2型糖尿病双下肢动脉病变MSCTA诊断及危险因素分析

Lower extremities vascular disease in type 2 diabetes:16-detector row CT angiography diagnosis and risk factors clinical analysis

目的研究2型糖尿病患者双下肢动脉病变MSCTA影像表现,并探讨影响双下肢动脉病变的主要危险因素。方法 61例患者行双下肢动脉MSCTA检查,运用MPR、MIP、VR等后处理分析动脉硬化斑块的分布情况及各节段狭窄程度等。详细记录患者年龄、病史、踝臂指数、生化指标（总胆固醇（TC）,甘油三酯（TG）,高密度脂蛋白（HDL-C）,低密度脂蛋白（LDL-C））。运用Logistic回归分析双下肢动脉狭窄及踝臂指数的主要危险因素。结果 61例均扫描成功,共1281段血管：327段有硬化斑块;28段轻度狭窄,21段中度狭窄,10段重度狭窄,14段闭塞。硬化斑块主要好发于上段（腘动脉以上）,Х^2=115.371,P〈0.001;狭窄多发生在下段（腘动脉及其以下）,Х^2=13.523,P〈0.001。下肢动脉狭窄危险因素有年龄、病史和TC异常,TC异常是独立危险因素（OR=7.860,95%CI：1.988-31.077）;踝臂指数异常危险因素为动脉狭窄和TC异常,动脉狭窄是独立危险因素（OR=28.310,95%CI：5.411-148.121）。结论 MSCTA可以清楚、准确判断2型糖尿病双下肢血管的病变。对于踝臂指数异常或者TC升高的糖尿病患者,更容易伴有双下肢动脉的狭窄,建议对此类患者有必要进行临床干预和进一步行MSCTA检查。

Objective To study manifestations of 16-detector row CT angiography and main risk factors of Lower extremities vascular disease in patients with type 2diabetes.Methods 61 cases lower extremities vascular were estimated by MSCTA.Locations of atherosclerotic plaques and the degree of stenosis of all segments were carefully analyzed using the post-processing technicals of MPR,MIP,VR et al.Then,the patient＇s age,duration,ABI,TC,TG,HDL-C,LDL-C were analyzed using Logistic regression to find the risk factors of lower extremities vascular stenosis and ABI abnormality.Results 61 cases of MSCTA were performed successfully.327（of 1281）segments presented with atherosclerotic plaques;28,21,10,14（out of 1281）Segments were found with mild,moderate,serious stenosis and occlusion respectively.Upper segments（above the popliteal artery lever）were found frequently with atherosclerotic plaques compared with lower segments（including popliteal artery）,Х^2=115.371,P〈0.001;While,the stenosis were more often found in lower segments,Х^2=13.523,P〈 0.001.Patient＇s age,duration,elevated TC were the risk factors of lower extremities vascular stenosis,the elevated TC was the independent risk factor（OR=7.860,95%CI：1.988-31.077）.Elevated TC and vascular stenosis were the risk factors of ABI abnormality,while the latter was found as the independrisk factor（OR=28.310,95%CI：5.411-148.121）.Conclusion The 16-detector row CT angiography can provide accurate diagnosis of lower extremities vascular disease.The diabetes patient with TC elevated or ABI abnormality may be suggested as a candidate to conduct clinical interventional treatment or MSCTA performance further.