Ⅱ型糖尿病合并下肢慢性静脉功能不全临床特征分析

Clinical characteristics of chronic venous insufficiency in type 2 diabetic patients

目的探讨Ⅱ型糖尿病合并下肢静脉功能不全患者的临床及彩色多普勒超声影像学特点。方法将住院并诊断下肢慢性静脉功能不全(Chronic venous insufficiency,CVI)的Ⅱ型糖尿病患者共35例,使用静脉临床严重程度评分(Venous clinical severity score,VCSS)表对其静脉功能评分。彩色多普勒超声检查评估患者双下肢静脉病变。结果 35例Ⅱ型糖尿病患者平均年龄(68.83±11.12)岁,男:女=26∶9;平均糖尿病诊断时间(7.73±5.03)年;BMI(22.95±3.15)kg/m2;糖化血红蛋白(8.50±2.32)%。94.3%的患者合并糖尿病周围神经病变,54.3%存在下肢动脉狭窄或者闭塞;15例患者合并足部溃疡(占同期住院糖尿病足溃疡的14.3%)。VCSS评分为(7.24±4.22)分。静脉彩色多普勒超声显示18例患者存在下肢静脉返流、静脉血栓、静脉壁增厚或者钙化等影像学改变(病变组),其余17例患者静脉彩超无异常发现(非病变组);前者较后者糖化血红蛋白显著性升高(P=0.033),但两组间各项CVSS评分及CVSS总分无统计学差异(P>0.05)。结论Ⅱ型糖尿病患者下肢CVI主要通过临床症状和体征诊断;静脉彩超检查正常不能排除CVI。年龄、糖尿病病程长、长期血糖控制欠佳及合并糖尿病周围神经病变是其发生的危险因素。早期诊断、早期治疗可预防糖尿病足的发生。

Objective To investigate clinical and color Doppler ultrasound imaging features of chronic venous insufficiency（CVI） in type 2 diabetic patients.Methods 35 type 2 diabetic patients diagnosed with CVI were enrolled in this study.Venous clinical severity score（VCSS） was used to evaluate severity of CVI.Color Doppler ultrasound was administered to confirm properties of the venous disorders.Results The average age of the patients was 68.83±11.12 years old（44～87yr.The period from diagnosis of diabetes was 7.73±5.03 years（1month～20years）.BMI was 22.95±3.15 kg/m2 and HbA1c 8.50±2.32%（4.4～14.4%）.94.3% of the patients accompanied with diabetic peripheral neuropathy.54.3% had stenosis or occlusion of lower limb arteries.15 cases complicated with diabetic foot ulcer,accounted for 14.3% of the hospitalized diabetic foot patients in the same periods.Average VCS scoring was 7.24±4.22.Color Doppler ultrasound showed that venous reflux,venous embolism,venous wall thickening and calcification of venous wall were present in 18 patients and other 17 cases had normal venous imaging.The former had significantly higher HbA1c than the latter（P=0.033）.And their CVS scores were not statistically different（P0.05）.Conclusion Diagnosis of CVI in the diabetic patients is mainly dependent on clinical symptoms and signs.Normal venous imaging of lower limbs detected by color Doppler ultrasound cannot exclude CVI.Age,long-term of diabetic course,poorly controlled glucose and diabetic peripheral neuropathy may be the risk factors of CVI.Early diagnosis and treatment are important to prevent foot ulcer.