Lower Extremity Arterial Disease in Patients with Type 2 Diabetes: Prevalence and Associated Factors at the Libreville University Hospital Center

Introduction: Lower extremity arterial disease in diabetic patients has distinct characteristics. Objectives: To study the hospital frequency of lower extremity arterial disease and identify associated factors in diabetic patients at the Libreville University Hospital Center (CHUL). Materials and Methods: This was a cross-sectional study conducted from July 1, 2023, to January 31, 2024, in the endocrinology department of the CHUL. All patients with type 2 diabetes over the age of 18 admitted to this department, regardless of the reason for hospitalization, who provided informed consent, were included. Socio-demographic data and cardiovascular risk factors were recorded. Personal and family cardiovascular history and functional symptoms were investigated. The physical examination included measuring blood pressure, heart rate, and the ankle-brachial index in all patients. Results: A total of 219 patients were included, of whom 75 had lower extremity arterial disease, representing a prevalence of 34.24%. It was compensated in 28 cases (37.33%) and decompensated in 39 patients (52%). In eight cases (10.67%), there was critical chronic ischemia. Cardiovascular risk factors associated with diabetes were physical inactivity (89.5%), hypertension (55.25%), overweight (49.77%), obesity (22.84%), and smoking (10.04%). In multivariate analysis, only hypertension (OR = 2.09;95% CI: 1.05 - 4.17;p = 0.035) and LDL cholesterol (OR = 2.75;95% CI: 1.10 - 6.85;p = 0.03) were significantly associated with lower extremity arterial disease in diabetics at the University Hospital of Libreville. Conclusion: Lower extremity arterial disease is common in diabetic patients at the University Hospital of Libreville. It is often asymptomatic, thus requiring systematic screening.[-rId11-]

Investigation and analysis of lower extremity arterial disease in hospitalized elderly type 2 diabetic patients

Background:The risk of lower extremity arterial disease (LEAD) is increased in diabetic patients.LEAD in diabetic patients occurs earlier and is often more severe and diffuse;however,it is largely underdiagnosed and untreated.The purposes of this study were to investigate and analyze LEAD situation of hospitalized elderly type 2 diabetic patients.Methods:The ankle-brachial index (ABI) was used to screen LEAD in hospitalized elderly type 2 diabetic patients.The patients were divided into 5 groups based on the screening results:non-LEAD group and LEAD group;the LEAD group was divided into mild stenosis group,moderate stenosis group,and severe stenosis group.Results:The percentage of patients who had LEAD was 43%.Significant difference in age,diabetes duration,peak velocity,microalbuminuria,and vibratory sensory neuropathy was observed between patients with and without LEAD;regression analysis showed that urinary albumin and vibratory sensory neuropathy were independent risk factors for LEAD.Significant difference in age,body mass index (BMI),peak velocity,urinary albumin,and high-density lipoprotein cholesterol (HDL-C) was observed between mild stenosis group,moderate stenosis group,and severe stenosis group;regression analysis showed that urinary albumin,BMI,and HDL-C were independent risk factors for accelerating vascular stenosis.Conclusions:The incidence of LEAD in hospitalized elderly type 2 diabetic patients is high;age,diabetes duration,peak velocity,BMI,urinary microalbumin,vibratory sensory neuropathy,and HDL-C are the maior risk factors for LEAD.Active control of risk factors is helpful to reduce or delay LEAD.

The Role of Color Doppler Ultrasound Arterial Mapping for Decision Making in the Treatment of Patients with Lower Extremity Peripheral Arterial Disease

