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目的了解踝肱指数(ankle-brachial index,ABI)和左右臂踝脉搏波传播速度(brachial-ankle pulse wave velocity,baPWV)对诊断糖尿病下肢动脉病变的意义及ABI异常的相关危险因素。方法收集住院的2型糖尿病(T2DM)患者100例,检测其ABI和baPWV,根据ABI分为两组,ABI<0.9为糖尿病下肢外周动脉病变(peripheral arterial disease,PAD)组、ABI≥0.9为非PAD组,测量身高、体重、血压、血脂、尿微量白蛋白、血肌酐水平,行双下肢血管彩色多普勒超声和超声心动图检查。对与ABI相关的因素行多重线性回归分析,筛选ABI的独立危险因素。结果 100例2型糖尿病患者中,ABI≥0.9组82例(占82%),ABI<0.9组18例(占18%)。ABI<0.9组患者的年龄、糖尿病病程、左右baPWV绝对差值、下肢动脉血管狭窄程度、24h尿微量白蛋白(MAU)、血肌酐及高血压、冠心病、糖尿病肾病发病率均高于ABI≥0.9组患者,差异有统计学意义(P<0.05)。多重线性回归分析显示,ABI与下肢动脉血管狭窄程度(β=-0.429,P=0.023)、左右baPWV绝对差值(β=-0.131,P=0.012)独立相关。结论下肢动脉血管狭窄程度、左右baPWV绝对差值是ABI的独立危险因素,临床上可以联合左右baPWV绝对差值和ABI共同筛选PAD患者,从而减少假阳性和假阴性率。
Objective To investigate the significance of ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) in the diagnosis of diabetic lower extremity arterial disease and related risk factors of ABI abnormalities. Methods 100 patients with type 2 diabetes mellitus (T2DM) were enrolled and their ABI and baPWV were detected. They were divided into two groups according to ABI. ABI <0.9 was the group of diabetic peripheral arterial disease (PAD) PAD group, height, weight, blood pressure, blood lipids, urine microalbuminuria, serum creatinine were measured. Color Doppler echocardiography and echocardiography were performed on both lower extremities. Multiple linear regression analysis was performed on ABI-related factors to screen for independent risk factors for ABI. Results Among the 100 patients with type 2 diabetes, 82 (82%) had ABI ≥ 0.9 and 18 (18%) had ABI <0.9. ABI <0.9 group of patients with age, duration of diabetes, left and right baPWV absolute difference, lower extremity arterial stenosis, 24h urine microalbumin (MAU), serum creatinine and hypertension, coronary heart disease, diabetic nephropathy incidence was higher than ABI ≥ 0.9 group of patients, the difference was statistically significant (P <0.05). Multiple linear regression analysis showed that ABI was independent of the degree of stenosis of lower extremity artery (β = -0.429, P = 0.023) and absolute difference of left and right baPWV (β = -0.131, P = 0.012). Conclusions The degree of arterial stenosis in the lower extremities and the absolute difference of baPWV around are the independent risk factors of ABI. Combined with the absolute difference between baPWV and ABI, the screening of PAD patients can reduce the false positive rate and false negative rate.