老年人下肢动脉病变预后随访及危险因素分析

Analysis of prognosis and risk factors in the elderly patients with 1ower extremity atherosclerotic disease

目的:分析老年人下肢动脉病变发生的影响因素及其预后的影响。方法:回顾性分析2004～2009年于哈尔滨医科大学第一临床医学院干部二病房明确诊断为下肢动脉病变的住院患者181例。全部行双下肢动脉彩色多普勒检查,按照动脉病变程度将患者分为3组:斑块组、狭窄组(≥50%)和闭塞组。收集其性别、年龄、血脂、空腹血糖(FBG)、纤维蛋白原(FIB)、高血压、脑卒中及吸烟史等信息。比较不同病变组一般情况及生化指标间的差异,并对老年下肢动脉粥样硬化病变危险因素采用回归方法进行分析。所有患者均接受16个月随访,观察患者的主要终点事件包括下肢坏疽、侧支循环、死亡。结果:①年龄、糖尿病病程、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、FBG、血脂异常、性别比例、糖尿病、冠心病、脑卒中合并率在三组间的差异无统计学意义(P>0.05)。②三组间高血压病程、高血压合并率、吸烟时间、吸烟率、HDL-C、FIB在三组之间的差异有统计学意义(P<0.05)。③Logistic回归分析结果显示TG、高血压、纤维蛋白原与老年LEAD的发生成正相关(P<0.05),HDL-C与LEAD成负相关(P<0.05)。④经过16个月随访,三组间生存率无显著差异(P>0.05)。结论:老年LEAD患者男性明显多于女性,且常有较高的吸烟率、高血压、糖尿病、脑卒中、血脂异常的合并率。TG、FIB水平增高及合并高血压病其下肢血管病变程度更重,是加剧下肢动脉硬化的主要因素,HDL-C对LEAD具有保护作用。经过16个月随访,老年LEAD患者死亡的主要原因为心脑血管疾病,与血管狭窄严重程度无相关性。

Objective：To investigate the prognosis and its related risk factors of 1ower extremity atherosclerotic disease in the elderly patients.Methods：To analyze retrospectively 181 cases with suffering from lower extremity atherosclerotic ischemia who were hospitalized in The First clinical college of Harbin Medical University from December 2004 to December 2009.All these patients were checked on both lowerlimbs by Doppler,the patients were classified into three groups：plaque formation（plaque）,arterial stenosis（stenosis）（1uminal narrowing≥50）and arterial occlusion（occlusion）.After collecting their clinical information such as gender,age,blood lipid profile FBG,fibrinogen（FIB）,the history of hypertension,stroke and smoking and so on.The differences in ordinary and biochemical indices among these groups of patients were compared,and analyzed by the method of logistic regression.All of patients follow-up for 16 months,Observed in patients with primary endpoint events,including lower limb gangrene,side limb cycle,death.Results：There were no significant differences in age,the proportion of male and female,DM duration,TG,TC,LDL-C,FBG,dyslipidemia,coronary heart disease,stroke and the proportion of smoker among the three groups（P〉0.05）.Among the three groups hypertension,hypertension with the rate of smoking time,smoking,HDL-C,FIB difference were statistically significant（P〈0.05）.Logistic regression analysis showed that triglyceride（TG）,hypertension,fibrinogen（FIB）were positive correlated with LEAD lesions（P〈0.05）,while high-density lipoprotein cholesterol was negative correlated with LEAD lesions（P〈0.05）.After16months of follow-up,among the three groups no significant difference in survival rates（P〉0.05）.Conclusions：The number of male was obviously more than female＇s in patients with LEAD,and in whom there was a high prevalence of smoking,hypertension,DM,stroke and dyslipidemia.Triglyceride（TG）,fibrinogen（FIB）levels increased in patients with hypertension and vascular lesions in the lower extremities increased the process severity advanced and were the major factors aggravating LEAD.HDL-C has a protective effect on LEAD.After 16months of follow-up,cardio cerebral disease is the main reason for death of patients which suffer from 1ower extremity atherosclerotic disease in the elderly patients and severity of vascular stenosis no correlation.