【摘要】：目的·明確下肢動脈疾病超聲篩查是否對2型糖尿病患者的冠狀動脈粥樣硬化性心臟病(冠心病)有提示作用。方法·納入606例2型糖尿病住院患者,檢測所有患者肝腎功能、糖代謝、腫瘤指標(biāo)等生化指標(biāo),并進(jìn)行下肢動脈超聲和冠狀動脈CT血管造影(CTA)檢查。根據(jù)動脈超聲檢查結(jié)果將患者分為合并糖尿病下肢動脈粥樣硬化性病變(LEAD)組(n=318)及不合并LEAD組(n=288);根據(jù)冠狀動脈CTA或經(jīng)皮冠狀動脈介入治療(PCI)史或經(jīng)皮冠狀動脈腔內(nèi)血管成形術(shù)(PTCA)史,分為合并冠心病組(n=280)及不合并冠心病組(n=326)。分析不同下肢動脈病變患者的冠心病患病率及其相互關(guān)系。結(jié)果·2型糖尿病患者冠心病患病率隨著下肢動脈病變加重而升高,其中下肢動脈硬化組冠心病的患病率為29%,斑塊伴下肢動脈狹窄小于50%組冠心病的患病率為63%,下肢動脈狹窄大于50%或閉塞組冠心病的患病率為81%,后2組明顯高于不合并LEAD組(P=0.021,P=0.015)。Spearman相關(guān)分析發(fā)現(xiàn)年齡、性別、糖尿病病程、收縮壓、血清總膽固醇、下肢動脈病變、股動脈內(nèi)中膜厚度與冠心病患病率呈正相關(guān),而高密度脂蛋白膽固醇、腎小球濾過率與冠心病患病率呈負(fù)相關(guān)。Logistic回歸分析進(jìn)一步發(fā)現(xiàn),糖尿病病程、下肢動脈病變與冠心病患病率獨立相關(guān)。校正年齡、糖尿病病程、血脂等影響因素后,動脈病變與冠心病的OR分析顯示,下肢動脈病變患者的冠心病患病風(fēng)險提高4.818倍(OR=5.818,95%CI為2.627~12.888,P=0.000)。結(jié)論·下肢動脈超聲顯示的下肢動脈病變可提示冠狀動脈病變患病風(fēng)險。
[Abstract]:Objective to determine whether ultrasound screening of lower extremity arterial diseases may be useful for coronary atherosclerotic heart disease (CHD) in type 2 diabetic patients. Methods A total of 606 patients with type 2 diabetes were enrolled in this study. The liver and kidney function, glucose metabolism and tumor indexes were measured. The lower extremity artery ultrasound and coronary CT angiography (CTA) were performed. According to the results of arterial ultrasound, the patients were divided into two groups: (LEAD) group with diabetes mellitus lower extremity atherosclerotic lesion (nf318) and group without LEAD (nnc288); (PCI) history or percutaneous transluminal coronary artery intervention (PTCA) with coronary CTA or percutaneous coronary intervention was used to treat patients with diabetic lower extremity atherosclerotic lesions. History of angioplasty (PTCA), The patients were divided into two groups: coronary heart disease group (n = 280) and non-coronary heart disease group (n ~ (326). To analyze the prevalence and relationship of coronary heart disease in patients with different arterial lesions of lower extremity. Results the prevalence of coronary heart disease in patients with type 2 diabetes increased with the exacerbation of arterial lesions of lower extremities. The prevalence of coronary heart disease in the arteriosclerosis of lower extremity group was 29. The prevalence rate of coronary heart disease was 63 in the group with plaque and artery stenosis of lower extremity less than 50%. The prevalence rate of coronary heart disease was 81 in the group of arteriosclerosis of lower extremity more than 50% or in the group of occlusion. Age of association with LEAD group (P0. 021, P0. 015). Spearman correlation analysis, P < 0. 021). Sex, course of diabetes, systolic blood pressure, serum total cholesterol, arteriopathy of lower extremity, medial thickness of femoral artery were positively correlated with the prevalence of coronary heart disease, while high density lipoprotein cholesterol, The glomerular filtration rate was negatively correlated with the prevalence of coronary heart disease. Logistic regression analysis further found that the course of diabetes, arterial lesions of lower extremities and the prevalence of coronary heart disease were independently correlated. OR analysis of arterial lesion and coronary heart disease showed that the risk of coronary heart disease in patients with lower extremity artery disease was increased by 4.818 times (OR=5.818,95%CI = 2.627 ~ 12.888P0. 000) after adjusting for age, diabetes course, blood lipid and other influencing factors. Conclusion the lower extremity artery lesions can indicate the risk of coronary artery disease.
【作者單位】： 上海市糖尿病臨床醫(yī)學(xué)中心上海市"重中之重"代謝病臨床醫(yī)學(xué)中心上海市糖尿病研究所上海市糖尿病重點實驗室上海交通大學(xué)附屬第六人民醫(yī)院內(nèi)分泌代謝科;
【基金】：國家自然科學(xué)基金(81270397) 上海市教育委員會高峰高原學(xué)科建設(shè)計劃(20152232)~~
【分類號】：R445.1;R587.2

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