2型糖尿病患者彩超所见下肢动脉和颈动脉病变的临床分析

The clinical analysis of carotid and lower extremity artery lesions by color doppler ultrasonography in type 2 diabetes mellitus

目的了解尚未达到周围血管病变(PAD)诊断标准的糖尿病患者大血管病变的发生情况。方法踝肱指数(ABI)>0.9的住院T2DM患者601例,根据血管彩超结果分为无病变组和有病变组,另根据病变部位将有病变组分为下肢血管病变亚组、颈部血管病变亚组及多部位病变亚组进行比较分析。结果 64.2%(386/601)的患者存在不同程度的大血管病变,其中单纯下肢动脉病变者44.6%(172/386),单纯颈动脉病变者13.5%(52/386),多部位病变者41.9%(162/386)。与无病变组相比,有病变组TG、FIns、2hIns水平均较低,糖尿病性慢性肾脏疾病(CKD)及冠心病(CAD)的患病率较高,比较差异有统计学意义(P<0.05)。Logistic回归分析显示,CKD是血管病变发生的独立危险因素。结论在依据ABI诊断下肢动脉粥样硬化之前,血管彩超显示已有64.2%的糖尿病患者存在不同程度的大血管病变。

Objective To investigate the prevalence of peripheral arterial lesions by color doppler ultrasonography in type 2 diabetes mellitus.Methods 601 patients with type 2 diabetes and ABI＞0.9 were divided into normal group and abnormal group according to the result of color doppler ultrasound.Then using the doppler ultrasound results,the 386 patients were stratified into 3 groups,which included 44.6％（172/386） patients in the lower extremity artery disease subgroup,13.5％（52/386） patients in the carotid artery disease subgroup and 41.9％ （162/386） patients in the multi-position lesion subgroup.Results The total prevalence of peripheral arterial lesions was 64.2％ （386/601）,and the prevalence of lower extremity artery disease,carotid artery disease and multi-position disease was 44.6％ （172/386）,13.5％（52/386） and 41.9％（162/386）.The levels of TG,FIns and 2 hIns were lower,and the prevalence of diabetic nephropathy and coronary disease was higher in abnormal group than in normal group（P＜0.05）.Multivariate conditional logistic regression analysis showed that the CKD was an independent risk factor for peripheral arterial lesions.Conclusion The prevalence of peripheral arterial lesions was 64.2％ before diagnosing as PAD （ABI≤0.9）.