Purpose: To assess the efficacy of color Doppler imaging for decision making in the treatment of patients with lower extremity peripheral arterial disease (PAD) compared to digital subtraction angiography (DSA). Materials and Methods: Color Doppler scan was done on patients suspected for lower limb PAD, a day prior to the DSA which was done by a vascular surgeon. Also, for the patients who were candidates for endovascular intervention based on the color Doppler arterial mapping results, endovascular interventions were performed at the same time if the DSA findings are correlated with the color Doppler map. The grading for evaluated segments was normal, insignificant stenosis (<50%), hemodynamically significant stenosis (≥50%) and occlusion. We yielded the diagnostic efficacy indices of Doppler for detecting arterial stenosis in each 18 different arterial segments below the renal arteries including, infrarenal aorta, common and external iliac, common femoral, superficial femoral (proximal, middle and distal segments), deep femoral, popliteal artery, tibioperoneal trunk, anterior and posterior tibial arteries (proximal, middle and distal segments) and peroneal artery (proximal and distal segments). Then, we yielded the kappa agreement between Doppler and DSA findings considering the grade of stenosis in 18 arterial segments separately. Results: Totally 115 lower extremities (2045 arterial segments) were evaluated in 90 patients [mean age: 60.8 ± 8.9 (range: 47 - 84 years old)] of which 68 (75.6%) were men. The sensitivity of color Doppler for all arterial segments was 90% or higher except for common iliac artery, distal segment of superficial femoral artery and proximal segments of anterior and posterior tibialis and peroneal arteries. However, the specificity was 89% or higher, in all arterial segments. Kappa agreement was 0.72 or higher in all segments (All P-Values 0.001). Conclusion: This study suggests that considering excellent capability of color Doppler sonography in the evaluation of lower extremity arterial disease, color Doppler arterial mapping is sufficient for decision making in the treatment of these patients and can reduce the rate of diagnostic angiography.

Lower Extremity Arterial Occlusive Disease As a Rare Complication of Crohn’s Disease

Objective To investigate the clinical characteristics and treatment strategy of lower extremity arterial occlusive disease in patients with Crohn's disease (CD). Methods Clinical information of 9 cases suffering from lower extremity arterial occlusion and CD was investigated retrospectively. Results All the cases were less than 50 years old and the most were females (8/9). Arterial occlusions occurred in either active (5/9) or inactive (4/9) stage of CD. Besides the arteries of lower extremities, other arteries could also be involved such as aorta, iliac artery, renal artery or mesentery artery. Seven cases had atherosclerotic imaging findings (4 had aortic plaques and 6 had iliac artery stenoses). Embolectomy or thromboendarterectomy were mostly performed. Four (44.4%) cases had recurrent lower limb ischemia. Conclusions Arterial occlusive disease is a rare extraintestinal manifestation of CD. A thorough inspection of aorta is necessary. Embolectomy is mostly preferred. Anticoagulation treatment is highly recommended after the operation.

New Approach to Measuring the Ankle and Toe Brachial Indices as New Markers for Early Detection of Lower Extremity Peripheral Artery Disease

Background: Lower extremity Peripheral artery disease (PAD) is caused by atherosclerosis, or Plaque buildup, that reduces the blood flow to the legs and feet. PAD affects approximately 230 million adults worldwide and is associated with an increased risk of coronary heart disease, stroke, and leg amputation. The first-line method for diagnosis of PAD is the Ankle Brachial Index (ABI), which is the ratio of ankle to brachial higher systolic pressure measured in ankles and arms. The Toe Brachial Index (TBI), which is the ratio of the toe systolic pressure to brachial higher systolic pressure measured in both arms, is considered to be an alternative to the ABI in screening for PAD. The ABI and TBI are measured on the right and left side, and the lower of these numbers is the patient’s overall ABI and TBI. Clinical studies and meta-analysis reviews have shown that the conventional ABI measurement, which uses a cuff, and handheld sphygmomanometer and continuous-wave Doppler tracings, provides an acceptable-to-high specificity level but low sensitivity when compared with vascular color Doppler ultrasound, and/or angiography methods. Another study has shown that the TBI measurement has greater sensitivity but lower specificity than the ABI when compared with vascular color Doppler ultrasound diagnostic based on waveforms. The aim of this clinical study was to evaluate the specificity and sensitivity of the VasoPad System comparing its results to the vascular color doppler ultrasound waveforms. Materials and Methods: The VasoPad System is an automated device using the pulse wave method to measure the arms and ankles dorsalis and tibial posterior artery blood pressures, the photoplethysmography second derivative (PTGSD) to estimate the toe systolic pressure, a patented photoplethysmography (PTG) index marker and volume plethysmography via cuffs during deflation. Vascular Color Doppler ultrasound can diagnose stenosis through the direct visualization of atherosclerosis or plaques and through waveform analysis. The vascular color Doppler ultrasound provides 3 waveform types. The type 1, triphasic waveform is normal blood flow and no atherosclerosis or plaque, the type 2, diphasic waveform is seen when there are atherosclerosis plaques, but normal blood flow, and the type 3, monophasic waveform reflects stenosis with diameter reduction > 50%. Results: The sum of the overall ABI and TBI VasoPad values, called Sum of Brachial Indices (SBI), gave a specificity of 88.89% and sensitivity of 100% for detecting vascular color Doppler ultrasound biphasic and monophasic waveforms versus triphasic waveforms with a cutoff ≤ 1.36 (P Conclusion: The VasoPad was useful for detecting PAD, which is fully defined as having vessel stenosis > 50% (Doppler monophasic waveforms) but also early stage of atherosclerosis plaque of the lower extremities (Doppler biphasic waveforms). The VasoPad method provided a remarkable sensitivity of 100% and a specificity level similar to those of the conventional ABI test method compared with the vascular color Doppler ultrasound. In addition to being useful to screen and detect PAD, the VasoPad offers early detection of lower extremity atherosclerosis, with normal blood flow (Doppler biphasic waveforms), which could provide greater treatment options and thus reduce the overall number of lower extremity complications.

