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-]

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.

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.

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

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.

Diabetes and peripheral artery disease:A review

Peripheral arterial disease(PAD)refers to partial or complete occlusion of the peripheral vessels of the upper and lower limbs.It usually occurs as part of systemic atherosclerosis in the coronary and cerebral arteries.The prevalence of PAD is expected to continue to increase in the foreseeable future owing to the rise in the occurrence of its major risk factors.Nonhealing ulcers,limb amputation and physical disability are some of its major complications.Diabetes mellitus(DM)remains a major risk for PAD,with DM patients having more than two-fold increased prevalence of PAD compared with the general population.The clinical presentation in people with DM also differs slightly from that in the general population.In addition,PAD in DM may lead to diabetic foot ulcers(DFUs),which precipitate hyperglycaemic emergencies and result in increased hospital admissions,reduced quality of life,and mortality.Despite the epidemiological and clinical importance of PAD,it remains largely under diagnosed and hence undertreated,possibly because it is largely asymptomatic.Emphasis has been placed on neuropathy as a cause of DFUs,however PAD is equally important.This review examines the epidemiology,pathophysiology and diagnosis of lower limb PAD in people with diabetes and relates these to the general population.It also highlights recent innovations in the management of PAD.

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.

Lower Extremity Ulcers in Patients with Systemic Sclerosis

Introduction: Cutaneous manifestations of systemic sclerosis (SSc) include skin ulceration;4% - 12% of patients with SSc develop lower extremity ulcers of various etiologies. Limited data, significant morbidity, and substantial cost of wound care led us to undertake this study to describe and identify risk factors. Methods: After Institutional Review Board approval, we identified 30 patients with SSc and lower extremity ulcers over a 10-year period at a single center with an SSc clinic, which were included in a descriptive analysis. Results: Median age of onset of lower extremity ulcers was 59.5 years (range 20 - 84). Ninety percent of patients were female, 60% were Caucasian, 63% had limited SSc, 13% diffuse SSc and 23% an overlap syndrome. Immunomodulators or steroids were prescribed in 53%;hypercoagulable state identified in 16%. Ulcers were attributed to venous stasis (27%), SSc (20%), trauma (20%), arterial disease (17%), and multifactorial/unknown (17%). In patients with ulcers attributed to SSc, age at onset was lower (45.5 vs 59.5 years). Biopsies generally did not contribute to management. Multidisciplinary treatment was routine;20% required amputation, 10% endovascular intervention, 20% frequent surgical debridement, 10% hyperbaric oxygen, 26% local treatment and antibiotics and 13% received immunosuppression for wound treatment. Conclusion: Lower extremity ulcers are a serious clinical problem in patients with SSc. The clinical exam, venous dopplers, ankle-brachial indices and assessment of vascular risk factors helped define causality. In younger patients, ulcers were more frequently attributed to SSc and these patients were more likely to be on immunosuppressants/DMARDS, possibly indicating severe phenotype of SSc.

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。

下肢动脉3.0T Delta-Flow非增强磁共振血管成像的应用:与增强磁共振血管成像对照研究

目的评估3.0T非增强磁共振血管成像(NCE-MRA)诊断下肢动脉狭窄的价值,为临床提供可靠的检查方法。资料与方法 30例拟诊为下肢动脉病变的患者行NCE-MRA检查后接受增强磁共振血管成像(CE-MRA)检查,评价两种检查方法的图像质量,并以CE-MRA为标准,评估NCE-MRA诊断动脉显著性狭窄(≥50%)的准确度,分析两者诊断动脉显著性狭窄(≥50%)的一致性。结果 30例患者成功完成NCE-MRA和CE-MRA检查,NCE-MRA具有诊断价值的动脉节段有532个。小腿段NCE-MRA图像静脉污染较CE-MRA少(Z=4.92,P<0.01),腹盆部、大腿段NCE-MRA图像静脉污染较CE-MRA多(Z=4.58、3.56,P<0.01)。NCEMRA诊断下肢动脉显著性狭窄(≥50%)的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为97.89%、97.69%、97.74%、93.92%、99.22%,两种检查方法诊断下肢动脉显著性狭窄(≥50%)的一致性较好(Kappa=0.94,P<0.05)。结论在显示下肢动脉狭窄方面,NCE-MRA具有与CE-MRA相近的图像质量和诊断准确度,可以作为肾功能不全或不能使用对比剂的患者进行下肢动脉MRA检查的替代方法。

