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目的:探讨胫前动脉血管内皮舒张功能及血流动力学参数与2型糖尿病下肢疾病的相关性,为2型糖尿病下肢动脉病变的超声诊断提供更多的理论依据。方法:本研究设计经伦理审查委员会批准,所有研究对象在检查前均已签署知情同意书。将159例2型糖尿病患者分为下肢动脉病变(Peripheral Arterial Disease,PAD)症状组(具有间歇性跛行和(或)静息性腿痛)和无PAD症状组,使用高频超声二维时分别测量静息状态下及反应性充血后胫前动脉内径(D0,D1),内-中膜厚度(Intima Media Thickness,IMT),彩色流速流量定量技术测量胫前动脉收缩期峰值血流速度(Peak systolic Velocity,PSV),搏动指数(Pulse Index,PI),血管内压力(Pression,P)及压差(Friqunent,FRQ),比较两组胫前动脉血管内皮舒张功能((D1-D0)/D0),IMT及血流参数的差异,应用多元回归分析血管内皮舒张功能及以上血流动力学参数与下肢PAD症状的相关性。结果:(1)与非PAD症状组相比,PAD症状组血管内皮舒张功能,PSV、PI、P均减低,IMT增加;(2)PAD症状与年龄、病程、糖化血红蛋白、PSV、PI、Sten%、血管内皮舒张功能等有相关性,而与IMT等无相关性。结论:(1)袖带加压法测定血管内皮依赖性舒张功能方法简便且有潜在临床适用性;(2)血管内皮舒张功能作为一项新指标可以和经典的PSV一样反映下肢动脉病变的情况,从而为下肢动脉病变的诊断提供依据。
OBJECTIVE: To investigate the correlation between endothelium-dependent vasodilatation and hemodynamic parameters of anterior tibial artery and lower extremity diseases of type 2 diabetes mellitus, and to provide more theoretical evidences for the diagnosis of arterial disease of lower extremity in type 2 diabetes mellitus. Methods: The design of this study was approved by ethics review board. All subjects signed informed consent form before the examination. 159 patients with type 2 diabetes were divided into symptoms of Peripheral Arterial Disease (with intermittent claudication and / or resting leg pain) and no symptoms of PAD. Two-dimensional high-frequency ultrasound (D0, D1), Intima Media Thickness (IMT) and color flow rate were measured at rest and after reactive hyperemia. The peak systolic velocity of peak anterior tibial artery systolic Velocity (PSV), Pulse Index (PI), Pression (P) and Friqunent (FRQ) ), IMT and blood flow parameters, multivariate regression analysis of vascular endothelial relaxation and the above hemodynamic parameters and lower extremity PAD symptoms. Results: (1) Compared with non-PAD symptom group, the vascular endothelial relaxation function, PSV, PI, P decreased and IMT increased in PAD symptom group; (2) The symptoms and age, course of disease, HbA1c, PSV, PI, Sten %, Vascular endothelial relaxation and other related, but no correlation with IMT. Conclusion: (1) cuff pressure method for the determination of endothelium-dependent vasodilation method is simple and has potential clinical applicability; (2) as a new index of vascular endothelial relaxation can reflect the same as the classic PSV arterial disease , So as to provide the basis for the diagnosis of lower extremity arterial disease.