2型糖尿病患者下肢动脉病变的超声评价及临床相关因素分析  

Ultrasound findings and related factors of lower extremity arterial disease in patients with type 2 diabetes mellitus

作　　者：王锦惠[1] 于子芳 张莹 张琼[1] 李繁强 闫芳[1] 刘英[1] Wang Jinhui;Yu Zifang;Zhang Ying;Zhang Qiong;Li Fanqiang;Yan Fang;Liu Ying(Department of Ultrasonography,Taiyuan Second People's Hospital,Taiyuan 030002,Shanxi Province,China)

机构地区：[1]太原市第二人民医院超声诊断科,太原030002 [2]太原市第二人民医院糖尿病足中心,太原030002

出　　处：《中国基层医药》2023年第4期534-539,共6页Chinese Journal of Primary Medicine and Pharmacy

基　　金：山西省科学技术发展计划项目(社会发展)(201503130087)。

摘　　要：目的探讨2型糖尿病(T2DM)患者下肢动脉病变的超声诊断价值及与临床因素的相关性。方法对太原市第二人民医院2016年1月至2019年6月诊治的T2DM患者535例(糖尿病组)下肢动脉进行彩色多普勒超声(CD-US)检查,观察其血管内径、内-中膜厚度(IMT)、有无粥样硬化斑块形成、管腔狭窄或闭塞及血流动力学特征,结果与107例非T2DM患者(非糖尿病组)下肢动脉病变进行比较,分析其与病程、血糖控制水平、合并高血压与否及临床Wagner分级等的相关性。结果糖尿病组下肢动脉IMT增厚、粥样硬化斑块、狭窄、闭塞发生率分别为69.9%、89.0%、77.0%、11.6%,均明显高于非糖尿病组的41.1%、78.5%、72.0%、1.9%(χ^(2)=32.52,P<0.001;χ^(2)=8.76,P=0.003;χ^(2)=27.77,P<0.001);T2DM患者随着病程延长,下肢动脉病变发生率增加(P<0.001);T2DM患者血糖水平控制不良组与血糖水平控制较好组比较、伴高血压组与不伴高血压组比较,前者下肢动脉IMT增厚发生率、粥样硬化斑块检出率及下肢动脉狭窄、闭塞发生率均高于后者,差异均有统计学意义(均P<0.05);T2DM患者下肢动脉狭窄程度与Wagner分级有关,随着狭窄程度增加,Wagner分级相应增高,差异有统计学意义(P<0.001)。结论CD-US对评估T2DM下肢动脉病变具有重要价值。T2DM患者下肢动脉病变程度与病程、血糖控制水平、伴发高血压与否及临床Wagner分级等有相关性。CD-US检查对了解血管病变程度,指导临床早期干预有重要临床意义。Objective To investigate the value of ultrasound findings in the diagnosis of lower extremity arterial disease in patients with type 2 diabetes mellitus and correlate it with clinical factors.Methods A total of 535 patients with type 2 diabetes mellitus who received treatment in Taiyuan Second People's Hospital from January 2016 to June 2019 underwent color Doppler ultrasound examination(T2DM group).Vascular inner diameter,intima-media thickness,atherosclerotic plaque formation,lumen stenosis or occlusion,and hemodynamic characteristics were determined in patients with type2 diabetes mellitus compared with those in 107 patients with non-type 2 diabetes mellitus(non-T2DM group).These parameters were correlated with the course of the disease,blood glucose level,concomitant hypertension or not,and clinical Wagner grade.Results The incidences of intima-media thickening,atherosclerotic plaque,stenosis,and occlusion of lower extremity arteries were 69.9%,89.0%,77.0%and 11.6%respectively,in the T2DM group,which were significantly higher than 41.1%,78.5%,72.0%,and 1.9%respectively in the non-T2DM group(χ^(2)=32.52,P<0.001;χ^(2)=8.76,P=0.003;χ^(2)=27.77,P<0.001).With the prolongation of the course of T2DM,the incidence of arterial lesions in the lower extremities increased(P<0.001).The incidences of intima-media thickening,atherosclerotic plaque,stenosis,and occlusion of lower extremity arteries were significantly greater in the poor blood glucose control group and non-hypertension group compared with the good blood glucose control group and hypertension group(all P<0.05).The degree of lower extremity arterial stenosis in T2DM patients was related to Wagner's grade.As the degree of stenosis increased,Wagner's grade increased correspondingly and significantly(P<0.001).Conclusion Color Doppler ultrasound examination has an important value in evaluating lower extremity arterial lesions in patients with T2DM.The degree of arterial lesions in the lower extremities of T2DM patients is correlated with the course of the diseas

关 键 词：超声检查 多普勒 彩色 糖尿病 下肢 外周动脉疾病 诊断 血管内径 内-中膜厚度 斑块 动脉粥样硬化 影响因素分析 

分 类 号：R587.2[医药卫生—内分泌] R543.5[医药卫生—内科学]