肥胖患者下肢深静脉血流动力学变化的研究

Deep vein hemodynamics of the lower limbs in obesity

目的 探讨肥胖患者下肢深静脉血流动力学变化及其与下肢深静脉疾病的关系.方法 根据体质量指数（BMI）将人群分成肥胖组（BMI＞ 30 kg/m2）和正常组（ BMI＜ 25 kg/m2）,肥胖组22例（44条肢体）,正常组24例（45条肢体）.利用彩色多普勒超声比较2组人群的下肢深静脉血流动力学参数,测量股静脉内径、股静脉峰值流速、平均流速和最低流速.结果 肥胖组股静脉内径（10.4±1.3） mm＞正常组（7.1±1.0） mm,差异有统计学意义（P＜0.01）.肥胖组静脉峰值流速和最低流速间差值（8±3） cm/s＜正常组（11 ±5） cm/s,差异有统计学意义（P＜0.01）.肥胖组静脉剪切应力（0.30 ±0.09） dyn/cm2低于正常组（0.50±0.17） dyn/cm2,差异有统计学意义（P＜0.01）.Sperman等级相关分析显示腰臀比、腰围和股静脉峰值流速和最低流速之间差值、剪切应力分别呈负相关,腰臀比、腰围和股静脉内径呈正相关.结论 肥胖组与正常组下肢深静脉血流动力学表现显著不同,肥胖是导致慢性静脉功能不全和静脉血栓的高风险因素.

Objective To evaluate lower extremity deep venous hemodynamic changes and lower extremity deep venous disease in abdominal obesity.Methods To compare venous flow parameters of the lower limbs as assessed by Duplex ultrasound scanning in obese and nonobese individuals according to body mass index（BMI）.Venous hemodynamics were studied in a prospective cohort study in nonobese（ BMI 〈 25 kg/m2） and obese individuals（ BMI 〉 30 kg/m2 ）.Diameter,peak,mean,and minimum velocities were assessed.Results The study examined 45 limbs in 24 nonobese individuals and 44 limbs in 22 obese individuals.The diameter of the femoral vein was significantly greater in obese vs nonobese limbs （ 10.4 ± 1.3） mm vs （7.1 ± 1.0） mm,P 〈 0.01 ）.Calculation of venous amplitude and shear stress showed significantly higher values in nonobese vs obese limbs [ （ 11 ± 5 ） vs （ 8 ± 3 ） cm/s ],（ P 〈 0.01 ） and [ （0.50 ± 0.17 ） vs （ 0.30 ± 0.09 ） ] dyn/cm2,（ P 〈 0.01 ）.Spearman rank correlation revealed a significant inverse correlation between waist-to-hip ratios and waist circumference and velocities amplitude （peak ve locity-minim velocity）,and shear stress.Conclusions Lower limb venous flow parameters differ significantly between obese and nonobese individuals.These findings suggest the mechanical role of abdominal adipose tissue potentially leading to elevated risk for both chronic venous insufficiency and venous thromboembolism.