Epidemiology of Lower Extremity Artery Disease in People Living with HIV Followed at the Departmental University Hospital Center Ouémé-Plateau in 2019

Introduction: Lower extremity artery disease (LEAD) is a serious cardiovascular disease. People living with the human immunodeficiency virus (HIV) are at risk. The aim of the study was to determine the prevalence of LEAD and identify the associated factors among people living with HIV who were followed at the departmental university hospital Ouémé-Plateau in Benin. Methods: This was a cross-sectional study. It included all HIV-infected people who were monitored at the department of medicine of the target hospital during the study period and met the inclusion criteria (followed for at least three months, aged at least 25 years, and having given their written consent to participate). Data were collected during an individual interview, followed by the measurement of parameters. The ankle brachial index ≤ 0.9 was used for the diagnosis of LEAD. Associated factors were searched through a multivariable logistic regression. Results: The prevalence of LEAD was 34.2% among 222 respondents having a mean age was 42.9 ± 10.8 years and a female predominance (77.5%). No significant association was found between the presence of LEAD and sociodemographic factors. The presence of LEAD was significantly associated with hypertension and antiretroviral therapy. Hypertensive patients had a higher risk of LEAD compared to non-hypertensive patients (OR = 1.98, 95% CI [1.04-3.83], p = 0.037). Those who were receiving second-line therapy also had a higher risk of LEAD compared to those on first-line therapy (OR = 2.95, 95% CI [1.14-7.60], p = 0.025). Conclusion: This study showed a high prevalence of LEAD especially among hypertensive patients and those who were receiving second-line antiretroviral therapy. LEAD diagnosis and management should be included in the routine care of people living with HIV in Benin.

An evaluation of the arterial occlusions in peripheral arterial disease by 64-detector multi-slice CT angiography: DSA correlation

Objective: Evaluation of peripheral arterial disease with 64-detector multi-slice CT angiography (MDCT- A) and comparison of the results with the results of digital subtraction angiography (DSA), a standard reference. Materials and Method: The written informed consent of the patients and ethics committee approval were obtained. The retrospective study group consisted of 28 patients with a diagnosis of peripheral arterial disease. Using 64-MDCT-A, the arterial tree of the lower extremity was evaluated for the presence of steno-occlusive lesions that might have led to luminal stenosis. The diagnostic reliability of 64-MDCT- A was calculated and compared with that of DSA. Findings: In the segment-based analysis, the sensitivity, specificity, and reliability rates of 64-MDCT angiography in determining significant stenoses were 97.7%, 97%, and 97.3%, respectively. The Kappa co-efficiency for compatibility between 64-MDCT-A and DSA methods in grading stenosis was calculated as 0.896

Detection,management,and prevention of diabetes-related foot disease in the Australian context

Diabetes-related foot disease(DFD)is a widely feared complication among people who live with diabetes.In Australia and globally,rates of disability,cardiovascular disease,lower extremity amputation,and mortality are significantly increased in patients with DFD.In order to understand and prevent these outcomes,we analyse the common pathogenetic processes of neuropathy,arterial disease,and infection.The review then summarises important management considerations through the interdisciplinary lens.Using Australian and international guidelines,we offer a stepwise,evidence-based practical approach to the care of patients with DFD.

