50岁以上糖尿病人群周围动脉闭塞性疾病相关因素分析

Analysis of peripheral arterial obstructive disease related factors among diabetic population aged≥50

目的调查了解我国周围动脉闭塞性疾病(PAD)现患率及其相关影响因素。方法在我国7个大中城市15家三级甲等医院整群抽样入选50岁以上伴有一个以上危险因素的糖尿病患者以踝肱比(ABI)<0.9及脉波传导速度(PWV)>1400 cm/s 诊断 PAD,进行多因素回归分析其危险因素。结果调查的1397人中 PAD 的现患率为19.47%,其中男性占18.3%(122/664),女性占20.4%(150/733)。70岁以上 PAD 患病率上升到31.9%。PAD 与年龄、吸烟、收缩压、糖尿病病程及糖化血红蛋白均呈显著正相关。结论我国50岁以上糖尿病人群近五分之一患有 PAD。年龄、糖尿病病程、血糖水平和收缩期血压是 PAD 的危险因素。ABI、PWV 不仅是诊断 PAD 的手段,也可作为脑血管病(CVD)的预警指标。

Objective To analyze the peripheral arterial obstructive disease （PAD） related factors among diabetic population aged ≥50 in China. Methods The clinical data of 1397 diabetic patients aged ≥50 with at least one of the following risk factors： smoking, hypertension, and hyperlipidemia, from 15 Class Ⅲ Grade A hospitals in 7 major cities of China were collected. Diagnosis of PAD was based on the ankle brachial index （ABI） 〈0.9, and diagnosis of arteriosclerosis was based on pulse wave velocity （ PWV ） 〉 1400 cm/s. Regression studies were made to analyze the relations among PAD and various risk factors： age, sex, body mass index （BMI）, smoking, hypertension, hyperlipidemia, history of cerebral vascular disease （ CVD）, history of ischemia heart disease （IHD） etc. Results The current prevalence rate of PAD was 19.47% among the 1397 patients, 18.3 % （ 122/664 ） among the male patients, and 20. 4% （ 150/733 ） among the female patients. The prevalence of PAD in the patients aged ≥70 was as high as 31.9%. The duration of diabetes course was positively correlated with the prevalence of PAD （ χ^2 = 11.9, P = 0. 0026 ）. The ABI abnormality rate was 15.78% among those with a diabetic course of 5 years and was 23.84% among those with a diabetic course of 10 years, The abnormal ABI rate of the patients with CVD was 30. 57%, significantly higher than that of hose without CVD （ 17.29%, χ^2 = 21.49, P 〈0. 0001 ）. The abnormal ABI rate of the patients with IHD was 24.64%, significantly higher than that of the patients without IHD（ 18.20%, χ^2 = 5.85 ,P =0.0155）. The HbAlc value of the PAD patients was significantly higher than that of the patients without PAD （ χ2 = 5. 10, P = 0. 0239） Odd risk analysis showed that age increase of 10 years increased the PAD risk by 1.64 times （ OR = 1.6444 ,P = 0. 0001 ）. The PAD risk of the smokers was 1.68 times higher than that of the non-smokers （ OR = 1. 6852, P =0. 0001 ）. Increase of 10 mmHg in systolic blood pressure （SBP） increased the PAD risk by 1.19 times （OR = 1. 1926 ,P =0. 01 ）. The PAD risk of the patients with abnormal HbAIc was 2.44 times higher than that of the patients with normal HbAlc （OR =2.4473,P =0. 0001 ）. One-year＇s increase of the hypertension course increased the PAD risk by 1.02 times （ OR = 1. 0194, P = 0.03 ）. Logistic analysis indicated that the relations among PWV and the risk factors were almost the same among ABI abnormality and the risk factors. Conclusion Approximately one fifth of diabetic patients aged≥50 in China suffer from PAD. Age, course of diabetes, blood glucose level, SBP, IHD, and CVD are risk factors for PAD. Early intervention and treatment of hypertension and hyperglycemia, and quitting smoking are important in reducing the occurrence of PAD. ABI and PWV are not only diagnostic means for PAD, but also alarm guide indexes for cerebral vascular disease （CVD）.