Ⅱ型糖尿病患者下肢动脉病变的危险因素研究

摘要

Objective To investigate the prevalence of peripheral arterial disease ( PAD) of lower limbs in the type 2 diabetic patients and analyze the risk factors relevant to PAD.Methods 524 diabetic patients were enrolled in this study.ABI (pedal-brachial pressure index) assessed using hand-held Doppler Ultrasound.Blood pressure, height, fasting plasma glucose (FPG) and 2-hr plasma glucose (2hPG), fasting insulin (Fins), glycated hemoglobin ( HbA1c), triglycerides (TC), cholesterol (TC), low-density lipoprotein (LDL) - C), high-density lipoprotein ( HDL - C) and electrocardiogram (EKG) were measured, and calculated body mass index (BMI), HOMA-IR, HOMA - beta and insulin sensitivity index( ISI).Multi-factorial logistic stepwise regression analysis was used to screen the risk factors of ABI.Results Of the 524 diabetic patients, 156 (29.8％) patients had their ABI＜0.9.The patient with ABI＜0.9 was defined to PAD.Compared with those in non-PAD group, patient s with PAD had older age, longer course, higher levels of 2h glucose and pulse pressure, TG, LDL-C, higher smoking rates.Age, course of disease, TG, HbA1c were the independent risk factors for PAD by logistic stepwise regression.Conclusion Diabetic patients with PAD have significant metabolic disturbance.So it may be necessary to routinely detect ABI for PAD.And it is very important to strictly control hypertension, dyslipidemia and hyperglycemia.%目的 对Ⅱ型糖尿病(T2DM)患者检测踝肱动脉血压指数(ABI),探讨下肢动脉病变(PAD)的患病率并分析其相关的危险因素.方法 选取住院糖尿病患者中进行ABI测定的患者524例,采用多普勒血流探测仪测定T2DM患者的足背动脉、胫后动脉与肱动脉的比值,比值＜0.9入PAD组,≥0.9入非PAD组,同时对所有患者均进行身高、血压、空腹血糖(FPG)、餐后2小时血糖(2hPG)、空腹胰岛素(Fins)、糖化血红蛋白(HbA1c)、甘油三酯(TC)、胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)及心电图(EKG)检查,计算体重指数(BMI)、HOMA-IR、HOMA-β、胰岛素敏感指教.结果 PAD组156例,占29.8%.PAD组与非PAD组比较,前者的年龄大、病程长、2hPG、TG、LDL-C、脉压差、吸烟率明显增高,DBP和HbA1c达标率明显降低.逐步回归分析显示,年龄、病程、TG、HbAlc是影响ABI的独立危险因素.结论 增龄、病程长、高TG、高血糖是加剧下肢动脉硬化的主要因素;对高危患者及时进行ABI检测,以早期诊断糖尿病合并PAD,防治糖尿病足的进展.