彩色多普勒定量分析腘动脉参数在2型糖尿病患者下肢血管病变中的应用研究

目的:分析彩色多普勒定量分析腘动脉参数在2型糖尿病(T2DM)患者下肢血管病变中的应用价值。方法:采用回顾性分析法,将天津市河西医院2019年8月—2022年10月进行健康体检的25例志愿者纳入对照组,将51例T2MD患者纳入观察组。按腘动脉中膜厚度(IMT)情况将观察组分为A组(IMT正常)20例、B组(IMT增厚)6例、C组(斑块形成)25例。对比观察组与对照组患者腘动脉最大管径(R)、峰值血流速(peak systolic velocity,PSV)、壁剪应力(wall shear stress,WSS),对比A组、B组、C组患者病程、年龄、体重指数、血压、血糖等可能影响动脉斑块形成的因素,对比三组患者R、PSV、WSS。分析WSS预测T2DM患者效能以及WSS相关因素。结果:观察组患者PSV、WSS低于对照组,差异有统计学意义(P<0.05)。与A组比较,B组患者年龄更高,病程更长,甘油三酯、WSS更低,差异有统计学意义(P<0.05)。与A组比较,C组患者年龄更高,病程更长,PSV、WSS更低,差异有统计学意义(P<0.05)。与B组比较,C组患者年龄更高,PSV、WSS更低,差异有统计学意义(P<0.05)。WSS取1.82 dyne/cm^(2),预测T2DM患者下肢血管病变的特异度、灵敏度分别为84%、66%。WSS与病程、年龄、腘动脉IMT呈负相关(r=-0.370、-0.570、-0.592,P<0.05),与PSV呈正相关(r=0.601,P<0.05)。结论:彩色多普勒超声定量分析下腘动脉WSS能有效预测T2DM患者下肢血管病变,建议综合患者病程、年龄及腘动脉IMT提高诊断准确性。

虎杖清脉饮治疗下肢小血管病早期热郁毒聚证临床观察

目的:观察虎杖清脉饮治疗下肢小血管病(LESAD)早期热郁毒聚证的临床治疗效果和安全性。方法:选取70例LESAD早期热郁毒聚证患者随机分为试验组和对照组各35例,两组患者均给予西医常规治疗,在此基础上,试验组给予虎杖清脉饮颗粒治疗,对照组给予虎杖清脉饮安慰剂颗粒治疗,3个月后比较两组临床疗效,治疗前后症状体征积分、中医证候积分,治疗前后脂代谢、糖代谢、炎症因子水平变化、安全性及不良反应情况。结果:试验组总有效率94.11%高于对照组63.33%(P<0.05);治疗后试验组症状、体征积分及中医证候积分较对照组显著降低(P<0.05);实验室指标中,治疗后试验组脂代谢、糖代谢、炎症因子水平均较对照组改善(P<0.05)。结论:虎杖清脉饮治疗LESAD早期热郁毒聚证患者临床疗效显著,可明显改善患者临床症状,减少动脉粥样硬化的诱发因素。

下肢动脉病变程度对富血小板凝胶治疗糖尿病足溃疡的影响

目的探讨下肢动脉病变程度对富血小板凝胶治疗糖尿病足溃疡的影响。方法选取糖尿病足溃疡患者129例为研究对象。根据踝肱指数和下肢动脉血管超声结果分为轻度组49例、中度组44例和重度组36例。3组患者均给予常规治疗联合富血小板凝胶治疗。比较3组患者治疗前后溃疡面积变化和肉芽面积变化。结果3组治疗前后的溃疡面积及其差值比较,差异有统计学意义(P<0.05);3组治疗前后的肉芽面积及其差值比较,差异有统计学意义(P<0.05)。溃疡面积差值与踝肱指数呈正相关(r=0.392,P<0.001),与糖尿病病程呈负相关(r=-0.420,P<0.001);肉芽面积差值与踝肱指数呈正相关(r=0.406,P<0.001),与糖尿病病程呈负相关(r=-0.375,P<0.001)。结论下肢动脉病变越严重,富血小板凝胶治疗糖尿病足溃疡的疗效越差。

