糖尿病足病患者下肢动脉病变超声影像学特点

目的探讨糖尿病足病患者下肢动脉病变超声影像特点及不同Fontaine分级的下肢动脉病变超声评分。方法对189例糖尿病足患者,共375条下肢,行彩色多普勒超声检查,其中Fontaine分级Ⅰ级210条下肢,Ⅱ级46条下肢,Ⅲ级43条下肢,Ⅳ级76条下肢。按动脉狭窄程度分为管径减少≤50%、管径减少51%～99%及闭塞,分析股总、股浅、腘、胫前、胫后、腓及足背动脉各段病变特点,对动脉狭窄程度进行评分,并比较不同Fontaine分级的下肢动脉病变超声评分。结果 375条下肢斑块发现率达97.60%(366/375),斑块分布以小腿动脉最多,占97.60%(366/375);斑块类型以程度最重的各种斑块均有者最高,占59.47%(223/375);周围动脉病变(PAD)肢体数占63.73%(239/375),小腿血管受累较重;不同Fontaine分级的下肢血管超声疾病严重度评分有差异,分级越高,评分越高;Fontaine分级Ⅰ级的糖尿病足病患者下肢血管闭塞发生率为30.00%,而FontaineⅢ级患者发生率为93.42%(P<0.05)。结论超声成像是糖尿病足病PAD重要的筛查工具,可对斑块类型、动脉病变严重程度及发生部位详细评估。糖尿病足病患者PAD发生率高,小腿血管受累较重;Fontaine分级越高,下肢血管发生狭窄或阻塞的节段越多。

The Ultrasound Image Characteristics of Lower Extremities Arteries in Diabetic Foot

Objective To identify the ultrasound image characteristics of lower limb arteries in diabetic feet.Methods 189 patients with diabetic feet were recruited in this study.375 lower limbs of the patients were classified into grade Ⅰ-Ⅳ according to their Fontaine classifications and accepted Color Doppler Ultrasound examinations.Of the 375 lower limbs,210 were classified as level Ⅰ,46 as level Ⅱ,43 as level Ⅲ and 76 as level Ⅳ.The degree of artery stenosis was categorized into ≤50% reduction in diameter,51%-99% reduction in diameter and complete occlusion.The lesion characteristics of common femoral arteries,superficial femoral arteries,popliteal arteries,anterior tibial arteries,posterior tibial arteries,peroneal arteries and dorsalis pedis arteries were analyzed.The ultrasound scores of lower limbs arterial diseases were compared in the patients with different levels of Fontaine classifications.Results The incidence of plagues in lower extremities arteries was 97.60%(366/375).Most plaques(97.60%,366/375) were distributed in crus arteries and the majority of plaques(59.47%,223/375) were serious.The incidence of PAD was 63.73%(239/375).Crus vasculars involvement was more serious.The levels of Fontaine classifications of the lower limb arteries were associated with ultrasound vascular disease severity scores.The higher grade had higher scores.The lower limbs with at least one occlusive blood vessel in the patients with Fontaine grade Ⅰ reached 30%.Conclusion The Ultrasound image is an important screening tool for PAD in diabetic feet.It can estimate the type of plaques,the seriousness of artery diseases and the location of lesions.Because up to 30% diabetic feet with Fontaine Ⅰ classifications have at least one occlusive blood vessel,the clinical manifestations do not provide enough evidence for the diagnosis of PAD.