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-]

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.

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.

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.

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.

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.

Clinical observation of Furongtongmai capsule on the lower extremity Atherosclerotic Occlusive Disease after Intervention Operation

Objective To investigate the effect of Furongtongmai capsule on the in-stent restenosis （ISR） of superficial femoral artery after interventional operation in lower extremity Arteriosclerosis Occlusion （ASO）. Methods： A total of 110 inpatients with ASO who performed Superficial femoral artery stent implantation were randomly divided into observation group and control group, with 55 cases in each group.Both groups received Aspirin 100 mg/d and Clopidogrel 75 mg/d. The observation group was given Furongtongmai capsule on the basis of routine treatment. After continuous treatment for 6 months, the clinical efficacy, Ankle Brachial Index （ABI）, high-sensitivity C-reactive protein （Hs-CPR） and ISR were compared between the two groups. Results： At 6 months after operation, the plasma levels of Hs-CRP in the two groups were significantly lower than those in the control group （P 〈 0.05）. The ABI of treatment group was significantly higher than the control group （P 〈 0.05）. There was a statistically significant difference in ISR incidence between the treatment group and the control group 6 months after surgery （9.09% vs 27.78%, P 〈 0.05）. Conclusion： Furongtongmai Capsule can inhibit Hs-CRP in patients with ASO after femoral artery intervention, improve the ankle brachial index and reduce the incidence of ISR.

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.

INTRACRANIAL ARTERIAL OCCLUSIVE LESION IN PATIENTS WITH GRAVES DISEASE

Objective To investigate the distribution and clinical manifestations of intracranial arterial occlusive lesions （IA- OLs）, and their correlation with thyroid function. Methods We enrolled 7 patients who had Graves＇ disease （GD） with IAOLs screened and evidenced by transcranial Doppler, then further confirmed with digital substract angiography in 2 patients and magnetic resonance angiography in 5 patients. Brain magnetic resonance imaging （MRI） was performed in all 7 patients. Three patients were followed up. Results Among 7 patients, 1 was male and 6 were females. The mean age was 32.0 ± 5.5 （ range from 11 to 49） years old. Six of them had symptoms of GD but one was asymptomatic with abnormality of I3, T4, and thyroid stimulating hormone. The lesions of intracranial arteries were symmetrical bilaterally in the intemal carotid artery system in 6 patients, as well as asymmetrical in 1 patient. Terminal internal carotid artery （TICA） were involved in all 7 patients. Middle cerebral artery （MCA） were involved in 3, anterior cerebral artery in 2, and basilar artery in 1 patient. Net-like collateral vessels and mimic moyamoya disease were observed in the vicinity of the occlusive arteries in 2 patients. All patients presented symptoms of ischemic stroke including transient ischemic attack and/or infarction while IA- OLs were found. Three patients had obvious involuntary movements. Brain MRI revealed infarctions located in the cortex, basal ganglion, or hemiovular center in 5 patients. The remaining 2 patients had normal brain MRI. The neurological symptoms were improved concomitant with relief of the thyroid function in 2 patients, while IAOLs were aggravated with deterioration of the thyroid function in 1 patient. Conclusion IAOLs in patients with GD mainly involve intracranial arteries, especially the TICA and MCA, which is similar to moyamoya disease. The neurological symptoms and severity of involved arteries may relieve while the hyperthyroidism is gradually under control.

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

选择性尺动脉持续循环压迫降低老年冠状动脉介入治疗患者桡动脉闭塞的效果观察

目的 探讨选择性尺动脉持续循环压迫降低老年冠心病行冠状动脉介入治疗患者桡动脉闭塞的效果。方法 选取行冠状动脉介入治疗的450例老年冠心病患者为研究对象,采用随机数字表法分为对照组和试验组,每组225例。对照组术后采取桡动脉非闭塞性压迫,试验组在对照组基础上采用定制的脉搏波血压计进行选择性尺动脉持续循环压迫,持续4 h。比较2组患者穿刺处出血、疼痛、拇指皮温、护士工作量、延时取压率、桡动脉血流速度、术后24 h桡动脉闭塞率和狭窄率等指标。结果 2组患者穿刺处出血、疼痛、拇指皮温、护士工作量和延时取压率等指标比较,差异无统计学意义(P>0.05)。与对照组比较,试验组在解除血压计前0.5 h桡动脉血流速度较快,术后24 h桡动脉闭塞率和狭窄率较低,差异有统计学意义(P<0.05)。结论 在不增加患者出血风险、疼痛、护士工作量和延时取压率的前提下,采用定制脉搏波血压计选择性持续循环压迫4 h可以增加桡动脉血供,降低术后桡动脉闭塞率和狭窄率。

