彩色多普勒超声诊断糖尿病下肢中小型动脉病变的价值

Evaluation of diagnosing pathological changes in lower limb small and medium arteries of diabetic patients by color Doppler ultrasound

目的 应用彩色多普勒超声对糖尿病人下肢膝以下中小型动脉病变的研究,探讨其临床价值。方法 对145例糖尿病患者腘动脉、胫前动脉、足背动脉、胫后动脉进行彩色多普勒超声检查,观察动脉壁硬化、狭窄程度和血流改变情况,并对糖尿病人按病程长短和血糖控制好坏进行分组对照。结果 145例糖尿病人中101例下肢小型动脉有不同程度粥样硬化改变,总发生率为69.7％,其中又以足背动脉发病最高,发生率为63.4％。糖尿病患者病程较长组与病程较短组动脉硬化斑块发生率无显著差异(p>0.05),但动脉狭窄与闭塞发生率明显增高(p<0.05)。血糖控制较差组比血糖控制较好组各种动脉粥样硬化病变发生率均显著增高(p<0.05)。7例糖尿病足患者均有动脉硬化闭塞,且未见侧支循环形成。结论 糖尿病人病程长、血糖控制较差者膝以下动脉粥样硬化发生早,损伤后果严重,用彩色多普勒超声检测不仅对糖尿病下肢动脉病变患者确定病变的部位和程度,而且对早期无症状患者也能提供诊断依据,对临床有重要的意义。

Purpose To study the pathological changes in the small and medium arteries below the knees of patients with diabetic by means of applying the color Doppler ultrasound in order to conclude it s clinical significance. Methods Having investigated 145 cases popliteal artery, tibialis anterior artery, dorsalis pedis artery , tibialis posterior artery with the color Doppler ultrasound apparatus for observing the cirrhosis of artery wall, extent of blood vessel of stenosis, and the changing conditions in the blood current, as well as comparing in different groups of diabetic patients as their respective length of medical history and extent of blood sugar control. Results Among 145 cases of diabetic patients, 101 had been observed pathological changes of atheromatosis with different extent in lower limb miniature arteries. The total incidence rate was 69.7% , of which the majority was dorsalis pedis artery account for 63.4% . There was no significant difference between the patients with long medical history and the ones with shorter history in the incidence rate of artery hardening plaque (p > 0.05) , however, the former had been observed to have higher incidence rate of stenosis and emphraxis. (p < 0.05). There was an obvious higher incidence rate of atheromatosis in the group of malcontrolled the blood sugar in comparison with well controlled (p<0.05). All 7 cases of patients with diabetic foot had artery emphraxis, and there were no collateral circulation to be established . Conclusion The patients with long history of diabetes mellitus and bad controlled the blood sugar not sufficient can have atheromatosis at earlier stage, and will result in more severe consequences. The utilization of color Doppler ultrasound apparatus, can not only locate the exact spot and extent of the pathological change in patients of diabetes lower limb disease, but also provide diagnosis evidence for those without early stage symptoms, so that has very important clinical significance.