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目的:分析老年人下肢动脉病变发生的影响因素及其预后的影响。方法:回顾性分析2004～2009年于哈尔滨医科大学第一临床医学院干部二病房明确诊断为下肢动脉病变的住院患者181例。全部行双下肢动脉彩色多普勒检查,按照动脉病变程度将患者分为3组:斑块组、狭窄组(≥50%)和闭塞组。收集其性别、年龄、血脂、空腹血糖(FBG)、纤维蛋白原(FIB)、高血压、脑卒中及吸烟史等信息。比较不同病变组一般情况及生化指标间的差异,并对老年下肢动脉粥样硬化病变危险因素采用回归方法进行分析。所有患者均接受16个月随访,观察患者的主要终点事件包括下肢坏疽、侧支循环、死亡。结果:①年龄、糖尿病病程、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、FBG、血脂异常、性别比例、糖尿病、冠心病、脑卒中合并率在三组间的差异无统计学意义(P>0.05)。②三组间高血压病程、高血压合并率、吸烟时间、吸烟率、HDL-C、FIB在三组之间的差异有统计学意义(P<0.05)。③Logistic回归分析结果显示TG、高血压、纤维蛋白原与老年LEAD的发生成正相关(P<0.05),HDL-C与LEAD成负相关(P<0.05)。④经过16个月随访,三组间生存率无显著差异(P>0.05)。结论:老年LEAD患者男性明显多于女性,且常有较高的吸烟率、高血压、糖尿病、脑卒中、血脂异常的合并率。TG、FIB水平增高及合并高血压病其下肢血管病变程度更重,是加剧下肢动脉硬化的主要因素,HDL-C对LEAD具有保护作用。经过16个月随访,老年LEAD患者死亡的主要原因为心脑血管疾病,与血管狭窄严重程度无相关性。
Objective: To analyze the influencing factors of lower extremity arterial disease and its prognosis in the elderly. Methods: A retrospective analysis of 181 hospitalized patients diagnosed as lower extremity arterial disease in the second wards of cadres in Harbin Medical University from January 2004 to December 2009 was retrospectively analyzed. All patients underwent double-lower extremity arterial color Doppler examination, according to the degree of arterial disease patients were divided into 3 groups: plaque group, stenosis group (≥ 50%) and occlusion group. Collecting information such as sex, age, blood fat, fasting blood glucose (FBG), fibrinogen (FIB), hypertension, stroke and smoking history. The differences between the general conditions and the biochemical indexes in different lesion groups were compared. The risk factors of the atherosclerosis in lower extremities were analyzed by regression. All patients underwent a 16-month follow-up. The primary endpoints observed in the patients included gangrene in the lower extremities, collateral circulation, and death. Results ① Age, duration of diabetes, total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL-C), FBG, dyslipidemia, sex ratio, diabetes, coronary heart disease, There was no significant difference between groups (P> 0.05). ② The duration of hypertension, the rate of hypertension, smoking time, smoking rate, HDL-C and FIB among the three groups were statistically significant (P <0.05). ③Logistic regression analysis showed that TG, hypertension and fibrinogen were positively correlated with the occurrence of LEAD (P <0.05), while HDL-C was negatively correlated with LEAD (P <0.05). ④ After 16 months of follow-up, there was no significant difference in survival rates among the three groups (P> 0.05). Conclusion: There are more men than women in elderly patients with LEAD, and often have higher rates of smoking, hypertension, diabetes, stroke, and dyslipidemia. TG, FIB levels and hypertension in patients with lower extremity vascular lesions is more serious, is to accelerate the lower extremity arteriosclerosis, the main factor, HDL-C has a protective effect on LEAD. After 16 months of follow-up, the main cause of death in elderly patients with LEAD is cardiovascular and cerebrovascular diseases, and has no correlation with the severity of vascular stenosis.