经皮氧分压联合踝臂指数在2型糖尿病合并下肢动脉病变中的临床应用

Clinical applications of transcutaneous oxygen pressure combined with ankle-brachial index in Type 2 diabetics with peripheral arterial disease

目的:比较经皮氧分压(transcutaneous oxygen pressure,TcPO2)与踝臂指数(ankle-brachial index,ABI)在2型糖尿病(Type 2 diabetes mellitus,T2DM)合并下肢动脉病变(peripheral arterial disease,PAD)中的应用价值,探讨TcPO2与ABI在PAD诊断及治疗中的意义。方法:368例T2DM患者(男性188例,女性180例),采用多通道经皮氧分压检测仪测定足背TcPO2。依据TcPO2水平分为无受损组、轻度受损组、重度受损组。同时,采用彩色双功能超声诊断仪测定踝动脉压/肱动脉压比值即ABI,依据ABI水平分为无病变组(ABI≥0.9)和PAD组(ABI<0.9)。结果:PAD组与无病变组相比,年龄增大,病程延长,合并冠心病者增多,空腹血糖、餐后2 h血糖、糖化血红蛋白、尿肌酐均升高,TcPO2减低(P<0.05)。相关分析显示:年龄、病程、空腹血糖、三酰甘油、糖化血红蛋白A1c、体质量指数与TcPO2水平呈负相关(P<0.05),高密度脂蛋白、ABI与TcPO2水平呈正相关(P<0.05);TcPO 2与ABI检测结果的符合率为93.9%,敏感度为90.2%,特异度约为95.2%。结论:随着年龄、病程的延长以及尿白蛋白肌酐比值的增加,糖尿病患者PAD程度越严重,PAD程度随着ABI和TcPO2减低而加重;TcPO2联合ABI对早期诊断糖尿病PAD具有较高的临床价值。

Objective To compare the clinical application in diagnosis and therapy for Type 2 diabetes patients with perpheral arterial diease（PAD） between transcutaneous oxygen pressure（TcPO2） determination and ankle-brachial index（ABI）. Methods A total of 368 Type 2 diabetics（188 males and 180 females） were recruited into the study.TcPO2 of the acrotarsium was detected by multiple-channel transcutaneous tissue oxygen tension survey meter.According to the TcPO2 level,these patients were divided into a non-injury group,a mild injury group,and a severe injury group.Moreover,the ankle artery pressure and brachial artery pressure were determined by Doppler color ultrasonography and the ABI was calculated.According to the level of ABI,the patients were divided into a non pathological change group（ABI≥0.9） and a PAD group（ABI〈0.9）. Results Indexes including the age,duration of diabetes,incidence of diabetes associated with coronary heart disease,fasting blood glucose（FBG）,2-hour postprandial blood glucose,glycated hemoglobin A1c and urinary creatinine in the PAD group were markedly higher than those in the non pathological change group,whereas the TcPO2 in the PAD group was lower than that in the non pathological change group.Correlation analysis showed that TcPO2 was negatively related with the age,duration of diabetes,FBG,triglyceride,glycated hemoglobin A1c and body mass index while TcPO2 was positively related with the high density lipoprotein and ABI.The concordance rate of detection results for TcPO2 and ABI was 93.9%.The sensibility and specificity was 90.2% and 95.2% respectively. Conclusion With the progress of diabetes and the increase in ratio of urinary albumin to creatinine,the degree of peripheral arterial disease are increased.The ABI and TcPO2 are negatively related with the degree of peripheral arterial disease.TcPO2 combined with ABI have a profound value in the early diagnosis of Type 2 diabetics with peripheral arterial disease.