下肢动脉超声筛查对 2 型糖尿病患者冠状动脉病变的提示价值
Indicating value of lower extremity atherosclerotic disease ultrasound screening for cardiovascular diseases in type 2 diabetes patients#br#

目的 · 明确下肢动脉疾病超声筛查是否对2 型糖尿病患者的冠状动脉粥样硬化性心脏病（冠心病）有提示作用。方法 · 纳 入 606 例 2 型糖尿病住院患者，检测所有患者肝肾功能、糖代谢、肿瘤指标等生化指标，并进行下肢动脉超声和冠状动脉 CT 血管造 影（CTA）检查。根据动脉超声检查结果将患者分为合并糖尿病下肢动脉粥样硬化性病变（LEAD）组（n=318）及不合并 LEAD 组 （n=288）；根据冠状动脉CTA 或经皮冠状动脉介入治疗（PCI）史或经皮冠状动脉腔内血管成形术（PTCA）史，分为合并冠心病组 （n=280）及不合并冠心病组（n=326）。分析不同下肢动脉病变患者的冠心病患病率及其相互关系。结果 · 2 型糖尿病患者冠心病患病 率随着下肢动脉病变加重而升高，其中下肢动脉硬化组冠心病的患病率为29%，斑块伴下肢动脉狭窄小于 50% 组冠心病的患病率为 63%，下肢动脉狭窄大于50% 或闭塞组冠心病的患病率为81%，后 2 组明显高于不合并LEAD 组（P=0.021, P=0.015）。 Spearman 相 关分析发现年龄、性别、糖尿病病程、收缩压、血清总胆固醇、下肢动脉病变、股动脉内中膜厚度与冠心病患病率呈正相关，而高密 度脂蛋白胆固醇、肾小球滤过率与冠心病患病率呈负相关。Logistic 回归分析进一步发现，糖尿病病程、下肢动脉病变与冠心病患病 率独立相关。校正年龄、糖尿病病程、血脂等影响因素后，动脉病变与冠心病的 OR 分析显示，下肢动脉病变患者的冠心病患病风险 提高4.818 倍 (OR=5.818，95% CI 为 2.627 ～ 12.888，P=0.000)。结论 · 下肢动脉超声显示的下肢动脉病变可提示冠状动脉病变患病 风险。
：Objective · To verify the indicating value of the simple screening of lower extremity atherosclerosis artery disease (LEAD) by lower extremity arterial ultrasound examination for coronary atherosclerotic heart disease (CAD) in patients with type 2 diabetes. Methods · A total of 606 type 2 diabetes patients were enrolled. Their clinical data and biochemical parameters (hepatorenal function, glycometabolism, tumor markers) were collected. All patients were undertaken lower extremity vascular ultrasound and CT angiography (CTA) scan for coronary artery disease. According to the results of lower extremity ultrasound, patients were divided into two groups, patients with LEAD group (n=318) and patients without LEAD group (n=288). According to the history of coronary CTA or percutaneous coronary intervention (PCI) or percutaneous transluminal coronary angioplasty (PTCA), the patients were divided into CAD group (n=280) and non-combined CAD group (n=326). The prevalence of CAD in different LEAD groups was compared and their relationship was analyzed. Results · The degree of LEAD was proportional to the prevalence of CAD. Both of the prevalences of CAD in group with arterial stenosis >50% (81%) and group with plaque and stenosis<50% (63%) were significantly higher than that in group without plaque (29%) (P=0.021, P=0.015, respectively). Spearman analysis found that age, sex, duration of diabetes, systolic blood pressure, total cholesterol, LEAD, femoral artery intima-media thickness were positively correlated with CAD. However, high density lipoprotein cholesterol and glomerular filtration rate were negatively associated with CAD. Logistic regression analysis revealed that duration of diabetes, existence of LEAD were independent associated factors of CAD. After adjusting the confounding factors, odds ratio risk analysis