踝肱指数与糖尿病患者血管病变危险因素的相关分析

目的探讨糖尿病患者踝肱指数(ABI)同心血管病相关危险因素的关系,了解糖尿病患者ABI同糖尿病肾病的相关性,评估ABI同彩色多普勒超声检查方法观察糖尿病患者外周动脉病变的一致性。方法对151例入院诊治的糖尿病患者测定ABI,按测定的结果分成正常ABI组、低ABI组和高ABI组。详细询问患者病史,测定血糖、血脂、尿酸,计算12 h尿微量白蛋白排泄率等。依照12 h尿微量白蛋白排泄率将151例患者分为3组进行ABI的比较。行颈部、双下肢血管超声多普勒检查,观察外周动脉有无病变。结果①正常ABI组、低ABI组和高ABI组年龄、病程、糖化血红蛋白、三酰甘油、12 h尿微量白蛋白排泄率比较均有显著性差异。3组的高血压合并率分别为53%,79%,67%,低ABI组与正常ABI组高血压合并率比较有显著性差异(2=5.431,P<0.025)。3组空腹血糖、胰岛素、C肽、胆固醇、低密度脂蛋白、高密度脂蛋白、尿酸比较无显著性差异。②外周动脉病(PAD)在糖尿病肾病中占41%,在临床蛋白尿期的患病率达60%。随着蛋白尿的增加,PAD的患病率明显增加;PAD的患病率随着糖尿病肾脏病变的加重而明显增高。③经血管超声多普勒诊断PAD的患病率为81.5%。依据异常ABI(包括低和高的ABI)诊断PAD占21.9%。使用ABI诊断PAD同彩色超声多普勒比较特异性为92.9%,敏感性为25.2%。结论糖尿病患者中,年龄、病程、糖化血红蛋白、三酰甘油、蛋白尿为ABI最相关因素;高ABI同低ABI有相似的心血管病危险。异常ABI同糖尿病肾病相关,糖尿病肾病人群中PAD的患病率增高。糖尿病患者PAD的患病率高。ABI用于发现糖尿病患者的PAD不敏感。

Analysis of correlation between risk factors of vascular disease and ankle-brachial index in DM patients

Objective It is to investigate the correlation between ankle-brachial index(ABI) and risk factors of angiocardiopathy in DM patients,and to know about correlation between ABI and diabetic nephropathy,to evaluate concordance between ABI and color Doppler ultrasonography for the diagnosis of PAD.Methods According to ABI measured by Doppler flow imaging survey meter,151 hospitalized diabetics were divided into three groups: normal ABI group,low ABI group and high ABI group.All subjects were inquired in detail about medical history and their blood glucose and fat,insulin,C-peptide and uric acid.Their 12 hours UAE was calculated too.According to 12 hours UAE,151 subjects were divided into three groups to compare their ABI and color Doppler ultrasonography was used to observe peripheral arterial disease in neck and both lower extremities.Results ①The three groups(normal,low and high ABI) had statistic significance in comparison of their age,course of disease,HbA1c,TG and 12-hour UAE.The hypertension complicating rate in the three groups were 53%,79% and 67% respectively.Their hypertension complicating rate had statistic significance between low ABI group and the normal ABI ones(χ2=5.431,P<0.025).The three groups had no significant difference in fasting blood glucose,insulin,c-peptide,TC,LDL-C,HDL-C and uric acid.②The prevalence of PAD was 41% in diabetic nephropathy and 60% in subjects in the stage of clinical albuminuria.With augmenting albuminuria,the prevalence of PAD was increasing.And it showed that the more severe diabetic renal lesions,the higher prevalence of PAD.③The prevalence of PAD diagnosed by the color Doppler ultrasonography was 81.5%.And according to abnormal ABI(including the low and the high),it was 21.9%.The specificity of diagnosing PAD by ABI compared with Doppler ultrasonography was 92.9%,and the sensitivity by it was 25.2%.Conclusion ABI is mostly in correlation with age,course of disease,HbA1c,TG and albuminuria in diabetics.High ABI has the same angiocardiopathy risk factors as that in the low one.Abnormal ABI is in correlation with diabetic nephropathy,and the prevalence of PAD is higher in patients with diabetic nephropathy.The prevalence of PAD is higher in the diabetics,and it is not sensitive to detect PAD with ABI in the diabetics.