踝肱指数在评估2型糖尿病早期微血管并发症的作用分析

Role of ankle-brachial index in the assessment of early microvascular complications in type 2 diabetes mellitus

目的分析踝肱指数(ABI)与2型糖尿病早期微血管并发症的相关性,评估ABI预测2型糖尿病早期微血管病变的实际应用价值。方法回顾性分析山西医科大学第二医院内分泌代谢科收治的100例2型糖尿病住院患者的临床资料,测量ABI值,将ABI≤0.9与ABI≥1.3纳入ABI异常组,0.9<ABI<1.3纳入ABI正常组。分别采用视网膜动静脉比值(AVR)与肾小球滤过率(eGFR)反映2型糖尿病患者视网膜与肾脏病变情况,并分析ABI与糖尿病肾病(DKD)、糖尿病视网膜病变(DR)的关联。结果与ABI正常组比较,ABI异常组患者年龄[(56.02±8.93)岁比(62.27±10.58)岁,t=2.857,P=0.005]、病程[(9.59±5.96)年比(13.28±8.14)年,t=2.411,P=0.018]、肌酐[(89.75±57.26)μmol/L比(180.32±121.54)μmol/L,t=5.004,P<0.001]、胱抑素C[(1.27±0.66)μmol/L比(2.08±1.63)μmol/L,t=3.536,P=0.001]、血尿素氮[(7.12±3.09)μmol/L比(9.20±6.11)μmol/L,t=2.216,P=0.029]含量均显著升高,差异具有统计学意义;ABI异常组患者DKD、DR发病率均显著高于ABI正常组,差异具有统计学意义(54.17%比23.68%,χ^(2)=7.923,P=0.005;33.33%比14.47%,χ^(2)=4.216,P=0.040)。ABI分组与AVR、eGFR呈负相关,相关系数r分别为-0.198与-0.275;Logistic回归分析提示ABI异常与AVR、eGFR异常有密切关联,ABI异常组AVR、eGFR异常发生率分别是ABI正常组的4.523倍与2.915倍。结论ABI异常与2型糖尿病早期微血管并发症之间有密切关联,可以作为评估2型糖尿病早期微血管病变的预警指标。

Objective To analyze the correlation between ankle-brachial index(ABI)and early microvascular complications in type 2 diabetes mellitus(T2DM),and to evaluate the practical application value of ABI in predicting early microangiopathy in T2DM.Methods The clinical data of 100 patients with T2DM admitted to the Department of Endocrinology and Metabolism of Second Hospital of Shanxi Medical University were retrospectively analyzed.According to ABI,the patients were divided into two groups:the abnormal ABI group(ABI≤0.9 or ABI≥1.3)and the normal ABI group(0.9<ABI<1.3).Arteriole-to-venule ratio(AVR)and estimated glomerular filtration rate(eGFR)were used to reflect retinal and renal lesions in patients with T2DM,and the correlation among ABI,diabetic kidney disease(DKD)and diabetic retinopathy(DR)was analyzed.Results Compared with the normal ABI group,age[(56.02±8.93)years old vs.(62.27±10.58)years old,t=2.857,P=0.005],course of disease[(9.59±5.96)years vs.(13.28±8.14)years,t=2.411,P=0.018],creatinine[(89.75±57.26)μmol/L vs.(180.32±121.54)μmol/L,t=5.004,P<0.001]cystatin C[(1.27±0.66)μmol/L vs.(2.08±1.63)μmol/L,t=3.536,P=0.001]and blood urea nitrogen[(7.12±3.09)μmol/L vs.(9.20±6.11)μmol/L,t=2.216,P=0.029]index of the abnormal ABI group significantly increased,and the differences were statistically significant.The incidence of DKD and DR in the abnormal ABI group was significantly higher than those in the normal ABI group(54.17%vs.23.68%,χ^(2)=7.923,P=0.005;33.33%vs.14.47%,χ^(2)=4.216,P=0.040).ABI grouping was negatively correlated with AVR and eGFR,and the correlation coefficients(r)were-0.198 and-0.275,respectively.The results of logistic regression analysis indicated that ABI abnormalities were closely related to AVR and eGFR abnormalities,and the incidence of AVR and eGFR abnormalities in the abnormal ABI group was 4.523 and 2.915 times higher than those in the normal ABI group,respectively.Conclusion Abnormality of ABI is closely associated with early microvascular complications in T2DM,which can be regarded as a warning indicator for evaluating early microangiopathy in patients with T2DM.