踝肱指数和彩色多普勒超声检查在2型糖尿病患者下肢动脉病变诊断中的价值

摘要

Objective To compare the results of ABI and doppler color ultrasonography of lower extremity in patients with type 2 diabetes mellitus and to investigate the accuracy and reliability of the ABI in the screening of patients with type 2 diabetes mellitus.Methods 300 cases of type 2 diabetes hospitalized patients were performed with ABI and lower extremity artery ultrasound examination,respectively,observing the coincidence rate of detectionbetween ABI and ultrasonic on the diagnosis of lower limb artery stenosis,and analysis the risk factors of lower extremity arterial lesions.Results The patients were divided into normal group (76 cases,25.3％),IMT thickening group (20 cases,6.7 ％),arterial plaque group (166 cases,55.3 ％),and stenosis group (38 cases,12.7 ％).ABI mean was statistically significant in stenosis group compared with other groups (P ＜ 0.05),ABI mean showed no significant difference between the other three groups.According to the ROC curve,the best cutoff value of ABI on forecasting ultrasonic detection of vascular stenosis was determined as 0.865,judged by ABI ＜ 0.865,the negative predictive value of ultrasonic vascular stenosis was 231/249 (92.8％) and the positive predictive value was 20/49 (40.8％).LOGISTIC regression analysis showed that age,alcohol,consumption,diabetes,hypertension and high cholesterol were the risk factors of lower extremity arterial disease (P ＜ 0.05).Conclusion Age,diabetes,hypertension and high cholesterol are the risk factors of lower extremity arterial disease.ABI≤＜0.865 is the point of tangency in the diagnosis of lower limb vascular stenosis.%目的 比较2型糖尿病患者的踝肱指数(ABI)与下肢动脉彩色多普勒超声检查结果,探讨ABI筛查2型糖尿病患者大血管病变的准确性和可靠性.方法 对300例2型糖尿病住院患者分别进行ABI和下肢动脉彩色多普勒超声检查,观察ABI与超声诊断下肢动脉狭窄的符合率,并分析下肢动脉病变的危险因素.结果 根据下肢动脉彩色多普勒超声检查结果将患者分为正常组76例(25.3％),内膜中层厚度(IMT)增厚组20例(6.7％),动脉斑块组166例(55.3％),狭窄组38例(12.7％).狭窄组与其他三组的ABI均值分别比较,差异有统计学意义(P＜0.05),而其他三组之间ABI均值差异无统计学意义;根据ROC曲线,确定以ABI预测超声检测血管狭窄的最佳cutoff值为0.865;以ABI≤0.865判断血管狭窄的阴性预测率231/249(92.8％),阳性预测值20/49(40.8％).Logistic回归分析显示年龄、饮酒、糖尿病病程、高血压病史和高胆固醇血症为下肢动脉病变的危险因素.结论 年龄、糖尿病病程、高血压病史和高胆固醇血症是下肢动脉病变的危险因素;ABI≤0.865是诊断下肢血管狭窄的切点.