前列地尔对糖尿病下肢动脉病变ABI、8-iso-PGF2α及ox-LDL的影响

目的探讨前列地尔脂质乳剂注射液对糖尿病下肢动脉病变患者踝臂指数(ABI)、8-异前列腺素F2α(8-iso-PGF2α)及氧化低密度脂蛋白(ox-LDL)的影响。方法纳入糖尿病下肢动脉病变患者90例,随机分为对照组(n=45)和治疗组(n=45)。对照组行常规降糖、降压、调脂治疗;治疗组在对照组基础上联合前列地尔脂质乳剂注射液(10μg,qd),疗程14d。比较两组治疗前后ABI值、尿8-iso-PGF2α、血ox-LDL的变化情况。结果治疗组经前列地尔治疗后ABI值升高,8-iso-PGF2α及ox-LDL明显降低,差异有统计学意义(P<0.05);对照组ABI值、8-iso-PGF2α及ox-LDL较治疗前无显著变化(P>0.05);治疗14天后治疗组8-iso-PGF2α及ox-LDL较对照组明显降低,ABI值较对照组明显升高,差异均有统计学意义(P<0.05)。结论前列地尔脂质乳注射液可改善患者ABI值,可能与降低患者体内氧化应激水平改善下肢血供有关。

经皮腔内血管成形术治疗髂-股动脉狭窄或闭塞

目的探讨经皮腔内血管成形术(PTA)及血管内支架植入术治疗髂-股动脉狭窄或闭塞的应用价值。方法 66例髂-股动脉狭窄或闭塞患者,患肢均有不同程度的缺血症状,均采用PTA和(或)支架植入术进行介入治疗,分别于治疗前、后测定踝/肱指数(ABI)。结果 66例患者成功完成介入治疗,共植入支架73枚,其中髂动脉植入27枚,股浅动脉植入32枚,髂-股动脉植入14枚,无严重并发症发生。术后患者患肢缺血症状明显减轻或消失。ABI由术前0.39±0.12上升至0.72±0.15,术后随访3～24个月(平均15个月),10例患者因复发而再次接受介入治疗。结论 PTA及血管内支架植入术,因其创伤小、可重复性高、疗效显著等特点已成为治疗髂-股动脉狭窄或闭塞的有效手段。

α-硫辛酸对糖尿病合并下肢动脉血管病变患者血管舒张功能及血清氧化应激因子的影响

目的探讨α-硫辛酸对糖尿病合并下肢动脉血管病变患者血管舒张功能及血清氧化应激因子的影响。方法 120例糖尿病合并下肢动脉血管病变(DLEAD)患者按照随机数字表法分为硫辛酸组40例、前列地尔组40例和丹参组40例。在常规治疗的基础上,硫辛酸组患者给予硫辛酸0.6 g,静脉滴注,每日1次,前列地尔组患者给予前列地尔10μg,静脉滴注,每日1次,丹参组患者给予丹参注射液40 m L,静脉滴注,每日1次,3组患者均治疗3周。采用行走受损问卷(WIQ)评价患者日常活动能力,彩色多普勒超声检查舒张末期肱动脉内径,并计算血管扩张功能(FMD),同时检测患者血清丙二醛(MDA)、谷胱甘肽(GSH)、白细胞介素-6(IL-6)、纤溶酶原激活物抑制物-1(PAI-1)水平。结果 120例患者实际收集有效病例118例,其中硫辛酸组39例,前列地尔组40例,丹参组39例。3组患者治疗前WIQ评分、肱动脉内径、FMD、足背动脉血流速度、血流量、血清GSH、MDA、IL-6、PAI-1水平比较差异均无统计学意义(P>0.05)。治疗2、3周后,3组患者足背动脉血流速度与治疗前比较差异均无统计学意义(P>0.05),WIQ评分、肱动脉内径、FMD、足背动脉血流量、血清GSH水平均显著高于治疗前(P<0.05),血清MDA、IL-6、PAI-1水平均显著低于治疗前(P<0.05);治疗3周WIQ评分、肱动脉内径、FMD、足背动脉血流量、血清GSH水平均显著高于治疗2周(P<0.05),血清MDA、IL-6、PAI-1水平显著低于治疗2周(P<0.05)。治疗3周硫辛酸组患者WIQ评分、肱动脉内径、FMD、足背动脉血流量、GSH水平显著高于同时段前列地尔组和丹参组(P<0.05),MDA、IL-6、PAI-1水平显著低于同时段前列地尔组和丹参组(P<0.05)。结论α-硫辛酸能提高下肢血管舒张功能,其作用机制可能与降低患者体内氧化应激水平、缓解炎症反应有关。

