2型糖尿病伴发下肢动脉硬化闭塞症——附43例报告

Arteriosclerosis obliterans in lower extremity accompanying type-2 diabetes mellitus——report of 43 cases

目的 探讨确诊 2型糖尿病伴发下肢动脉硬化闭塞症的检查方法。方法 主诉下肢或足部麻木或疼痛、溃疡、坏疽的 2型糖尿病患者中 ,经下肢动脉节段性测压 (踝 肱指数ABI)或彩色超声检查发现有下肢动脉缺血征象者 ,进一步作磁共振血管显像 (MRA)、螺旋CT血管显像 (SCTA)或数控动脉造影检查 (DSA)以明确诊断。结果 4 3例患者经ABI测定诊断为 2型糖尿病合并下肢动脉硬化闭塞症 ,ABI在 0 .0 0～ 0 .6 8范围 ,平均 0 .36。全组患者均作了MRA或SCTA ,DSA检查 ,ABI无一例假阳性 ,最后确定 4 3例中 5例为主髂动脉段闭塞 ;19例为股月国动脉段闭塞 ;11例为股月国动脉伴月国动脉 1～ 2分支闭塞 ;8例为膝以下动脉闭塞。 4 3例根据造影结果分别接受了不同的手术或 (和 )药物治疗。结论 节段性测压和彩超检查是初步诊断下肢动脉硬化闭塞症的无创检查方法 ,它的特点是简易、价廉、无损伤性、患者易接受 ;MRA ,SCTA也属无损伤性检查 ,对确定动脉闭塞的部位、程度和范围均十分有益 ,最精确的检查还是插管动脉造影。

Objective To investigate the rational diagnostic methods for arteriosclerosis obliterans in lower extremity accompanying type-2 diabetes mellitus. Methods Several hundreds of outpatients with type-2 diabetes mellitus who complained paraesthesia, pain, ulcer or gangrene in lower extremity were selected to receive segmental blood pressure or color Doppler ultrasound examination. The patients with ischemia sign by either of these two examinations were asked to receive further examinations such as magnetic resonance angiography(MRA), spiral computed tomoangiography (SCTA) or digital substraction angiography(DSA) to make a definite diagnosis. Results Forty three patients were diagnosed as type-2 diabetes mellitus complicated by arteriosclerosis obliterans in lower extremity by segmental blood pressure examination at first. The ankle/brachial index(ABI) ranged from 0.00 to 0.68, with an average of 0.36. Then all the patients received MRA, SCTA or DSA examination to make definite diagnosis. The diagnoses of all patients were confirmed and classified. Of these patients, 5 had aortic-iliac artery occlusion, 19 had femoral artery occlusion, 11 had femoral artery occlusion combined with one or two branches of popliteal artery occlusion, and 8 had occlusion of arteries below the knees. According to these results, all the patients received adequate therapies. Conclusions Segmental blood pressure or color Doppler ultrasound can be used to detect patients as the first choice,since they are easy to be performed, cheap, non-invasive,and acceptable. MRA and SCTA are also harmless, and can make a diagnosis about the area and the degree of artery occlusion, but they are expensive. The exact diagnostic method is DSA.