糖尿病足患者下肢血管造影特点及其临床意义

Angiographic characteristics of lower extremities in diabetic foot patients

目的探讨糖尿病足下肢动脉的血管造影成像特点,并分析其临床意义。方法分析糖尿病足患者35条患肢的造影结果,分别对下肢缺血病变不同临床分期、不同部位的血管狭窄程度进行比较,并进行统计学分析。结果（1）以管腔狭窄程度〈50%为0分,50%-74%为1分,75%-99%为2分,管腔完全闭塞者为3分。膝以上与膝以下共210个动脉节段比较,两组血管的狭窄程度为0,1,2,3分的分别是32.9%比18.5%,20.0%比9.3%,12.9%比14.3%,34.2%比57.9%,差异均有统计学意义（P均〈0.05）。膝以上血管以轻中度狭窄为主,膝以下血管则以重度乃至完全闭塞病变为主。（2）每侧患肢腓动脉重度狭窄的几率（57.1%）明显低于胫前（77.1%）和胫后动脉（74.3%）。（3）间歇性跛行患肢膝以下三叉血管系统重度狭窄率41.7%,与静息痛（83.3%）或溃疡（79.5%）患肢相比,差异均有统计学意义（P均〈0.05）。结论临床出现静息痛、溃疡及坏疽时,表明膝以下血管出现广泛重度病变,且多为三支血管联合病变。糖尿病足患者血管病变大多累及下肢远段小血管,其双侧动脉病变多为对称性同步发展。腓动脉在糖尿病性动脉硬化发病过程中病变较轻,为膝以下小动脉搭桥提供了良好的流出道。

Objective To explore the angiographic characteristic of lower extremities of patients with diabetic foot. Methods The angiographic results of 35 lower extremities of diabetic patients, the characteristics of respective clinical stages and the stenosis degree at different arterial segments were undergone statistical analysis. Results （ 1 ） A lotal of 210 arterial segments were divided into the above-knee and the below-knee section. There was significant difference in stenosis degree between the two sections （P 〈0. 01 ）. Most of the above-knee arteries were slightly or moderately stenosed, but the majority of the below-knee arteries were severely stenosed or were complete occlusion. （2） The stenosis degree of peroneal arteries （57.1% ） was lower than the anterior tibial arteries （77.1% ） and the posterior tibial araeries （74. 3% ） respectively （both P 〈 0. 05 ）. （3） The degree of stenosis in the below-knee section was less severe in patients with intermittent claudication （41.7%） compared with patients with rest pain（ 83.3% ） and gangrene patients （79.5%） （both P 〈0.05）. Conclusion When rest pain, ulcer or gangrene developed in the lower limbs, there were most likely to have severe stenosis in the below-knee arteries which involved all the three main arteries. Diabetic atherosclerosis developed symmetrically in the distal in both legs. Less severe stenosis were found in the peroneal arteries which could offer run-off artery for by-pass grafting on small artery to treat diabetic foot.