2型糖尿病患者血清γ-谷氨酰转肽酶水平与下肢动脉病变的相关性

目的探讨2型糖尿病患者下肢动脉病变(LEAD)与血清γ-谷氨酰转肽酶(γ-GGT)水平的相关性。方法选取2017年9月至2018年12月于海南省人民医院内分泌科住院治疗的2型糖尿病患者580例为研究对象。并以151例正常成人作为对照组,观察两组之间γ-GGT水平及LEAD的差异,分析血清γ-GGT水平与LEAD的相关性。结果(1)T2DM组γ-GGT水平高于对照组(P<0.05);T2DM组发生LEAD 301例,其中双侧97例;NC组LEAD者19例,其中双侧6例。(2)相关分析显示γ-GGT水平与BMI、FPG、TG、TC、LDL-c呈正相关(P<0.05)。(3)Logistic回归分析显示年龄、病程、FPG、TG、Fib及GGT是LEAD的独立预测因素。结论2型糖尿病患者血清γ-GGT水平与LEAD相关。

CE-MRA在外周血管闭塞性疾病诊断中的应用

目的：介绍对比增强磁共振血管成像（CE-MRA）在外周血管闭塞性疾病诊断中的方法及应用体会。方法：2005年2～7月间36例临床怀疑下肢动脉闭塞症患者行自动移床三维增强磁共振血管成像（3DCE-MRA）检查，范围包括主动脉、髂动脉、股动脉、胭动脉及其三个分支。结果：36例中32例下肢动脉可见不同部位、不同程度的狭窄及闭塞。阳性诊断率89％。与数字减影血管造影（DSA）检查结果符合率94％。结论：正确掌握检查方法，可以获得良好的图像质量。自动移床3DCE-MRA是一种无创的、简便而有效的下肢血管性病变的检查方法。

高三酰甘油血症-腰围表型与2型糖尿病患者下肢动脉病变的关系研究

目的探讨高三酰甘油(TG)血症-腰围(WC)表型(HTGW)与2型糖尿病患者下肢动脉病变的关系。方法选取2013年5月—2014年7月在中国医科大学附属第一医院内分泌与代谢病科住院的2型糖尿病患者404例,根据是否具有高TG、高WC分为4组:TG和WC正常组(A组,n=65)、单纯高TG组(B组,n=19)、单纯高WC组(C组,n=103)和HTGW组(D组,n=217),比较4组患者的一般情况及下肢动脉病变发生率,同时分析下肢动脉病变的独立危险因素,最后应用受试者工作特征(ROC)曲线分析HTGW、WC、腰臀比(WHR)、BMI分别对男、女患者下肢动脉病变的预测价值。结果 D组WC、WHR、BMI、空腹C肽(F-C肽)水平均高于A、B、C组,总胆固醇(TC)、血尿酸(UA)、空腹胰岛素(FINS)、餐后2 h C肽(2 h-C肽)、TG水平均高于A、C组,低密度脂蛋白胆固醇(LDL-C)水平高于A组,差异有统计学意义(P<0.05);而4组餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb A1c)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、餐后2 h胰岛素(2 h INS)、高密度脂蛋白胆固醇(HDL-C)水平间差异无统计学意义(P>0.05)。D组下肢动脉病变发生率均高于A、B、C组,差异有统计学意义(P<0.01)。多因素Logistic回归分析结果显示,性别、年龄、HTGW是2型糖尿病患者下肢动脉病变的影响因素(P<0.05)。HTGW预测男、女患者下肢动脉病变的ROC曲线下面积均最大,分别为0.643、0.706(P<0.05);WC、WHR预测女性患者下肢动脉病变的ROC曲线下面积分别为0.647、0.612(P<0.05),而BMI对男、女患者下肢动脉病变的诊断均无统计学意义(P>0.05)。结论 HTGW与2型糖尿病患者下肢动脉病变有关,为下肢动脉病变的独立危险因素,可作为预测2型糖尿病患者合并下肢动脉病变的良好指标。

