2型糖尿病患者周围动脉疾病危险因素分析

目的 探讨2型糖尿病患者周围动脉疾病(PAD)的患病率及传统和非传统危险因素对其影响.方法 选择病程超过1年的2型糖尿病患者共420例,以踝臂指数(ABI)≤0.90定义为有PAD,评价年龄、性别、体重指数、吸烟、高血压、糖尿病病程、糖化血红蛋白、血尿酸、三酰甘油、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、高敏C反应蛋白(hs-CRP)、纤维蛋白原、尿白蛋白排泄率(UAER)等危险因素对PAD患病率的影响.结果 2型糖尿病患者PAD患病率为16.4%(69/420),PAD患者年龄偏大、糖尿病病程较长、HDL-C偏低,有高的UAER、hs-CRP和纤维蛋白原,Logistic回归可见年龄、UAER、hs-CRP、纤维蛋白原均为PAD的独立危险因素.PAD患病率在年龄<50岁、50～70岁和>70岁时分别为4.7%(2/43)、12.9%(27/209)和23.8%(40/168),在hs-CRP<1 mg/L、1～3 mg/L和>3 mg/L时分别为7.9%(14/177)、9.3%(11/118)和35.2%(44/125),在UAER正常、微量白蛋白尿和大量白蛋白尿时分别为9.7%(30/310)、34.4%(33/96)和42.9%(6/14),在纤维蛋白原≤4 g/L和>4 g/L时分别为12.1%(43/356)和40.6%(26/64).结论 2型糖尿病患者PAD的患病率较高,一些非传统危险因素也参与PAD的发生.

Analysis of risk factors for peripheral arterial disease in type 2 diabetic patients

Objective To analyze the prevalence of peripheral arterial disease (PAD) in type 2 diabetic patients and its association with traditional and non-traditional risk factors. Methods A total of 420 type 2 diabetic patients with duration exceeding 1 year and without acute myocardial infarction, unstable angina,and infection were evaluated. PAD was diagnosed by ankle-brachial index ≤0.90. Risk factors included age, gender, body mass index, smoking, hypertension, diabetes duration,glycated hemoglobin A[C ( HbA_1C ), uric acid, triglyceride, total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol(HDL-C),high sensitive C reactive protein(hs-CRP),fibrinogen,and urinary albumin excretion rate (UAER). Results The prevalence rate of PAD was 16.4%(69/420). Older age, longer diabetes duration,lower HDL-C, higher UAER, hs-CRP and fibrinogen were associated with PAD. Multiple Logistic regression revealed that only age, UAER, hs-CRP and fibrinogen levels were independent risk factors. The prevalence rate of PAD was 4.7%(2/43), 12.9%(27/209) and 23.8%(40/168) in patients of less than 50 years old,50-70 years old and more than 70 years old, and was 7.9%( 14/177),9.3%( 11/118) and 35.2% (44/125) in different hs-CRP group (hs-CRP < 1 mg/L,l-3 mg/L, >3 mg/L), and was 9.7% (30/310) ,34.4%(33/96) and 42.9%(6/14) in normoalbuminuria, microalbuminuria and macroalbuminuria, and was 12.1%(43/356) and 40.6%(26/64) in different fibrinogen levels group (≤4 g/L and > 4 g/L). Conclusions The prevalence rate of PAD is higher in type 2 diabetic patients. Non-traditional cardiovascular risk factors may be involved in the development of PAD.