2型糖尿病患者下肢动脉病变预测无症状冠心病的临床价值研究  

Value of perirheral artery disease in predicting asymptomatic coronary artery disease in type 2 diabetes mellitus

作　　者：曾玲[1] 陆泽元[1] 伍贵富[1] 余颖 柳岚[1] 张华清 庄雄杰 蒋凤秀[1] 桑丹[1] ZENG Ling;LU Zeyuan;WU C-uifu(Department of Endocrinology,The EighthAffiliated Hospital of Sun Yat-sen University,Shenzhen 518033,China)

机构地区：[1]中山大学附属第八医院内分泌科,深圳518033

出　　处：《中国糖尿病杂志》2018年第11期890-894,共5页Chinese Journal of Diabetes

基　　金：深圳市科创委科技计划项目(JCYJ20140416094256882);深圳市福田区卫生公益性科研项目(FTWS20160015)

摘　　要：目的探讨T2DM患者下肢动脉病变(PAD)与无症状冠心病(CAD)患病风险的关系及预测价值。方法 365例无CAD病史且无胸闷、胸痛等CAD症状的T2DM患者为研究对象,按照下肢动脉彩超任一节段狭窄率≥50%或闭塞分为下肢动脉病变(PAD,n=63)组和非PAD组(n=302),根据冠状动脉(下称"冠脉")血管造影检查有1支或1支以上冠脉狭窄≥50%定义为无症状CAD。结果 PAD总检出率为17.3%(63/365),PAD组年龄、SBP、高血压病、吸烟史、入院前降压药及他汀类药物使用、无症状CAD患病率均高于非PAD组(P<0.05或P<0.01)。Logistics回归分析结果显示,校正年龄、性别、吸烟、血压、血糖、血脂、eGFR、口服ACEI/ARB类降压药物和他汀类降脂药百分比等混杂因素后,PAD为T2DM患者无症状CAD的独立危险因素,OR(95%CI)为2.177(1.117~4.243)(P<0.05)。PAD组中冠脉单支≥50%的发生率低于非PAD组,但3支冠脉病变≥50%的发生率高于非PAD组(P<0.01)。两组双支冠脉病变≥50%的发生率比较,差异无统计学意义(P>0.05)。结论 T2DM患者合并PAD时无症状CAD的患病风险增加,且冠脉3支病变更多见。Objective To investigate the association of peripheral artery disease（PAD）and asymptomatic coronary artery disease（CAD）in type 2 diabetic patients（T2DM）and its predictive value.Methods A total of 365 T2DM who had no CAD history and no symptoms such as chest tightness and chest pain were enrolled.According to the stenosis rate of≥50% or occlusion of any segment of vascular ultrasound,they were divided into PAD group and non-PAD group.Based on the findings of the coronary CTA angiography,patients with one or more coronary artery stenosis ≥ 50% were defined as asymptomatic CAD. Results The detection rate of PAD in hospitalized T2DM patients was 17.3%（63/365）.The age,SBP hypertension history,the proportion of smoking,the use of statins and antihypertensive drugs and the rate of asymptomatic CAD were higher in PAD group than those in the non PAD group（P0.05 or P0.01）.Logistics regression analysis showed that the presence of PAD was an independent risk factor for asymptomatic CAD in patients with T2DM after adjusting for age,gender,smoking,blood pressure,blood glucose,blood lipids,eGFR,ACEI/ARB and statin use[OR（95% CI）2.177（1.117~4.243）]（P0.05）.In PAD group,the incidence of single coronary stenosis was lower than that in the non-PAD group,but the incidence of three coronary lesions was higher than that in the non-PAD group（P0.01）.There was no significant difference in the incidence of two coronary lesions≥50% between the two groups（P0.05）. Conclusion T2DM patients with PAD have an increased risk of asymptomatic CAD and often present with three coronary lesions.

关 键 词：糖尿病 2型 下肢动脉病变 无症状冠心病 

分 类 号：R587.2[医药卫生—内分泌]