丙泊酚-芬太尼静脉麻醉复合局麻在血管旁路移植术治疗LEAOD中的应用

目的通过观察丙泊酚-芬太尼静脉麻醉复合局部浸润麻醉应用于下肢动脉硬化闭塞症(LEAOD)行血管旁路移植术中的麻醉效果,了解该种麻醉方式与气管插管全麻相比在老年患者手术中的优点。方法选择LEAOD行血管旁路移植术患者82例,男71例,女11例,随机分为两组:丙泊酚-芬太尼静脉麻醉复合局部浸润麻醉组(A组)及气管插管全凭静脉全身麻醉组(B组)。每组各41例。观察并记录血压、心率、血氧饱和度、手术时间、术毕麻醉苏醒时间、芬太尼用药量及术后恶心、呕吐的发病率。结果 A、B两组术后第1h、2h的血压与麻醉前相比均降低(P<0.05);而组间血压、心率及血氧饱和度比较,无统计学意义,且均在正常值范围内。A组术后恶心呕吐发病率及芬太尼用药量显著低于B组(P<0.05或0.01);手术时间及术毕麻醉苏醒时间两组未见显著性差异。而B组有4例(9.8%)患者出现拔管困难,被送入重症监测病房(ICU),1周后因呼吸衰竭死亡1例(2.4%)。结论丙泊酚-芬太尼全凭静脉麻醉复合局部浸润麻醉可较有效地应用于LEAOD行血管旁路移植术中,且可避免因全麻气管插管导致老年患者拔管困难的发生。

股浅动脉支架植入术后血清内皮素-1、内脂素水平变化与支架内再狭窄的关系

目的探讨股浅动脉支架植入术(SFAS)后下肢股浅动脉粥样硬化闭塞症患者血清内皮素-1(ET-1)、内脂素水平变化与支架内再狭窄(ISR)的关系。方法选取2017年3月至2020年7月合肥市第二人民医院招募的297例接受SFAS治疗的下肢股浅动脉粥样硬化闭塞症患者。术后随访9个月,根据随访期间是否发生ISR将患者分为ISR组和非ISR组。采用酶联免疫吸附试验测定术前(入院后24 h内)及术后6 h、3 d、7 d、1个月、3个月时的血清ET-1、内脂素水平。分析术后9个月下肢股浅动脉粥样硬化闭塞症患者SFAS后发生ISR的独立危险因素,以及血清ET-1、内脂素水平对SFAS后ISR发生风险的预测价值。结果297例下肢股浅动脉粥样硬化闭塞症患者中,ISR组患者80例,非ISR组患者217例。ISR组患者的糖尿病患者比例高于非ISR组患者(P<0.05)。非ISR组患者术后6 h时的血清ET-1和内脂素水平明显上升且达到峰值。ISR组患者术后7 d、1个月和3个月时的血清ET-1水平均高于非ISR组患者,术后3 d、7 d、1个月和3个月时的内脂素水平均高于非ISR组患者,差异均有统计学意义(P<0.05)。多因素分析结果显示,术后3 d、7 d和1个月时的血清ET-1和内脂素水平升高均是下肢股浅动脉粥样硬化闭塞症患者SFAS后发生ISR的独立危险因素(P<0.05)。术后7 d,血清ET-1联合内脂素预测下肢股浅动脉粥样硬化闭塞症患者SFAS后9个月ISR发生风险的AUC高于术后3 d的AUC值(P<0.05)。结论SFAS后发生ISR的下肢股浅动脉粥样硬化闭塞症患者血清ET-1和内脂素水平均较高,ET-1和内脂素可作为预测该类患者预后的潜在生物标志物。