基于患者疾病自我管理能力的下肢动脉疾病药学服务模式的构建

目的构建下肢动脉疾病(LEAD)患者院内药学监护+院外药学门诊一体化服务模式,提高患者的疾病自我管理能力及疾病治疗的有效性和安全性。方法构建LEAD患者院内药学监护及院外药学门诊服务模式(包含药学评估、自我管理能力宣教、药学随访),对患者进行长期管理。选取2021年9月-2022年12月在我院血管外科住院或门诊就诊并经药师管理的65例LEAD患者为研究对象,由药师进行院内药学监护+院外门诊持续管理,比较经药师管理3个月前后疾病治疗有效性指标、安全性指标和患者疾病自我管理能力指标。结果65例患者经药师管理3个月后,55例患者Fontaine分期降低,管理前后Fontaine分期差异有统计学意义(P<0.001);完全遵循指南用药的患者占比由63.1%提升至96.9%,小出血发生率减少7.7%,患者Morisky用药依从性评分和疾病自我管理能力评分显著提高(P<0.001),就医满意度为“好”的患者占比增加了18.4%。结论LEAD患者院内外一体化药学服务模式可有效提高患者疾病自我管理能力,提高患者疾病治疗的有效性及安全性。

英国前瞻性糖尿病研究评分联合下肢动脉病变分级对2型糖尿病患者冠状动脉病变程度的预测价值

目的:探讨英国前瞻性糖尿病研究(UKPDS)评分联合下肢动脉病变分级对2型糖尿病(T2DM)患者冠状动脉病变(CAD)程度的预测价值。方法:选择行冠状动脉造影的T2DM患者213例,依据冠状动脉造影结果分为T2DM组(75例)和T2DM合并CAD组(138例)。收集患者临床资料,检测患者糖脂代谢指标,使用UKPDS评分评估10年冠心病风险(CADRISK)。以冠状动脉SYNTAX评分对患者CAD程度进行评估,并分为高分组(≥23分)和低分组(<23分),比较两组CADRISK值及下肢动脉病变分级。分析T2DM患者CAD影响因素。分析CADRISK值、下肢动脉病变分级与SYNTAX评分的相关性,以及两者对T2DM合并CAD的预测价值。结果:T2DM合并CAD组和T2DM组在年龄、病程、收缩压、总胆固醇(TC)、下肢动脉病变分级、CADRISK值、SYNTAX评分上比较,差异有统计学意义(均P<0.05)。病程、TC、下肢动脉病变分级、CADRISK值、SYNTAX评分是T2DM合并CAD的影响因素(均P<0.05)。依据SYNTAX评分将患者分为高分组(26例)和低分组(56例),低分组CADRISK值低于高分组,高分组下肢动脉病变分级2~3级占比高于低分组(均P<0.05)。病程、TC、下肢动脉病变分级、CADRISK值与SYNTAX评分呈正相关(均P<0.05)。CADRISK值、下肢动脉病变分级均可预测T2DM患者CAD程度,两项联合预测价值更高(均P<0.05)。结论:UKPDS评分、下肢动脉病变分级与T2DM患者CAD程度相关,两者联合对T2DM合并CAD有较好的预测价值。

下肢外周动脉疾病铁死亡相关基因的生物信息学分析

目的探索下肢外周动脉疾病的潜在铁死亡相关生物标志物及诊断治疗靶点。方法应用生物信息学方法从基因表达综合数据库(gene expression omnibus,GEO)中下载下肢外周动脉疾病的转录组数据集,筛选出差异表达基因(differential expressed genes,DEGs),并与铁死亡基因取交集,得到下肢外周动脉疾病相关的铁死亡基因,对其进行功能富集,同时通过受试者工作特征(receiver operating characteristic,ROC)曲线分析下肢外周动脉疾病相关的铁死亡基因的诊断价值;之后构建蛋白质相互作用网络,应用Cytoscape中的算法预测关键基因;最后通过miRWalk预测靶向关键基因的miRNA并构建网络图。结果共筛选出9个下肢外周动脉疾病铁死亡相关基因,GO与KEGG的功能富集分析结果表明,这些基因与铁死亡、免疫调节、凋亡及糖尿病、动脉粥样硬化等相关,ROC诊断提示下肢外周动脉疾病患者中9个相关的铁死亡基因的平均曲线下面积(area under the curve,AUC)为0.930;基于算法筛选出4个关键基因:HMOX1、ALOX5、IL1B和CYBB,而CYBB和HMOX1同时受miR-6734-3p调控。结论通过生物信息学方法分析得出HMOX1、ALOX5、IL1B和CYBB在下肢外周动脉疾病中存在诱导铁死亡的潜在作用,而miR-6734-3p作为HMOX1与CYBB的共同靶向miRNA,有望成为潜在诊断生物标志物及治疗靶点。

