验组行彩色多普勒超声诊断法,通过踝肱压指数对比两组下肢血管病变检出率。结果实验组下肢血管病变检出率为92.0%,对照组下肢血管病变检出率为76.0%,实验组高于对照组,组间对比差异有统计学意义(P0.05)。结论在2型糖尿病下肢血管病变诊断的过程中,采用彩色多普勒超声诊断法检出率较高,值得推广。     

2型糖尿病下肢动脉病变伴发率及其危险因素分析

目的了解伴有高危因素的2型糖尿病患者下肢动脉病变（PAD）的伴发率,分析其危险因素,同时评价踝肱比指数（ABI）的意义.方法对入选的130例患者测定踝肱比指数（ABI）,与下肢血管彩超对比,并对ABI与吸烟、年龄、高血压、高血脂进行相关性分析.结果13例ABI＜0.9,下肢血管彩超检查有异常者10例.ABI与年龄和低密度脂蛋白呈负相关（P＜0.05）.结论合并危险因素的2型糖尿病PAD伴发率为10%,ABI与年龄和低密度脂蛋白呈负相关,且与下肢血管彩超检查结果相关性好,可作为2型糖尿病PAD的筛查.     

踝肱指数在糖尿病周围血管病变中的应用

踝肱指数是一种简单、有效的评估周围血管疾病的指标,可通过观察下肢血管的血流量,快捷、非侵入性的筛选早期动脉粥样硬化.近年来广泛用于糖尿病患者外周血管病变的诊断和预后分析,对糖尿病患者下肢动脉病变的筛查、随访以及预防坏疽有重要的临床价值.本文从踝肱指数测量、诊断标准、影响因素、临床运用等方面作一综述.     

2型糖尿病不同尿白蛋白排泄率患者合并外周动脉疾病临床分析

目的 探讨2型糖尿病不同尿白蛋白排泄率（UAER）合并外周动脉疾病（PAD）的发生率及其相关性.方法 依据尿微量白蛋白排泄率将375例2型糖尿病患者分为对照组（UAER〈20μg/min）、A组（微量蛋白尿组,UAER 20～200μg/min）和B组（临床蛋白尿组,UAER〉200μg/min）,检测所有患者的尿白蛋白排泄率、糖化血红蛋门和踝肱指数（ABI）,并分析各组患者外周动脉疾病的发生率、踝肱指数与尿白蛋白排泄率及其它指标的相关性.结果 2型糖尿病微量白蛋白尿组和临床蛋白尿组外周动脉疾病发生率均较对照组高,两者比较差异有显著性（P〈0.05,P〈0.01）,踝肱指数随尿白蛋白排泄率的增加而减低（P〈0.05）,外周动脉疾病发生率随尿白蛋白排泄率增加而增加（P〈0.05,P〈0.01）;踝肱指数与年龄、病程、尿白蛋白排泄率呈明显负相关（P〈0.05）.结论 2型糖尿病微量白蛋白尿组和临床蛋白尿组外周动脉疾病的发生率较对照组明显增加,且尿白蛋白排泄率与踝肱指数显著相关,提示尿微量白蛋白不仅是肾脏病变的表现,同时伴有肾外血管病变发病率的增高,是全身血管病变的标志.     

心踝血管指数与冠状动脉狭窄程度的关系

目的 探讨心踝血管指数对冠心病的预测价值.方法 对497例冠状动脉造影患者行心踝血管指数测量、病史采集及常规化验检查.根据病变累及冠状动脉支数分为冠状动脉正常组(178例)、单支病变组(102例)、双支病变组(104例)和三支病变组(113例).冠状动脉病变的严重程度用病变的血管支数及Gensini积分表示.比较各组患者冠心病危险因素以及心踝血管指数的差异,采用logistic回归分析比较危险因素在冠心病发病中的作用.结果 冠心病组患者的性别构成、年龄、高血压、糖尿病、血脂异常和吸烟率等显著高于冠状动脉正常组(P<0.05).单支病变组、双支病变组和三支病变组心踝血管指数均显著高于冠状动脉正常组(P<0.05).冠状动脉造影Gensini积分与心踝血管指数成正相关(r=0.763,P<0.01).Logistic回归分析发现,年龄、高血压、糖尿病、血脂异常、吸烟以及心踝血管指数升高与冠心病的发生显著相关(P<0.05).结论 与年龄、高血压、糖尿病、血脂异常和吸烟一样,心踝血管指数增高也是冠心病发病的危险因素.心踝血管指数是冠心病冠状动脉狭窄严重程度的独立预测因子.     

