颈动脉内中膜厚度在预测糖尿病足发生发展中的地位研究

Position of carotid intima media thickness in the development of diabetic foot

目的通过对不同程度糖尿病足与单纯糖尿病患者颈动脉内中膜厚度的对比研究,探讨颈动脉内中膜厚度是否可作为糖尿病足发生发展的预测指标。方法选择2011年1月至2013年4月于空军总医院内分泌科住院的糖尿病患者共333例,分为wagner4-5级糖尿病足组（151例）、wagner0-3级糖尿病足组（84例）、单纯糖尿病组（98例）,对三组患者的颈动脉内中膜厚度、一般临床资料、相关检查及检验指标进行回顾性对比分析。计量资料采用t检验或秩和检验,计数资料采用χ^2检验。结果糖尿病足组,不论wagner4-5级还是wagner0-3级,其颈动脉内中膜增厚率（分别为84.1%、81.0%）与单纯糖尿病组64.3%比较,均有显著差异,差异具统计学意义（P〈0.05）。wagner4-5级糖尿病足组与wagner0-3级糖尿病足组颈动脉内中膜增厚率比较,无显著差异,差异无统计学意义（P〉0.05）。wagner4-5级和wagner0-3级糖尿病足组体质量指数、总胆固醇、甘油三酯、高密度脂蛋白及低密度脂蛋白与单纯糖尿病组比较,均有显著差异,差异具统计学意义（P〈0.05）。结论颈动脉内中膜厚度可作为糖尿病足发生危险性的预测指标。血脂代谢紊乱是动脉粥样硬化及中膜增厚的病理生理基础。因此,对糖尿病患者尽早进行调脂治疗是降低动脉粥样硬化及动脉内中膜增厚的有力措施,对减少糖尿病足的发生具有重要意义。

Objective Investigate the carotid intima media thickness（CIMT） is available as a predictor of the development of diabetic foot（ DF）,by comparing the difference of CIMT between varying degrees of diabetic foot and simple diabetic patients. Methods Totally 333 hospitalised diabetic patients in Air Force General Hospital during January 2011 to April 2013 were enrolled,and were individed into wagner4-5 DF group,wagner 0-3 DF group,and simple diabetic group. Clinical characteristics,examination results and CIMT were analyzed. The continuous data were examined t test or rank test,and discrete data with chisquare test. Results There was significant difference in abnormal rate of CIMT between wagner4-5 DF group or wagner0-3 DF group and simple diabeitc group（ P〈0. 05）. There was no significant difference in abnormal rate of CIMT between wagner4-5 DF group and wagner0-3 DF group（ P〉0. 05）. There were significant differences in BMI,TC,TG,HDL-C and LDL-C between wagner4-5 DF group or wagner0-3 DF group and simple diabetic group（ P〈0. 05）. Conclusions CIMT can be used as a predictor of the risk occurring of DF. Dyslipidemia is the pathophysiological basis of atherosclerosis and medial thickening. So,early Lipid-lowering therapy is an effective measures to reduce atherosclerosis and arterial intima thickening,which is significant for reducing the incidence of diabetic foot.