2型糖尿病患者下肢动脉硬化的影响因素及治疗效果分析

Arteriosclerosis in Lower Extremity Complicated with Type 2 Diabetes Mellitus-Risk Factors and the Therapeutic Effect

目的：探讨2型糖尿病患者不同程度下肢动脉硬化与传统动脉硬化危险因素、代谢控制状况的关系,以及对前列腺素E治疗的反应。方法：选取近2年住院的2型糖尿病患者168例,采用多普勒血流测定仪进行下肢动脉节段性测压（踝/臂指数ABI）,比较不同程度下肢动脉硬化患者胰岛功能、代谢控制状况及动脉硬化的相关危险因素,同时所有患者经前列腺素E（凯时）治疗10～14d后复查ABI,比较其治疗前后的变化。结果：全体患者根据ABI测定结果分为无下肢动脉硬化组（ABI〉1）,轻-中度下肢动脉硬化组（1〉ABI〉0.5）,重度下肢动脉硬化组（ABI〈0.5）共3组,结果发现：重度下肢动脉硬化组24h血压监测最低舒张压明显低于其他2组,差异有统计学意义（P〈0.05）,超声心动图显示射血分数在轻-中度动脉硬化组明显高于其他2组,差异有统计学意义（P〈0.05）,尿白蛋白排泄率（UAER）在中度下肢动脉硬化组明显高于无下肢动脉硬化组（P〈0.05）,且与下肢动脉硬化程度呈正相关（r分别为0.288、0.361、0.544,P值分别为0.036、0.001、0.001）。此外,年龄、病程、基础C肽、糖化血红蛋白、血脂水平在合并下肢动脉硬化组均高于无下肢动脉硬化组,但差异无统计学意义。前列腺素E治疗后各组ABI水平与治疗前比较均有不同程度升高,但治疗前后差异无统计学意义。结论：下肢节段性测压是发现和评价动脉硬化程度的简便有效手段,通过HDL（高密度脂蛋白）可以推断ABI的预测值,尿白蛋白排泄率与下肢动脉硬化发生有密切联系,前列腺素E治疗对改善ABI水平有效。

Objective To investigate the effect of metabolic control and different risk factors of arteriosclerosis in lower extremity complicated with type 2 diabetes mellitus, and the therapeutic efficacy of PGE1. Methods One hundred and sixty-eight hospitalized patients with type 2 diabetes mellitus in the recent two years were enrolled in our study. We observed the ABI level through the Hunt Leigh Doppler manometry, and compared the risk factors such as the function of pancreatic island, metabolic control etc. Among the diabetics with macro-vascular complications, a therapy of Lipo prostaglandin E1 （ PGE1 ） was installed in all patients whose ABI were lower than 1 for 10 to 14 days, and then the ABI levels were observed again. All subjects in our study were divided into three sub-groups based on their ABI, they are group A： ABI 〉 1, group B ： 1 〉 ABI 〉 0.5, group C ： ABI 〈 0.5. Results The results of 24 h monitoring of blood pressure showed that the Min-DBP in group C was significantly lower than that in group A and B, the P-values were 0. 047 and 0.010 respectively. In UCG, the level of EF in group B was significantly higher than those in group A and C, the P-values were 0.006 respectively and 0.005 respectively. The level of UAER in group B was significantly higher than that in group A, P = 0.22. Univariate analyses showed that in all lower ABI patients, age at examination, duration of diabetes, C-peptide level, total cholesterol and LDL cholesterol, glycosylated hemoglobin Alc, urinary albumin excretion rate（UAER） were higher than those who had normal ABI, although the difference was not significant. Multivariate analyses showed that UAER was positively related to ABI. After the PGE1 therapy for 10 or 14 days, the ABI levels were all higher than the baseline, but difference was not significant. Conclusion ABI level is effective in evaluatin g the arteriosclerosis in lower extremity in type 2 diabetes. We can deduce the ABI level by HDL cholesterol. PGE1 can improve the ABI level of chronic arterial ischemia of legs.