下肢动脉介入术后支架内再狭窄的危险因素分析

目的 探讨下肢动脉介入术后支架内再狭窄的危险因素。方法 收集2019年3月至2021年5月于北京小汤山医院接受介入术的148例下肢动脉疾病患者的临床资料,根据介入术后1年随访期间是否发生支架内再狭窄将患者分为再狭窄组(n=31)和对照组(n=117)。比较两组患者的临床特征、介入治疗相关信息,采用多因素Logistic回归模型分析下肢动脉介入术后支架内再狭窄的危险因素。结果 再狭窄组患者的年龄、糖尿病比例、体重指数、术前C反应蛋白水平均高于对照组患者,差异均有统计学意义(P<0.05)。再狭窄组患者植入2枚以上支架的比例高于对照组患者,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄≥65岁、体重指数>28 kg/m^(2)、糖尿病、术前C反应蛋白水平>5 mg/L以及支架植入数量≥2枚均是下肢动脉介入术后发生支架内再狭窄的独立危险因素(P<0.05)。结论 年龄、体重指数、糖尿病、术前C反应蛋白水平及支架数量均与下肢动脉介入术后发生支架内再狭窄密切相关,临床需考虑上述因素并提前实施干预措施,从而降低下肢动脉介入术后支架内再狭窄的发生率。

胸阻抗法无创血流动力学检测指标与中老年2型糖尿病下肢动脉病变的相关性分析

目的:探讨胸阻抗法无创血流动力学检测指标与中老年2型糖尿病(T2DM)下肢动脉病变(LEAD)的相关性。方法:选取2021年12月—2022年7月武汉市中心医院收治的中老年T2DM患者158例作为研究对象,根据是否并发LEAD分为单纯T2DM组和LEAD组。比较两组一般资料,分析中老年T2DM患者发生LEAD的影响因素以及胸阻抗法无创血流动力学检测指标预测中老年T2DM患者发生LEAD的效能。结果:空腹血糖、心输出量(CO)、心脏指数(CI)、每搏外周阻力(SSVR)、每搏外周阻力指数(SSVRI)是中老年T2DM患者发生LEAD的影响因素(P<0.05)。CO、CI预测中老年T2DM患者发生LEAD的受试者操作特征曲线下总面积为0.701、0.685。结论:空腹血糖、CO、CI、SSVR及SSVRI是中老年T2DM患者发生LEAD的影响因素,且CO、CI检测对中老年T2DM合并LEAD具有一定预测价值。

血清Hcy、sdLDL-C水平与2型糖尿病下肢动脉血管病变的相关性

目的:探讨血清同型半胱氨酸(Hcy)、小而密低密度脂蛋白胆固醇(sdLDL-C)水平与2型糖尿病(T2DM)下肢动脉血管病变(LEAD)的相关性。方法:选取120例T2DM患者为研究对象,根据踝肱指数(ABI)分为单纯T2DM组(ABI>0.90,n=55)和LEAD组(ABI≤0.90,n=65);另选同期60名健康体检者为对照组。比较各组血糖[空腹血糖(FPG)、糖化血红蛋白(HbA1c)]、血脂[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、Hcy和sdLDL-C水平;Pearson相关系数分析血清Hcy、sdLDL-C与LEAD的相关性;Logistic回归模型筛选LEAD的危险因素;受试者工作特征(ROC)曲线分析血清Hcy和sdLDL-C对LEAD的预测价值。结果:与对照组相比,T2DM组和LEAD组血清FPG、TC、TG、LDL-C、HbA1c、Hcy和sdLDL-C水平均更高(P<0.05),HDL-C水平均更低(P<0.05);与T2DM组相比,LEAD组血清FPG、TC、TG、Hcy和sdLDL-C水平均更高(P<0.05),但两组HDL-C、LDL-C和HbA1c水平差异均无统计学意义(P>0.05)。相关性分析显示,血清Hcy和sdLDL-C水平与ABI负相关(P<0.001)。回归分析显示,Hcy和sdLDL-C的OR值分别为1.531、1.662,是T2DM患者发生LEAD的独立危险因素(P<0.05)。ROC曲线分析显示,Hcy、sdLDL-C及二者联合预测LEAD的曲线下面积(AUC)分别为0.849、0.857、0.935,二者联合预测的价值最高。结论:血清Hcy和sdLDL-C水平升高与T2DM患者发生LEAD有关,联合应用对LEAD的预测价值较高。

