糖尿病患者下肢深静脉血栓形成和肺血栓栓塞症的相关因素

Related factors of lower extremity deep vein thrombosis and pulmonary embolism in patients with diabetes mellitus

目的探讨糖尿病患者下肢深静脉血栓形成（LEDVT）和肺血栓栓塞症（PE）的相关因素。方法对58例糖尿病患者行双下肢^99Tc^m-大颗粒聚合白蛋白（MAA）深静脉显像和（或）超声检查、肺灌注显像，同期收集空腹血糖、血胆固醇、血三酰甘油等实验室资料及年龄、病程、胸部症状（胸痛、呼吸困难）、下肢症状（肿胀、静脉曲张、糖尿病足）、急性并发症（酮症酸中毒和高渗性昏迷）等临床资料，分析各因素与糖尿病患者LEDVT、PE患病率的关系。结果（1）58例糖尿病患者中28例（4813％）并发LEDVT，10例（17．2％）并发PE，有LEDVT的糖尿病患者PE患病率明显高于无LEDVT的糖尿病患者（32．1％比3．3％，Х^2=6．53，P〈0．05）。（2）年龄≥65岁、病程≥15年、空腹血糖〉15．0mmol／L、血胆固醇〉6．00mmol／L、血三酰甘油〉1．24mmol／L、伴有胸部症状、下肢症状或急性并发症时，糖尿病患者LEDVT患病率上升（均P〈0．05）。血压、体质量指数、糖尿病类型等3种因素对糖尿病患者LEDVT患病率的影响差异无统计学意义（均P〉0．05）。（3）伴有胸部症状、下肢症状、急性并发症的糖尿病患者PE患病率增加（均P〈0．05），其余因素对糖尿病患者PE患病率的影响差异无统计学意义（均P〉0．05）。结论糖尿病患者因高龄、长病程、高血糖、高胆固醇、高三酰甘油等多种危险因素相互累积而易致LEDVT，伴有急性并发症、胸部症状、下肢症状的重症糖尿病患者为PE的高危人群。

Objective To explore the related factors of lower extremity deep vein thrombosis （LEDVT） and pulmonary embolism （PE） in patients with diabetes mellitus. Methods Fifty-eight diabetic cases underwent lower extremity ^99Tc^m- macroaggregated albumin （MAA） veins imaging （and/or uhrasonography） and pulmonary perfusion imaging. The related laboratory data, including fasting blood glucose （FBG）, blood cholesterol, blood long chain triglycerides （LCT）, and clinic informations, including age, disease courses, chest symptoms （chest pain and dyspnea） , lower extremity symptoms （swelling, varicose veins and diabetic foot） and acute complications （diabetic ketoaeidosis and hyperosmolar non-ketotic diabetic coma）, were collected in the same period. The relationship among factors with the prevalences of LEDVT and PE were analyzed. Results （1）Twenty-eight patients （48.3%） were found to be with LEDVT, 10 cases（17.2%） with PE. The PE prevalence in the patients with LEDVT was higher than that of patients without LEDVT （32.1% vs 3.3%, Х^2=6.53, P〈0.05）. （2）When age≥65 years, disease course≥15 years,FBG〉15.0 mmol/L, blood cholesterol〉6.00 mmol/L, LCT〉1.24 mmol/L, accompanied with chest symptoms, lower extremity symptoms or acute complication, the LEDVT prevalence of patients with diabetes significantly increased （all P〈0.05）. But the factors such as hypertension, body mass index and diabetes mellitus type, had no influence on the LEDVT prevalence respectively （all P〉0.05 ）. （3）When accompanied with chest symptoms, lower extremity symptoms or acute complication, the PE prevalence of patients with diabetes significantly increased （all P〈0.05）. The other factors had no influence on the PE prevalence of patients with diabetes （all P〉0.05 ）. Conclusions The high prevalence of LEDVT in patients with diabetes mellitus contributes to the various dangerous factors, such as old age, long disease course, high FBG, high cholesterol and high LCT. The patients with serious diabetes mellitus, accompanied with chest symptoms, lower extremity symptoms or acute complication may be the high-risk groups for PE.