门诊2型糖尿病患者慢性并发症患病率调查及危险因素分析

对我院门诊439例糖尿病患者进行详细问诊、全面体格检查、周围神经病变检查、踝肱指数测定、糖尿病足检查、眼底检查及血糖、血脂、糖化血红蛋白、尿微量白蛋白（白蛋白/肌酐比）等检查。发现2型糖尿病患者中视网膜病变的患病率为24.6%,糖尿病肾病19.2%,周围神经病变63.6%,冠心病18.2%,脑血管病变9.1%,下肢大血管病变9.4%。患者的年龄、病程及血糖、血压、血脂控制水平等因素与慢性并发症的发生密切相关。     

The relationship between serum LDL-cholesterol, HDL-cholesterol and systolic blood pressure in patients with type 2 diabetes

BACKGROUND: The prevalence of hypertension and lipid disorders is increased in patients with diabetes. The relationship between cholesterol and blood pressure values has not yet been well established in this group of patients. AIM: To assess the correlation between lipid levels and blood pressure values in patients with type 2 diabetes. METHODS: The study group consisted of 122 patients (82 females, 40 males, mean age 63+/-10 years) with type 2 diabetes. The mean duration of diabetes was 7.4+/-5.8 years, and hypertension 3.2+/-4.6 years. In all patients glycosylated haemoglobin (HbA1c) and lipid serum concentrations were assessed. RESULTS: The mean serum LDL-cholesterol was 112+/-37 mg/dl (median: 112 mg/dl) and HDL-cholesterol - 47+/-18 mg/dl (median: 44 mg/dl). A significant inverse correlation between HDL-cholesterol and systolic blood pressure (r=-0.177, p=0.05) as well as a positive correlation between LDL-cholesterol and systolic blood pressure values (r=0.196, p=0.031) were found. CONCLUSION: In patients with type 2 diabetes there is a significant relationship between lipid levels and blood pressure values, which suggests an increased susceptibility to vascular disease associated with LDL-cholesterol in these patients.     

Epidemiology of chronic obstructive arterial disease of the lower limbs and diabetic patients at the University Hospital of Cotonou (Benin)

The aims of this study were to determine the prevalence of chronic obstructive arterial disease of the lower limbs and to identify the factors which contribute to its occurrence in a population of adult African francophone diabetics. This was a prospective study which included all consenting diabetics systematically over a 6 month period at the out patient clinic or during hospital admission. Patients with incomplete data were excluded. An ankle systolic pressure index of less than 0.9 was required for the diagnosis of obstructive arterial disease. Demographic parameters, the characteristics of the diabetes, the quality of blood sugar control, the presence of classical cardiovascular risk factors and the results of their treatment, the nature and distribution of the arterial lesions on ultrasonography were all studied. A univariate analysis and a multivariate analysis of their correspondences were undertaken to determine the correlation coefficients. The prevalence of arterial disease of the lower limbs in the 102 diabetics retained for the study (average age 53 years) was 33.3%. The arterial disease was distal in 47% of cases and diffuse in 26.5% of cases. The arterial wall was calcified in 19.6% of cases. In univariate analysis only age was correlated with arterial disease (p = 0.04), the duration of diabetes tended to be related (p = 0.07). In multi-factorial analysis of Correspondences with other factors, hypertension, hyperlipidaemia and multiple cardiovascular risk factors seemed to be correlated with arterial disease of the lower limbs. Therefore, arterial disease of the lower limbs is very common and an early complication of diabetic patients in Benin. Predisposing factors were age and, probably, duration of diabetes, hypertension, hyperlipidaemia and multiple cardiovascular risk factors.     

Determinants of arterial wall stiffness and peripheral artery occlusive disease in nondiabetic hemodialysis patients.

Aortic pulse wave velocity (Ao-PWV) and ankle-brachial blood pressure index (ABPI) are significant prognostic factors in patients with end-stage renal disease (ESRD). Diabetes mellitus (DM) promotes changes in arterial walls, including marked increases in Ao-PWV and decreases in ABPI. To determine the prevalence of peripheral arterial occlusive disease (PAOD) as well as the clinical variables useful in predicting these changes in nondiabetic patients with ESRD undergoing hemodialysis (HD), we performed a cross-sectional study in a cohort of 143 patients. Ao-PWV and ABPI were measured simultaneously and compared with several annual biochemical measurements and other clinical variables. The prevalence of PAOD in our cohort was 30.5%. In univariate regression analysis, Ao-PWV correlated positively with age, heart rate (HR), blood pressure (BP), pulse pressure (PP) and HbA1c, and negatively with serum albumin and ABPI. ABPI correlated negatively with age, HD duration, systolic BP, PP, low-density lipoprotein (LDL) cholesterol and hypersensitive C-reactive protein (hs-CRP), and positively with serum albumin and bone mineral density. In a step-down multiple regression analysis, HbA1c was identified as an independent determinant of Ao-PWV along with age, HD duration, HR and mean BP, while hs-CRP was an independent contributor to ABPI along with age, HD duration, PP and LDL cholesterol. Our results suggest that HD promotes aortic wall stiffness and PAOD progression. We recommend the monitoring of HbA1c to allow the prediction of aortic wall stiffness in nondiabetic ESRD patients. Our results did not confirm the influence of insulin resistance on the development of arterial sclerosis lesions.     

