踝肱指数与2型糖尿病患者下肢血管病变症状的关系

Relationship between ankle-brachial index and symptoms of peripheral artery disease in type 2 diabetes

目的:通过踝肱指数(ABI)检查,探讨ABI与糖尿病下肢血管病变临床症状的关系。方法:检测522例门诊2型糖尿病患者的ABI,按其结果分为:A组(ABI≥0.9)、B组(ABI<0.9且≥0.7)、C组(ABI<0.7且≥0.4)、D组(ABI<0.4),比较各组临床症状及生化指标,分析ABI与症状的关系及其影响因素。结果:522例2型糖尿病患者中,有血管病变症状者占46.74%,ABI异常者(<0.9,B、C、D组)占17.24%;ABI正常者(≥0.9,A组)与C组患者的症状表现形式差异有统计学意义(P<0.01),C组间歇性跛行47.83%、疼痛23.91%、皮肤发凉17.39%、溃疡26.09%、坏疽4.35%,A组分别为9.95%、24.31%、14.58%、5.56%、0。4组年龄、病程、运动强度、糖化血红蛋白、糖化血清蛋白间差异有统计学意义(P<0.05);而性别、吸烟、饮食控制、静脉血糖、血脂差异无统计学意义(P>0.05)。相关分析显示ABI与年龄、病程、糖化血红蛋白、糖化血清蛋白呈负相关,回归分析表明,病程及年龄是ABI的独立影响因素。结论:ABI对于无症状性血管病变筛查有良好作用;但ABI正常(≥0.9)人群中,仍有部分有血管病变症状表现,对于病程长、高龄或高糖化血红蛋白患者应当重视,应进一步进行血管评估。

Objective：To investigate the relationship between symptoms of peripheral artery disease（PAD） and ankle-brachial index（ABI） in noninsulin-dependent diabetes mellitus（NIDDM） .Methods：ABI was measured in 522 NIDDM outpatients,and the patients were assigned into 4 groups according to ABI：group A（ABI≥0.9） ,group B（ABI0.9 and ≥0.7） ,group C（ABI0.7 and ≥0.4） ,and group D（ABI0.4） .The clinical symptoms and biochemical indexes among the four groups were compared,and the influencing factors of ABI were analyzed.Results：The prevalence rate with abnormal ABI（group B,C,D） in 522 diabetic patients was 17.24%,and 46.74% patients had symptoms of vascular disease.The rates of patients with IC（47.83%） ,pain（23.91%） ,cold skin（17.39%） ,ulcer（26.09%） ,gangrene（4.35%） in group C were significantly higher than those of group A（9.95%,24.31%,14.58%,5.56%,0%,respectively,P0.01） .Age,duration,exercise intensity,glycosylated hemoglobin,glycosylated serum protein,of four groups were significantly different（P0.05） .And the differences of sex,smoking,diet control,glucose,blood lipid were not statistically significant.It showed a negative correlation between ABI and age,duration,HbA1c,glycosylated serum protein,and stepwise regressive analysis showed that duration and age were indepen-dent factors of ABI.Conclusion：Although ABI is good for screening asymptomatic vascular disease,there are still some patients with symptoms of vascular disease in the group of ABI≥0.9.Diabetic patients with long duration and high glycosylated hemoglobin and older age should undergo further vascular assessments.