老年人糖尿病下肢动脉粥样硬化临床特点及相关因素的研究

Clinical characteristics of diabetic atherosclerosis of lower extremities in the elderly

目的探讨糖尿病下肢动脉粥样硬化的特点及其相关因素。方法回顾性研究2001年12月至2005年12月首都医科大学宣武医院同期治疗的动脉硬化导致下肢缺血患者的资料,对比性分析了糖尿病组203例和非糖尿病组120例的年龄、性别构成比、病变累及的位置及其相关因素等。结果糖尿病组发病年龄平均为67.9岁,非糖尿病组平均为75.7岁,发病年龄提前7.8年;糖尿病组男女之比为2.2∶1,非糖尿病组男女之比为4∶1;病变累及位置,前者多累及股浅动脉以远的动脉,后者则多累及股浅动脉及其以近的动脉,前者多累及多个平面。Ⅰ型-股浅动脉及其近段病变以非糖尿病者多发生(P<0.01);Ⅱ型-单纯累及股浅动脉病变,以非糖尿病者多发生(P<0.01);Ⅲ型-股浅动脉及其远段病变,以糖尿病性者多发生(P<0.01);Ⅳ型-全程多节段病变,以糖尿病组者多发生(P<0.05)。糖尿病组血管造影显示,80.6%为双下肢病变,非糖尿病组为73.1%(P>0.05)。糖尿病组和非糖尿病组分别有53.2%和54.2%的患者伴有高血压(P>0.05)、16.3%和25%的同时患有冠心病(P>0.05)、14.8%和19.2%的同时患有脑梗死(P<0.01)、3.5%和4.7%的患者同时患有冠心病和脑梗死(P>0.05)。糖尿病组和非糖尿病组分别有30.5%和17.8%出现下肢远端的溃疡或坏疽(P<0.05)。结论糖尿病患者并发动脉粥样硬化发病年龄比非糖尿病者要早8年左右,男女比例也明显缩小,前者的下肢动脉病变更易发生在股浅动脉远端,更多累及多个节段动脉,更易出现下肢远段的组织坏疽或溃疡。

Objective To explore the characteristics of diabetic atherosclerosis of lower extremities and its related factors. Methods The data of inpatients suffering from lower extremity atherosclerotic ischemia in Xuanwu Hospital of Capital Medical University from December 2001 to December 2005 were analysed retrospecfively. The age, sex ratio, locus of pathological change and other related factors were compared between the group of 203 diabetic patients and the other group of 120 patients without diabetes. Results The mean age of atherosclerosis onset was 67.9 in the group of diabetics while it was 75.7 in the group of patients without diabetes and the former group was 7.8 years earlier than the latter group. The ratio of male to female was 2.2 ： 1 in group of diabetics and 4 ： 1 in group of patients without diabetes. The arteries below knee were involved in most diabetics and the arteries above knee were involved in most patients of the other group. Type- Ⅰ lesion, lower extremity atherosclerosis involving superficial femoral artery and the arteries proximal to it, was more commonly seen in the patients without diabetes; Type- Ⅱ lesion, simply involving the superficial femoral artery, was also more common in the patients without diabetes; Type- Ⅲ lesion, involving the superficial femoral artery and the arteries distal to it, was more common in the diabetics; Type- Ⅳ lesion, involving multifocal atherosclerotic changes of the lower extremity, was more common in the diabetics. Involvement of arteries of bilateral lower limbs accounted for 80.6% of the diabetics and 73.1% of patients without diabetes. Percentages of the diabetics and patients without diabetes had the concomitant diseases respectively as follows： 53.2% and 54.2% had hypertention; 16.3% and 25M had coronary heart disease; 14.8% and 19.2% had cerebral ischemia, 3.5 % and 4.7 % had coronary heart disease and cerebral ischemia, 30.5 % and 17.8 % had distal lower limb ulcer or gangrene. Conclusion The onset of atherosclerosis is about 8 years earlier in the diabetics than the patients without diabetes. Diabetes tends to affect the arteries distal to the superficial femoral artery with multifocal involvement and is apt to cause foot ulcer or gangrene.