颈动脉内膜中层厚度对糖尿病足溃疡创面的影响

Effect of carotid intima-media thickness on diabetic foot ulcer

目的探讨颈动脉内膜中层厚度(IMT)对糖尿病足溃疡创面的影响。方法选取糖尿病足患者181例,未合并糖尿病足2型糖尿病患者62例(非糖尿病足组)为研究对象,测定IMT值,糖尿病足溃疡患者按IMT值分三组:颈动脉内膜厚度正常组(IMT<0.9 mm),颈动脉内膜增厚组(IMT≥0.9 mm)及颈动脉斑块组,回顾性分析患者空腹血糖(FBG)、糖化血红蛋白(HbA1c)、血压、低密度脂蛋白胆固醇(LDL-C)、肌酐(Cr)、踝肱指数(ABI)、糖尿病足Wagner分级等资料。结果颈动脉内膜厚度正常组、颈动脉内膜增厚组、颈动脉斑块组糖尿病足Wagner分级依次升高,差异有统计学意义(P<0.05);随着IMT升高,患者的FBG、HbA1c、LDL-C、Cr、ABI、血压等水平均逐渐增高,差异有统计学意义(P<0.05或P<0.01);相关性分析显示IMT值与FBG、HbA1c、LDL-C、Cr、ABI、收缩压呈正相关(r分别为0.183、0.149、0.304、0.421、0.840、0.161,P均<0.05);多元回归分析显示HbA1c、收缩压、ABI为血管内膜增厚的危险因素。结论颈动脉IMT值与糖尿病足创面严重程度密切相关,IMT值越高,糖尿病足创面情况越严重,IMT值可能可作为糖尿病足创面严重程度及预后的判断指标之一。

Objective To investigate the effect of carotid intima-media thickness(IMT)on diabetic foot ulcers.Methods 181 cases of diabetic foot patients and 62 cases of type 2 diabetic mellitus(T2 DM)without diabetic foot were made as the research objects.The IMT value was measured.The patients with diabetic foot were divided into three groups according to the IMT value:normal carotid artery IMT(IMT<0.9 mm)group,carotid artery thickening(IMT>0.9 mm)group and carotid artery plaque group.The data of fasting blood-glucose(FBG),glycosylated hemoglobin,blood pressure,low density lipoprotein cholesterol(LDL-C),ankle brachial index(ABI)and diabetic foot Wagner grade were analyzed.Results In the normal carotid artery IMT group,carotid artery thickening group,and carotid artery plaque group,the Wagner grades of diabetic foot increased in turn(P<0.05).With the increasing of IMT,the levels of FBG,glycated hemoglobin,blood pressure,LDL-C,creatinine,ABI,blood pressure gradually increased(P<0.05).Correlation analysis showed that IMT was positively correlated with LDL-C,FBG,glycated hemoglobin,creatinine,ABI and systolic pressure(r=0.183,0.149,0.304,0.421,0.840,0.161,all P<0.05).Multiple regression analysis showed that glycated hemoglobin,systolic blood pressure,and ABI were risk factors for IMT.Conclusions IMT value is closely related to the severity of diabetic foot ulcers.The higher the IMT value,the more serious the wound condition of diabetic foot.IMT value might be one of the indicators of the severity and prognosis of diabetic foot wound.