2型糖尿病患者周围动脉疾病危险因素分析

Analysis of risk factors for peripheral arterial disease in type 2 diabetic patients

目的 探讨2型糖尿病患者周围动脉疾病（PAD）的患病率及传统和非传统危险因素对其影响。方法选择病程超过1年的2型糖尿病患者共420例，以踝臂指数（ABI）≤0．90定义为有PAD，评价年龄、性别、体重指数、吸烟、高血压、糖尿病病程、糖化血红蛋白、血尿酸、三酰甘油、总胆固醇、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、高敏C反应蛋白（hs-CRP）、纤维蛋白原、尿白蛋白排泄率（UAER）等危险因素对PAD患病率的影响。结果2型糖尿病患者PAD患病率为16．4％（69/420），PAD患者年龄偏大、糖尿病病程较长、HDL-C偏低，有高的UAER、hsCRP和纤维蛋白原，Logistic回归可见年龄、UAER、hsCRP、纤维蛋白原均为PAD的独立危险因素。PAD患病率在年龄〈50岁、50～70岁和〉70岁时分别为4．7％（2／43）、12．9％（27／209）和23．8％（40／168），在haCRP〈1mg／L、1—3mg／L和〉3mg／L时分别为7．9％（14／177）、9．3％（11／118）和35．2％（44／125），在UAER正常、微量白蛋白尿和大量白蛋白尿时分别为9．7％（30，310）、34．4％（33／96）和42．9％（6／14），在纤维蛋白原≤4g／L和〉4g/L时分别为12。1％（43／356）和40．6％（26164）。结论2型糖尿病患者PAD的患病率较高，一些非传统危险因素也参与PAD的发生。

Objective To analyze the prevalence of peripheral arterial disease （PAD）in type 2 diabetic patients and its association with traditional and non-traditional risk factors. Methods A total of 420 type 2 diabetic patients with duration exceeding 1 year and without acute myocardial infarction, unstable angina,and infection were evaluated. PAD was diagnosed by ankle-brachial index ≤0.90. Risk factors included age, gender, body mass index, smoking, hypertension, diabetes duration,glycated hemoglobin A1c （HbA1c）, uric acid, triglyceride, total cholesterol, low density lipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （HDL-C）, high sensitive C reactive protein （hs-CRP）, fibrinogen, and urinary albumin excretion rate （UAER）. Results The prevalence rate of PAD was 16.4% （69/420）. Older age, longer diabetes duration,lower HDL-C, higher UAER, hs-CRP and fibrinogen were associated with PAD. Multiple Logistic regression revealed that only age, UAER, hs-CRP and fibrinogen levels were independent risk factors. The prevalence rate of PAD was 4.7%（2/43 ）, 12.9%（27/209） and 23.8%（40/168） in patients of less than 50 years old, 50-70 years old and more than 70 years old, and was 7.9% （14/177）, 9.3% （11/118 ） and 35.2%（44/125） in different hs-CRP group （hs-CRP 〈 1 mg/L,1-3 mg/L, 〉3 mg/L）, and was 9.7% （30/310）, 34.4%（33/96） and 42.9%（6/14） in normoalbuminuria, microalbuminuria and macroalbuminuria, and was 12.1%（43/356） and 40.6%（26/64） in different fibrinogen levels group （ ≤4 g/L and 〉 4 g/L）. Conclusions The prevalence rate of PAD is higher in type 2 diabetic patients. Non-traditional cardiovascular risk factors may be involved in the development of PAD.