摘要
目的：应用无创的彩色多普勒超声检查观察2型糖尿病患者下肢血管及血流的异常改变，探讨彩色多普勒超声对糖尿病下肢病变的早期评估与康复的价值。 方法：选择2000-06／2004-06哈尔滨医科大学第一医院收治2型糖尿病下肢病变患者297例，以健康志愿者30例为正常对照组。应用彩色多普勒血管超声检查被试者下肢股动脉、腘动脉、胫后及足背动脉，观察频谱的形态，并测定血管内径、峰值流速、血流量及频谱宽度，同时观察下肢动脉粥样硬化斑块的发生情况；糖尿病病程与下肢动脉病变的发生情况。 结果：按意向处理分析，90例被试者全部进入结果分析。①血流量：糖尿病组左、右足背动脉低于正常对照组[(1．22±0．53)，(0．71±0．62)mm^3／s；(0．72±0．5)，(1．38±0．59)mm^3／s，P＜0．05]。②峰值流速：糖尿病组左、右足背动脉和左腘动脉均高于正常对照组(P＜0．05或0．01)，以足背动脉明显。③血管内径：糖尿病组左、右足背动脉和左腘动脉均低于正常对照组(P＜0．05或0．01)。④血流频谱：糖尿病组左、右足背动脉和左腘动脉均宽于正常对照组(P＜0．05或0．01)。⑤下肢动脉粥样硬化斑块发生率：60岁以上的两个年龄段糖尿病患者显著高于正常对照组(P＜0．05)．且出现下肢动脉病变的时间早；60岁以下的两个年龄段糖尿病患者也呈增高趋势，但差异无显著性意义(P＞0．05)。⑥糖尿病病程与下肢动脉病变关系：糖尿病患者在发病的第4年以后，下肢动脉病变的发病例数明显提高。 结论：①糖尿病患者较正常人发生动脉粥样硬化提前，发生率明显提高，并随病程的延长而加重。②糖尿病下肢动脉病变以足背动脉改变为最重。③彩色多普勒超声对糖尿病患者下肢血管的早期诊断、疗效观察、预防下肢坏疽的发生有重要的临床评估价值。
AIM： To observe the abnormal changes of the lower limbs＇ vessel and blood flow by using color Doppler ultrasonic examination in type 2 diabetic patients, and investigate the significance of color Doppler ultrasonic examination in the early diagnosis and rehabilitation of diabetic angiopathy of lower limbs. METHODS： Totally 297 type 2 diabetic patients with angiopathy of lower limbs, who were treated in the First Hospital of Harbin Medical University between June 2000 and June 2004, were selected, and another 30 healthy volunteers were taken as the normal control group. The femoral artery, popliteal artery, posteriortibial artery and dorsal artery of foot of lower limbs were tested with color Doppler ultrasonic examination to observe the spectral form. Vascular inner diameter, peak flow rate, blood flow and spectral width were determined. Meanwhile, the occurrence of atherosclerotic plaque in lower limbs, and the correlation between diabetic course and occurrence of lower limbs＇ angiopathy were observed. RESULTS： According to intention-to-treat analysis, all the 90 subjects were involved in the analysis of results. ① Blood flow： The blood flows of left and fight dorsal artery of foot in the diabetic group were lower than those in the normal control group [（1.22±0.53）, （0.71±0.62） mm^3/s; （0.72 ±0.5）, （1.38±0.59） mm^3/s, P 〈 0.05]. ② Peak flow rate： The peak flow rates of left and right dorsal artery of foot, and left popliteal artery in the diabetic group were all higher than those in the normal control group （P 〈 0.05 or 0.01）, and that of dorsal artery of foot was more obvious. ③ Vascular inner diameter： The vascular inner diameters of left and right dorsal artery of foot, and left popliteal artery were all lower in the diabetic group than in the normal control group （P 〈 0.05 or 0.01）. ④ Spectrum of blood flow： Those of left and right dorsal artery of foot, and left popliteal artery were all wider in the diabetic group than in the normal control group （P 〈 0.05 or 0.01）. ⑤ Incidence rate of atherosclerotic plaque in lower limbs： It was significantly higher in the diabetic patients of the two age groups above 60 years than in the normal control group （P 〈 0.05）, and the lower limbs＇ angiopathy occurred earlier. It showed an increasing trend in the diabetic patients of the two age groups below 60 years without significant difference （P 〉 0.05）. ⑥ Association between diabetic course and lower limbs＇ angiopathy： After the 4th year of the diabetic attack, the number of cases suffered from lower limbs＇ angiopathy was obviously increased. CONCLUSION： ① Atherosclerosis occurs earlier and the incidence rate is higher in the diabetic patients than in normal people, and it aggravates with disease course. ②The changes of dorsal artery of foot is the most severe in the diabetic angiopathy of lower limbs. ③ Color Doppler ultrasonic examination is of important clinical significance for the early diagnosis of lower limbs＇ vessels, observation of effect and preventing the occurrence of lower limbs＇ gangrene.
出处
《中国临床康复》
CAS
CSCD
北大核心
2005年第35期19-21,共3页
Chinese Journal of Clinical Rehabilitation
基金
黑龙江省自然基建项目(D2004-52)~~
作者简介
杨敏,女,1964年生,山东省人,汉族,2001年哈尔滨医科大学毕业,硕士,副主任医师,主要从事腹部疾病的研究.cspine@263.net.cn