顾步汤联合腔内成形术对下肢动脉硬化闭塞症患者双足震动感觉阈值及微循环的影响

[目的]探究顾步汤联合腔内成形术对下肢动脉硬化闭塞症(LEAOD)患者双足震动感觉阈值及微循环的影响。[方法]将152例2021年4月—2023年4月于丽水市中心医院进行LEAOD治疗的患者,通过随机数字表法分为观察组(腔内成形术+顾步汤,76例)和对照组(腔内成形术,76例),对两组患者的中医证候积分、临床疗效、微循环指标和双足震动感觉阈值做对比。[结果]两组肢体疼痛、肢体麻木、间歇性跛行、肢体怕冷等中医证候积分在治疗后均下降,且观察组下降幅度更明显(P<0.05);观察组临床疗效(96.05%)显著高于对照组(84.21%)(P<0.05);两组患者治疗后流态积分、管襻积分、襻周积分均下降,襻顶血管直径均增加,且观察组各项指标变化更明显(P<0.05);治疗后两组双足震动感觉阈值均下降,且观察组变化更为显著(P<0.05)。[结论]顾步汤联合腔内成形术能够有效降低LEAOD患者的双足震动感觉阈值,改善患肢微循环。

张伯礼教授基于“病证同治”理论辨治下肢动脉硬化闭塞症经验

总结张伯礼教授治疗下肢动脉硬化闭塞症(ASO)的临证经验。基于“病证同治”理论,提出“以辨病为先,以分期为主,以辨证为基”的诊疗思路。下肢ASO核心病机为气虚血瘀为本,热毒内蕴为标。治疗方法为全病程补气养血活血,选用当归补血汤;急性期清热解毒凉血,选用四妙勇安汤;稳定期温肾通络止痛,选用补肾通络药组。诊疗之际,应细心权衡轻重、详辨标本之急,处理好标本间关系,确定“治其所苦”为重要治疗策略。再通过典型病案,详细阐释诊疗思路及用药规律。

髂静脉内支架植入术治疗深静脉血栓后综合征的疗效分析

目的对髂静脉支架治疗深静脉血栓后综合征疗效进行评价。方法回顾性选取2020年1月—2023年6月柳州市柳铁中心医院收治的68例深静脉血栓后综合征(post-thrombotic syndrome,PTS)患者临床资料,根据其治疗方式分为支架治疗组(40例)和保守治疗组(28例)。支架治疗组行髂静脉球囊扩张成型支架置入术治疗,保守治疗组行保守治疗,比较两组患者Villalta评分、血管通畅率。结果治疗前,两组患者Villalta评分比较,差异无统计学意义(P>0.05);治疗后,两组患者术后3个月、6个月、12个月Villalta评分较术前均降低,且支架治疗组患者术后3个月、6个月Villalta评分(10.81±2.97)分、(8.62±2.68)分均低于保守治疗组的(12.54±3.81)分、(9.81±1.64)分,差异有统计学意义(t=2.103、2.089,P均<0.05)。支架治疗组患者治疗3个月、6个月和12个月的血管通畅率80.00%(32/40)、90.00%(36/40)和95.00%(38/40)均高于对照组的57.14%(16/28)、67.86%(19/28)、75.00%(21/28),差异有统计学意义(P均<0.05)。结论髂静脉内支架植入术治疗下肢静脉闭塞性疾病可以提高术后静脉血管通畅率,减轻下肢临床症状,提高患者术后生活质量。

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。

CTA与DSA评估慢性肢体威胁性缺血患者全球肢体解剖学分期系统分期的一致性分析

目的分析CTA与DSA在评估慢性肢体威胁性缺血(CLTI)患者全球肢体解剖学分期系统(GLASS)分期中的一致性。方法 回顾性分析2017年1月至2020年12月西安交通大学第一附属医院收治的CLTI患者临床资料。以DSA评估结果为金标准,分析CTA与DSA评估GLASS分期的一致性。结果 CTA评估GLASS评分与DSA具很强的一致性,其中两者评估股腘动脉段评分的加权Kappa系数为0.798(95%CI=0.722~0.873,P<0.01),评估膝下动脉段评分的加权Kappa系数为0.785(95%CI=0.725~0.845,P<0.01),评估GLASS整体评分的加权Kappa系数为0.832(95%CI=0.752~0.911,P<0.01),均显示出很强的一致性。结论 下肢动脉CTA检查可准确评估CLTI患者靶病变GLASS评分和分期,有助于下肢动脉硬化闭塞症诊断及血运重建技术难度评估。

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。