踝肱指数诊断糖尿病下肢动脉病变的临床意义

Ankle-brachial index in the diagnosis of peripheral artery disease and its relationship with cardiovascular risk factors in the patients with type 2 diabetes

目的了解踝肱动脉血压指数(ABI)在诊断T2DM患者下肢动脉病变中的意义及其影响因素。方法采用多普勒血流探测仪测定糖尿病患者的足背动脉、胫后动脉与肱动脉的比值,以比值小于0.9为异常。结果本组280例患者中检出ABI<0.9者60例,占21.4%。合并下肢动脉病变组与正常组比较,前者的年龄大、病程长、餐后血糖、TG、LDLC、UAlb/Cr比值的对数值、脉压差、吸烟率和合并冠心病率明显增高,DBP和HbA1c达标率明显降低。逐步回归分析显示,年龄、病程、TG、HbA1c是影响ABI的独立因素。结论ABI是一项花费小、简单无创的诊断下肢动脉病变的可靠指标。增龄、病程长、高TG、高血糖是加剧下肢动脉硬化的主要因素。

Objective To investigate the ankle-brachial index （ABI） in the diagnosis of peripheral artery disease （PAD） and its relationship with the cardiovascular risk factors in the patients with type 2 diabetes. Methods ABI was examined in the 280 patients with type 2 diabetes. The patients were divided into group A （ABI≥0. 9） and group B （ABI〈0.9）. The related risk factors of PAD were analyzed. Results 60 patients （21.4%） with abnormal ABI showed older age （63.4±10.9 vs 53.3 ±11.3 yrs）, longer duration of diabetes （ 96.0 ±98.7 vs 37.8 ±53.4 months）, higher 2h post-meal blood glucose（15.8±4.8 vs 13.5 ± 4.9 mmol/L）, higher levels of serum triglycerides（2.8 ± 2.5 vs 2.1±1.6 mmol/L）, LDL-C （3.1±0.8 vs 2.7±1.2 mmol/L）, and log-transferred urine albumin（1.4 ±0.5 vs 1.2±0. 5）, lower diastolic blood pressure（73±8 vs 78±11 mm Hg）and higher pulse pressure （60±16 vs 55±14 mm Hg）.There was lower freguency of the patients with HbAlc 〈7% （23.3 % vs 40.5%）,more smokers （51.7 % vs 31.0%） and more patients with cardiovascular diseases （43.3% vs 22.2%）in group B than in group A. Step-wise analysis showed that age, duration of diabetes, TG and HbA1c were the independent risk factors for PAD. Conclusion It is easy and economical to check ABI for diagnosing PAD in diabetic patients. Patients with abnormal ABI have more and severe macrovascular risk factors.