2型糖尿病合并高血压下肢动脉硬化闭塞症临床分析

Lower extremity arterial occlusive disease in patients with type 2 diabetes mellitus and hypertension

目的探讨老年2型糖尿病合并高血压患者下肢动脉硬化闭塞症的临床特点。方法回顾分析2004年1月至2010年12月浙江大学第一附属医院内分泌科及血管外科住院下肢动脉硬化闭塞症患者319例,其中男性223例,女性96例,平均年龄68岁以上。根据既往有无高血压及糖尿病分为对照组(无高血压及糖尿病,n=50)、糖尿病组(DM组,n=48)、高血压组(HNT组,n=80)、糖尿病合并高血压组(DM-HNT组,n=141),均初步行彩色多普勒超声检查或磁共振动脉成像(MRA),其中248例患者行下肢动脉造影。分析比较4组患者一般情况、生化指标间的差异及各组下肢动脉闭塞的特点,并对糖尿病下肢血管病变危险因素采用Logistic回归方法进行分析。结果①DM-HNT组年龄、空腹血糖、糖化血红蛋白、血压、心血管及脑血管并发症发生率均高于对照组(P<0.01);与其他3组相比,DM-HNT组TG、TC及LDL-c高(P<0.05)而HDL-c低(P<0.05);DM-HNT组糖尿病病程明显较DM组长(P<0.05);②DM-HNT组髂、股、小腿动脉段闭塞率分别为41.4%、72.7%、75.6%,高于HNT组(27.2%、41.3%、28.3%,P<0.05)及对照组(19.7%、27.9%、16.4%,P<0.01)。DM-HNT组髂、股动脉段闭塞率高于DM组(P<0.05),但小腿动脉段闭塞率差异无统计学意义(P>0.05)。③多因素Logistic回归分析显示收缩压、TC、LDL、糖尿病病程是糖尿病患者发生下肢动脉病变的独立危险因素。结论与非糖尿病患者相比,2型糖尿病患者以小腿动脉闭塞为主,而2型糖尿病患者合并高血压后发生髂动脉段及股动脉段闭塞率亦高,这可能与血压、血脂、糖尿病病程等多种危险因素有关。

Objective To investigate clinical features of lower extremity atherosclerotic occlusive disease in patients with type 2 diabetes mellitus and hypertension.Methods We performed a retrospective analysis of 319 patients（223 males and 96 males,a mean age of over 68） with lower extremity atherosclerotic occlusive disease who were hospitalized in Departments of Endocrinology and Vascular Surgery of the First Affiliated Hospital,School of Medicine,Zhejiang University,between January 2004 to December 2010.These patients were divided into 4 groups,control group（without hypertension or diabetes,n=50）,diabetes group（DM group,n=48）,hypertension group（HNT,n=80）,and diabetes and hypertension group（DM-HNT,n=141）.All these patients were examined by lower limbs color Doppler ultrasonography and/or magnetic resonance angiography（MRA）,and 248 patients（248/319） underwent arteriography on lower extremity.The differences in ordinary and biochemical indices among the various groups of patients were compared,and analyzed by logistic regression.Results In DM-HNT groups,the age,fasting blood glucose,HbA1c,blood pressure,and the occurrence of cardiovascular and cerebrovascular complications were higher than those in control group（P0.01）,TG,TC and LDL-c was significantly higher（P0.05） but HDL-c was significantly lower when compared with the other 3 groups（P0.05）,and the duration of diabetes was significantly higher in DM-HNT group compared with DM group（P0.05）.The rates of iliac,femoral,and crural artery atherosclerotic occlusion were 41.4%,72.7%,and 75.6% respectively in DM-HNT group,significantly higher than those in HNT group（27.2%,41.3%,and 28.3% respectively,P0.05） and the control group（19.7%,27.9%,and 16.4% respectively,P0.01）.These rates in DM-HNT group was significantly higher than those in DM group（P0.05）,except the crural artery had no difference（P0.05）.Logistic regression analysis showed that systolic blood pressure,LDL,and duration of diabetes were independent risk factors in lower extremity atherosclerotic occlusive disease in patients with diabetes.Conclusion Compared with the non-diabetic patients,type 2 diabetic patients are more liable to severe vascular lesions in the distal segments of the lower extremity,patients with type 2 diabetes mellitus and hypertension have higher susceptivity to iliac artery and femoral artery atherosclerotic occlusion,and it is associated with high blood pressure,serious disorder of lipid levels,longer duration of diabetes.