老年T2DM患者外周血Hcy、NLR与下肢血管病变的关系研究

目的 探讨老年2型糖尿病(T2DM)患者外周血同型半胱氨酸(Hcy)、中性粒细胞/淋巴细胞比值(NLR)与下肢血管病变(LEAD)的关系。方法 选取2022年1月~2023年10月当涂县人民医院收治的63例老年T2DM并发LEAD患者,设为LEAD组。同期选取性别、年龄1∶1配对的63例无LEAD的老年T2DM患者,设为T2DM组。比较两组的临床资料、外周血Hcy和NLR。分析老年T2DM患者并发LEAD的危险因素。结果 LEAD组外周血Hcy[(16.12±4.05)μmol/L vs.(13.48±3.16)μmol/L]、NLR[(3.02±0.76)vs.(2.25±0.50)]水平均高于T2DM组,差异有统计学意义(t=4.079、6.718,P<0.05)。总胆固醇(TG)(OR=3.053,P=0.007)、低密度脂蛋白胆固醇(LDL-C)(OR=2.815,P=0.009)、糖化血红蛋白(HbA1c)(OR=3.040,P=0.002)、空腹血糖(OR=2.552,P=0.028)、餐后2 h血糖(OR=2.375,P=0.011)、Hcy(OR=1.264,P=0.016)、NLR(OR=1.941,P=0.006)是老年T2DM患者并发LEAD的危险因素。结论 外周血Hcy、NLR与老年T2DM患者并发LEAD存在密切关联,可为老年T2DM患者并发LEAD的诊疗提供参考。

2型糖尿病下肢动脉病变患者应用彩色多普勒超声的诊断价值

目的:分析2型糖尿病下肢动脉病变患者应用彩色多普勒超声的诊断价值。方法:选取北京市西城区平安医院2022年1月-2023年6月收治的2型糖尿病下肢动脉病变患者268例作为观察组,选取同时期无2型糖尿病但患有下肢动脉病变者268例作为对照组。两组患者均行双下肢动脉超声检查,观察斑块大小、位置、形态及管腔狭窄、闭塞情况。比较两组股动脉、腘动脉、胫前动脉、胫后动脉及足背动脉血流量、血管壁内-中膜厚度(IMT)和阻力指数(RI)。结果:观察组股动脉、腘动脉、胫前动脉、胫后动脉及足背动脉血流量低于对照组,IMT、RI高于对照组。观察组下肢血管轻度病变发生率低于对照组,下肢血管中度和重度病变发生率高于对照组(P<0.001)。结论:彩色多普勒超声检查可以通过检测2型糖尿病患者的动脉血流量、IMT、RI、管腔狭窄程度,判断下肢动脉病变程度,是一种简便、准确、无创的诊断方法,可以为临床诊疗提供参考依据。

下肢动脉CT血管造影与磁共振血管造影在糖尿病下肢血管病变诊断中的应用价值

目的探讨下肢动脉CT血管造影(CT angiography,CTA)与磁共振血管造影(magnetic resonance angiography,MRA)在糖尿病下肢血管病变诊断中的应用价值。方法选取2021年1月—2023年12月晋江市医院晋南分院收治的84例疑似糖尿病下肢血管病变患者为研究对象,均接受下肢动脉CTA、MRA及X线数字减影血管造影(digital subtraction angiography,DSA)检查。将DSA作为诊断的金标准,比较CTA与MRA对糖尿病下肢血管病变患者的诊断结果、诊断效能以及对于不同部位糖尿病下肢血管病变的诊断符合率。结果经DSA确诊糖尿病下肢血管病变阳性60例,阴性24例,CTA诊断阳性59例,MRA诊断阳性59例。MRA对糖尿病下肢血管病变诊断的灵敏度、特异度、准确度均高于CTA,差异有统计学意义(P均<0.05)。MRA对膝上动脉、膝下动脉、足背动脉段的诊断符合率均高于CTA,差异有统计学意义(P均<0.05)。结论MRA对糖尿病下肢血管病变患者的诊断效能较好,且对不同部位糖尿病下肢血管病变的诊断符合率较高。