门诊2型糖尿病足高危患者的踝肱指数与糖尿病足的相关性研究

目的 对有下肢症状的门诊2型糖尿病患者进行踝肱指数(ankle-brachial index,ABI)监测,了解糖尿病下肢血管病变的患病率并探讨ABI与糖尿病足的关系.方法 在上海市糖尿病临床医学中心门诊就诊的1010例有下肢症状的2型糖尿病患者中测定ABI,同时测定空腹和餐后血糖、糖化血红蛋白(HbA1e)、血压、体重指数(BMI)、双下肢的振动感觉阈值等,按ABI结果将患者分为5组:A组(ABI>1.3,35例)、B组(0.91.3占3.5%(35/1010).合并足病者83例(8.02%),包括溃疡50例(4.95%),坏疽13例(1.29%),感染20例(1.98%).相关分析显示ABI与年龄、病程、收缩压、HbA1c和糖化血清白蛋白呈显著负相关(r值分别为-0.201、-0.171、-0.113、-0.160、-0.137,均P<0.01).Logistic回归分析显示ABI是糖尿病足病的独立危险因素(t=6.805,P=0.00).结论 门诊2犁糖尿病足高危患者中26.4%存在下肢动脉病变,8.02%存在足病.年龄、病程、血糖控制不佳是影响ABI的关键因素.ABI的降低与足病的发生密切关联.

The ankle-brachial index and its association with diabetic foot in type 2 diabetic outpatients with positive lower extremity symptoms

Objective To screen the prevalence of lower extremity artery disease (LEAD) in diabetic outpatients through examining the ankle-brachial index( ABI) , and investigate its relationship with diabetic foot. Methods ABI was determined by Nicolet ultrasonography and quantitative sensation tester in 1010 type 2 diabetic outpatients with positive symptom of lower extremity, and clinical characterristics such as BMl, plasma glucose, HbAlc, glycolated albumin(GA) and blood pressure were collected. Patients were divided into five groups based on ABI, ABI >1. 3 as group A(n =35), 0. 91 -1.3 as group B(n =708) , 0.71 -0.9 as group C(n = 118), 0.41-0.7 as group D(n = 115), and ≤0.4 as group E(n=34), their clinical features were compared, and the correlation and Logistic regression analysis of ABI were performed. Results Total ABI of these 1010 diabetics were 0.95 ±0.23(0.01 -2.08), and the prevalence of LEAD was 26.44% (267/1010) diagnosed by ABI<0.9, and another 3.5% (35/1010) with ABI>1.3. Eighty three cases (8.02% ) were diagnosed as foot disease including 50 cases of ulcer (4.95% ), 13 cases of gangrene (1.29%), 20 cases of infection ( 1.98% ). The correlation analysis inolicated that ABI was associated negatively with age, SBP, duration, HbAl c and GA,and the r value was -0.201, -0.113, -0.171, - 0.160, - 0.137, respectively. The Logistic regression analysis revealed that ABI was independent risk factors of foot problem (t = 6.805, P = 0.00). Conclusions The prevalence of lower extremity artery disease and diabetic foot is 26.4% and 8.02% in type 2 diabetes outpatients with symptoms, respectively. Age,diabetic duration, and glucose control are key risk factors of ABI.The reduction of ABI is associated nearly with the onset of diabetic foot.