Effects of age on the relationship between cardio-ankle vascular index and atherosclerotic progression in patients with type 2 diabetes mellitus

AIM: A new indicator of arterial stiffness, cardio-ankle vascular index (CAVI), has recently been developed, instead of conventional pulse wave velocity. CAVI is proposed as a blood pressure-independent indicator of atherosclerosis, however, there have been few studies on the association of CAVI with atherosclerosis. The purpose of this study was to investigate effects of age on the relationship between CAVI and atherosclerotic risk in patients with diabetes mellitus. METHODS: The relationship between CAVI and atherosclerotic risk was investigated in 105 subjects with type 2 diabetes mellitus (mean age, 65.1 years old). The mean intima-media thickness (IMT) of the carotid artery was used as an indicator of atherosclerotic progression. RESULTS: In 55.2% of the subjects, CAVI was abnormally high (> or =9.0). In simple regression analysis, CAVI showed significant correlations with age, duration of diabetes and IMT. In logistic regression analysis, crude odds of abnormally high values of CAVI were significant for highest versus lowest tertile groups of mean arterial pressure (MAP) and IMT. Age-and sex-adjusted odds of abnormally high values of CAVI were significant for highest versus lowest tertile groups of mean arterial pressure (MAP) and serum total cholesterol. In multiple regression analysis, CAVI showed significant correlation with IMT independently of MAP but not independently of age, while the significant correlation of ankle-brachial pressure index (ABPI) with IMT was independent of age, sex and MAP. CONCLUSIONS: CAVI reflects atherosclerotic risk and the relationship between CAVI and atherosclerotic progression is strongly confounded by age. Thus, age should be taken into account when CAVI is used as an indicator of atherosclerotic progression.     

2型糖尿病患者慢性并发症的患病率及相关因素分析

<正>糖尿病是一组呈全球流行趋势的慢性代谢性疾病。随着经济的发展和人民生活方式的改变以及人口老龄化,糖尿病患病率逐年增加是全球范围内的共同趋势。美国国家糖尿病委员会报道糖尿病病人患     

Asymptomatic peripheral arterial disease in type 2 diabetes mellitus: prevalence patterns and risk factor associations

Aim of the study was to estimate the prevalence of peripheral arterial disease (PAD), by measuring ankle brachial pressure index (ABPI), and evaluate risk factor impacts on asymptomatic PAD in type 2 diabetes mellitus (T2DM) patients in Eastern India. It is a clinic based study of consecutive patients with calculated number for reasonable power. Eighty-four patients were studied. Risk factors assessed were T2DM duration, age, gender, body mass index (BMI), systolic (SBP) and diastolic (DBP) pressure, lipids and smoking status. Risk factor levels and impacts on ABPI was studied in total patients and then by segregation according to gender, ABPI level, smoking status and duration (3 groups: <1 year;1–10 year; >10 year). Student’s T Test, Pearson’s correlation, Multiple linear regression. Prevalence of mild PAD was 53% and moderate 14%. Mean ABPI was lower in males (0.83?±?0.09) and smokers (0.84?±?0.099), but higher in <1 year duration (0.91?±?0.13). Male gender (p?=?0.000) and duration of T2DM (p?=?0.016) were prime contributors of ABPI lowering, lipids might play some role. Higher SBP was partially contributory; independent role of smoking, age, DBP was questionable. Higher BMI and female gender seems protective. Asymptomatic PAD prevalence in T2DM is high. Lean male dyslipidemics are more predisposed; duration and SBP adds to it. Risk factor impacts differ at different durations in the various segregated groups compared to the total patients.     

