老年糖尿病患者下肢动脉病变与血脂关系  

The relationship between hyperlipidemia and lower limb arterial disease in elderly diabetes patients

作　　者：陈秀华[1] 陆召麟[3] 郭发金[1] 唐志毅[2] 

机构地区：[1]卫生部北京医院超声诊断科,100730 [2]卫生部北京医院检验科,100730 [3]中国医学科学院中国协和医科大学北京协和医院内分泌科

出　　处：《中华内科杂志》2008年第7期556-559,共4页Chinese Journal of Internal Medicine

摘　　要：目的探讨老年糖尿病患者血脂水平与下肢动脉血管并发症的关系。方法老年糖尿病患者（糖尿病组）260例，同期健康体检老年人（对照组）206例，均测定空腹血糖（FPG）、餐后2h血糖（PG2h）、TC、TG、HDL-C、LDL-C、极低密度脂蛋白胆固醇（VLDL-C）、载脂蛋白A1（apoA1）、载脂蛋白B（apoB）、纤维蛋白原和血压等，同时行下肢动脉血管彩色多普勒超声检查。结果（1）糖尿病组FPG、PG2h、TC、TG、VLDL-C、HDL-C、LDL-C、apoB、纤维蛋白原与对照组比较，差异有统计学意义（P〈0．05或P〈0．01）；（2）下肢动脉彩色多普勒超声显示，糖尿病组下肢动脉内中膜明显增厚、斑块多发、病变弥漫、多支血管受累及由此导致的血管狭窄及闭塞，而且以膝关节以下节段性动脉病变为主，狭窄最严重的是胫前动脉，糖尿病组下肢动脉内中膜增厚、斑块、多支血管病变（2条血管以上）、血管狭窄分别为205例（78．85％）、241例（92．69％）、60例（23．08％）和89例（34．23％），对照组分别为37例（17．96％）、51例（24．76％）、27例（13．11％）和3例（0．01％），差异有统计学意义（P〈0．01）；（3）回归分析显示，下肢血管病变与LDL-C、低水平HDL-C有关。结论脂代谢异常是血管并发症形成的基础，下肢动脉粥样硬化斑块是糖尿病患者早期主要血管病变之一，彩色多普勒超声检查能及早提示老年糖尿病患者下肢血管病变。Objective To evaluate the correlation between hyperlipidemia and lower limb arterial disease in elderly diabetic patients with color Doppler uhrasonography. Methods Two hundred and sixty elderly diabetic patients and 206 normal subjects were enrolled in the study. Doppler ultrasonographic manifestations of lower limb arterial disease, blood pressure and blood biochemistry parameters including fasting plasma glucose（FPG） , postprandial plasma glucose（PPG） , TC, TG, HLD-C, LDL-C, apoprotein B （apoB） , very low density lipoprotein cholesterol （VLDL-C） , apoprotein A1 （apoA1 ） and fibrinogen （Fb） were compared between the 2 groups. Results （ 1 ） The blood biochemistry parameters, including the levels of FPG, PPG, TC, TG, VLDL-C, LDL-C, apoB and Fb were higher in diabetic patients than in normal subjects, while HDL-C was lower （ all P 〈 0. 05 ）. （2） The thickness of intima-media （IMT） in the lower limb arterial disease group was significantly increased and the presence of arterial stenosis and wall plaques more in diabetic patients [ IMT in 205 cases （78. 85% ）, atherosclerotic plaque in 241 cases （ 92. 69% ） , muhivessel disease （ more than 2 vessels ） in 60 cases （ 23.08% ） and arterial stenosis in 89 cases （34. 23% ） ] than in normal subjects [ IMT in 37 cases （ 17.96% ）, atherosclerotic plaque in 51 cases （ 24. 76% ） , multivessel disease in 27 cases （ 13.11% ） and arterial stenosis in 3 cases （ 0. 01% ） ], all P 〈 0. 01. （3） Regression analysis showed that lower limb arterial disease was correlated with high level of LDL- C and low level of HDL-C. Conclusions Arteriosclerotic plaque is one of the early manifestations in elderly diabetic patients and hyperlipidemia may provide the basis of its formation. Doppler ultrasonographic examination of lower limbarterial discloses the early arteriosclerotic changes of lower limb arterial disease in elderly patients and offers the basic data of indication for clinical treatment.

关 键 词：糖尿病 糖尿病血管病变 超声检查 多普勒 彩色 下肢动脉 血脂异常 

分 类 号：R686[医药卫生—骨科学]