糖尿病性和非糖尿病性动脉硬化下肢血管造影特点比较及其临床意义

Comparison of angiographic characteristics in lower extremity between nondiabetic and diabetic atheroscleroses with analysis of its clinical significance

目的通过造影比较,明确糖尿病性和非糖尿病性下肢动脉硬化的差异,并分析其临床意义。方法对非糖尿病性动脉硬化患者49例,糖尿病性动脉硬化患者76例的造影结果进行了分析。以造影显示的动脉管腔狭窄≥20%为阳性标准,分析以上两种疾病时膝以下血管的狭窄率,并行统计学分析比较。结果非糖尿病性动脉硬化患者下肢(小腿)动脉累及率为42·5%,糖尿病性动脉硬化患者下肢(小腿)动脉累及率为52·0%(χ2=5·66,P<0·05)。非糖尿病性动脉硬化患者双下肢膝下各血管受累几率相近(χ2<0·35,P>0·05)。糖尿病性动脉硬化患者双下肢同名动脉受累几率相近(χ2<3·20,P>0·05),胫前动脉狭窄率为64·5%(χ2<0·80,P>0·05);胫后动脉狭窄率为59·9%(χ2<0·80,P>0·05),腓动脉狭窄率为31·6%(χ2>12·56,P<0·05)。结论下肢非糖尿病性动脉硬化和糖尿病性动脉硬化均为双侧对称性发病,后者更易侵犯膝以下小动脉。而糖尿病性动脉硬化较少累及双侧腓动脉,这为膝以下小动脉搭桥治疗糖尿病足提供了良好的流出道。

Objective To compare the different angiographic characteristics in lower limbs between nondiabetic and diabetic atheroscleroses with analysis of the clinical significance. Methods Angiographic results of 49 patients with nondiabetic atherosclerosis and 76 patients with diabetic atherosclerosis were analyzed. The included criterion of arterial involvement was an arterial stenosis≥ 20% so as to statistically analyze the stenosis rate of the below-knee arteries, Results The involvement rate of below-knee arteries was 42.5% in nondiabetic atherosclerosis, and 57.0% in diabetic one （P〈0. 05）. The involvement rates of different below-knee arteries of bilateral lower extremity were similar in nondiabetic atherosclerosis （P〉0.05）. The involvement rates of the homonymic below-knee arteries of bilateral lower extremity were similar in diabetic atherosclerosis （P〈0.05）. In diabetics the stenosis rate of the anterior tibial artery was 64. 5% ; the posterior tibial artery, 59.9% and the peroneal artery, 31.6% （P〈0. 05）. Conclusions Both nondiabetic and diabetic atherosclerosis are symmetrical disease processes in bilateral lower extremity. The latter is apt to attack the below-knee artery with less involvement of bilateral peroneal artery, which fortunately offers run-off artery for bypass grafting on small artery to treat diabetic foot.