糖尿病合并下肢动脉硬化症危险因素分析

目的评价糖尿病患者下肢动脉硬化症发生的影响因素。方法回顾性分析2003～2006年在辽宁中医药大学附属医院住院的2型糖尿病(T2DM)患者65例(年龄≥50岁,病程≥7年),全部行双下肢动脉彩色多普勒检查。比较无血管病变组及不同程度动脉硬化病变组糖化血红蛋白、空腹血糖、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白(LDL-C)、脂蛋白a、C反应蛋白(CRP)、血压。评价血糖、血压、血脂等指标间的差异,并对糖尿病下肢动脉病变危险因素采用回归方法进行分析。结果①T2DM患者中有80%伴发下肢动脉硬化病变,病变的发生与空腹血糖、收缩压、HDL-C、LDL-C及脂蛋白a水平相关。②无血管病变组与不同程度动脉硬化病变组的收缩压、舒张压、糖化血红蛋白、空腹血糖、TG、CRP、脂蛋白a、HDL-C、LDL-C差异均有统计学意义(P<0.05)。③随着年龄的增大,下肢动脉硬化的患者人数逐渐增加。病程>10年的患病人数最多。结论糖尿病患者血糖控制水平与下肢动脉病变密切相关,血糖水平持续增高患者下肢动脉损伤明显加重,动脉硬化、血管狭窄发生率显著增高。预防和治疗糖尿病合并下肢动脉硬化症,应该严格、有效地控制血糖并纠正血脂代谢紊乱,这样有利于减少糖尿病足的发生。

Analysis of Risk Factors for Pathological Changes of Jower Limb Blood Vessels in Type 2 DM Patients

Objective To appraise the development and risk factors for pathological changes in lower limb blood vessels in type 2 DM patients. Method To analyze retrospectiVely 65 cases withtype 2 DM patients（ age ≥50 years, course≥ 7 years） who were hospitalized in Hospital affiliated Liaoning University of TCM between 2003 and 2006. All these patients were checked on both lower limbs by Doppler;and compare the HBAI C, FBG,TG, HDL-C, LDL-C,lipoprotein a, CRPa and BP. to evaluate the difference of these index among these groups,and analyzed by the method of logistic regression. Results ①The occurrence rate of lower limb blood vessel pathological changes among type 2 DM patients was 80%, and the occurrence of narrowed blood vessels was closelycorrelated with levels of the fasting blood sugar, high-density lipoprotein （HDL） and lipoprotein A. ②There were remarkable differences in blood sugar and blood lipoprotein （ P 〈 0.05 ） between DM groups with and without peripheral vascular disease. Condnsions Controlling the levels of blood sugar,lipid and blood viscosity is vital for preventing the development of lower limb blood vessel pathological changes in DM patients.