高血压对2型糖尿病患者颅内外动脉粥样硬化性病变的影响

目的采用超声技术评估高血压对2型糖尿病患者颅内外动脉粥样硬化性病变进程的影响。方法连续纳入2009年9月—2010年8月在首都医科大学宣武医院内分泌科住院的2型糖尿病合并高血压患者203例。以收缩压升高5 mmHg为观察单位,将患者分组。采用彩色多普勒血流显像（CDFI）和经颅多普勒超声（TCD）测量每组颅内外动脉血流动力学参数,据此判断血管病变的程度。分析收缩压和舒张压、年龄,高血压病程、糖尿病病程与颈总动脉内-中膜厚度（CCA-IMT）、颈动脉及颅内动脉狭窄检出率的相关性。结果①203例患者CCA-IMT为0.62～1.36 mm,平均（1.04±0.14）mm。颅内动脉狭窄检出率为52.7%,其中中度及以上狭窄的检出率为21.2%;颈动脉狭窄检出率为28.1%,其中中度及以上狭窄的检出率为14.8%。颅内动脉狭窄总检出率及中度及以上狭窄的检出率均高于颈动脉,其中狭窄总检出率差异有统计学意义（P〈0.01）,中度及以上狭窄的检出率差异无统计学意义（P〉0.05）。②多因素逐步回归分析显示,CCA-IMT与收缩压、年龄呈线性关系,收缩压每升高5mmHg,CCA-IMT将增加0.015mm;年龄每增加1岁,CCA-IMT增加0.008 mm。③颅内动脉狭窄总检出率与年龄呈线性关系,年龄每增加1岁,狭窄总检出率增加2.8%;中度及以上狭窄的检出率与收缩压呈线性相关,收缩压每升高5 mmHg,狭窄检出率增加2%。结论高血压合并2型糖尿病患者CCA-IMT随血压升高而逐渐增加。高血压促使糖尿病患者颅内动脉狭窄病程的进展较颈动脉明显。     

Risk factors for macrovascular disease in diabetes mellitus: the London follow-up to the WHO Multinational Study of Vascular Disease in Diabetics

Summary We have examined the relationship between baseline variables and the incidence of new macrovascular complications amongst the 497 members of the London cohort of the WHO Multinational Study of Vascular Disease in Diabetics over a mean 8.33-year follow-up. In univariate logistic regression analysis the incidence of new ischaemic electrocardiographic abnormality was significantly associated with systolic and diastolic blood pressure, diabetes duration and hypertension in patients with insulin-dependent diabetes, and with smoking in patients with non-insulin-dependent diabetes. New myocardial infarction was associated with systolic blood pressure, plasma cholesterol, proteinuria and smoking in patients with non-insulin-dependent diabetes; there were no significant associations among patients with insulin-dependent diabetes. All new ischaemic heart disease was associated with hypertension in patients with insulin-dependent diabetes, and plasma cholesterol and smoking in patients with non-insulin-dependent diabetes. New cerebrovascular disease was associated with systolic and diastolic blood pressure, ECG abnormality and hypertension. New peripheral vascular disease was associated with smoking. Multivariate analysis showed the following significant associations 1) in patients with insulin-dependent diabetes: ECG abnormality; hypertension, myocardial infarction; smoking, ischaemic heart disease; hypertension, diabetes duration and smoking, 2) in patients with non-insulin-dependent diabetes: ECG abnormality; smoking, myocardial infarction; serum cholesterol, proteinuria and smoking, ischaemic heart disease; smoking. For new cerebrovascular disease, proteinuria and ECG abnormality were significant predictors in multivariate analysis. Patients with diabetes share many of the established risk factors for non-diabetic subjects, in addition proteinuria may be of significance in the prediction of macrovascular disease in diabetes.     

Laser Doppler skin perfusion pressure in the diagnosis of limb ischemia in patients with diabetes mellitus and/or hemodialysis.

AIM: We investigated whether measurement of skin perfusion pressure (SPP), as measured by laser Doppler, can be used to evaluate the severity of limb ischemia in diabetes mellitus (DM) and/or hemodialysis (HD) patients. METHODS: From April 2004 to March 2005, the ankle brachial pressure index (ABPI) and SPP were evaluated in 44 consecutive lower limbs with peripheral artery disease (PAD) and in 24 patients (21 males and 3 females, aged from 45 to 84 years, with a mean age of 69.3 years) with DM and/or HD. Twelve limbs were categorized as Fontaine stage II, 19 as Fontaine stage III and 24 as Fontaine stage IV. RESULTS: The SPP did not differ significantly between limbs at Fontaine stage II and those at Fontaine stage III, but it was significantly lower in limbs at Fontaine stage IV than in those at Fontaine stage II or III. The ABPI did not differ significantly among limbs at Fontaine stages II, III and IV. CONCLUSION: The SPP, as measured by the laser Doppler technique, may be used as a standard for classifying the severity of PAD in patients with DM and/or HD.