2015年常熟市社区2型糖尿病患者踝肱指数调查及影响因素研究

Ankle-brachial index and its influencing factors in community patients with type 2 diabetes mellitus in Changshu City,2015

目的了解2型糖尿病患者中正常、高和低踝肱指数(ankle brachial index,ABI)的发生率,并探讨ABI的相关危险因素。方法 2015年7-8月,采用方便抽样的方法,在常熟市随机抽取4个乡镇,以每个乡镇的电子健康档案中的所有糖尿病患者为抽样框进行方便抽样,对抽取的1 320例2型糖尿病患者的临床资料及检查结果进行统计,并进行ABI相关危险因素的分析。结果 1 175例(89.22%)患者ABI值处于正常范围(0.9~1.3),73例(5.54%)患者ABI≤0.9,69例(5.24%)患者ABI≥1.3。≥65岁患者中ABI≤0.9的比例(8.92%)明显高于<65岁患者(1.75%)(P<0.05)。其中与正常ABI组比较,低ABI组年龄(岁)高于正常ABI组(70.65±8.43 vs.64.16±8.78)、收缩压水平(mm Hg)高于正常ABI组(141.74±25.40 vs.133.72±18.24),饮酒率低于正常ABI组(6.85%vs.19.08%),高ABI组高血压患病率(78.26%vs.62.97%)、城市人口比例(86.96%vs.74.55%)以及腰围(cm)(90.99±9.45 vs.87.94±9.37)均高于正常ABI组,差异均有统计学意义(P<0.05);与高ABI组比较,低ABI组年龄(岁)高于高ABI组(70.65±8.43 vs.63.54±8.54),腰围(cm)(87.52±10.36 vs.90.99±9.45)、舒张压(kg/m^2)(69.29±12.20 vs.73.56±9.52)、BMI值水平(24.42±3.90 vs.25.73±3.30)均低于高ABI组,差异有统计学意义(P<0.05)。多因素logistic回归结果显示,年龄(OR=0.918,95%CI:0.889~0.948)、收缩压(OR=0.986,95%CI:0.973~0.998)是ABI降低的独立影响因素,高龄、高收缩压者ABI相对较低;城乡(OR=0.405,95%CI:0.198~0.830,)、腰围(OR=1.032,95%CI:1.004~1.060)、高血压患病情况(OR=1.938,95%CI:1.068~3.515)是ABI升高的独立影响因素,城市、腰围粗、高血压患病率高者ABI相对较高。结论 2型糖尿病患者尤其老年患者ABI异常比例较高,年龄、收缩压、城乡、腰围、高血压患病情况是ABI的独立影响因素,应早期识别其危险因素并采取干预措施以改善糖尿病患者的生活质量。

Objective To investigate the prevalence rates of normal,high and low ankle-brachial index（ ABI） in patients with type 2 diabetes mellitus（ T2 DM）,and to explore the risk factors related to abnormal ABI. Methods A simple sampling method was used to randomly select 4 towns in Changshu City from July to August in 2015. The clinical data and physical examination results of 1,320 T2 DM patients chosen from all T2 DM patients with electronic health records in the 4 towns were statistically analyzed,and the risk factors associated with abnormal ABI were identified. Results There were 1,175（ 89.22%） patients with normal ABI（ ABI： 0.9-1.3）,73（ 5.54%） patients with low ABI（ ABI ≤ 0.9） and 69（ 5.24%） patients with high ABI（ ABI ≥1.3）. The prevalence of ABI ≤ 0.9 was found to be significantly higher in patients aged ≥ 65 years compared to those aged 65 years（ 8.92% vs. 1. 75%,P 0. 05）. Age（ years） and systolic blood pressure（ mm Hg） of the low ABI group were higher than those of the normal ABI group（（ 70.65±8.43） vs.（ 64.16±8.78）,（ 141.74±25.40） vs.（ 133.72±18.24）,both P〈0.05）,but the drinking rate of the low ABI group was lower than that of the normal ABI group（ 6.85% vs. 19.08%,P〈0.05）. The prevalence rate of hypertension,the proportion of urban and rural population and waist circumference（ cm） were higher in the high ABI group than in the normal ABI group（ 78.26% vs. 62.97%,86.96% vs. 74.55%,（ 90.99±9.45） vs.（ 87.94±9.37））,showing statistically significant differences（ all P〈0.05）. Age（ years） of the low ABI group was higher than that of the high ABI group（（ 70. 65 ±8. 43） vs.（ 63.54±8.54））,but waist circumference（ cm）,diastolic blood pressure（ mm Hg） and body mass index（ kg/m^2） were lower in the low ABI group than in the high ABI group（（ 87.52±10. 36） vs.（ 90.99±9.45）,（ 69.29±12.20） vs.（ 73.56±9.52）,（ 24. 42±3.90） vs.（ 25.73±3.30）,with statistically significant differences（ all P〈0.05）. Multi-factor logistic regression analysis showed that age（ OR = 0.918,95%CI： 0.889-0.948） and systolic blood pressure（ OR = 0.986,95% CI： 0.973-0.998） were the independent factors affecting the decline of ABI,and the patients with advanced age and high systolic blood pressure had a low ABI.Urban and rural areas（ OR = 0. 405,95%CI： 0.198-0.830）,waist circumference（ OR = 1.032,95%CI： 1.004-1.060） and the prevalence of hypertension（ OR = 1.938,95% CI： 1.068-3.515） were the independent factors affecting the increase of ABI,and the patients from urban areas,with high waist circumference,and with high prevalence rate of hypertension had a high ABI. Conclusions The prevalence of abnormal ABI is found to be higher in T2 DM patients,especially in the elderly patients. Age,systolic blood pressure,urban and rural areas,waist circumference and the prevalence of hypertension are the independent factors affecting ABI; and hence,early identifying the risk factors and adopting intervention measures should be actively recommended to improve the quality of life of T2 DM patients.