糖尿病患者下肢IMT和血管炎性因子的临床意义.docVIP

摘 要 目的 探讨2型糖尿病(Type 2 Diabetes Mellitus T2DM)大血管动脉内膜中层厚度(IMT)测量的临床意义及其与血管炎性因子的关系 ，为糖尿病足（Diabetes Mellitus Foot DMF）提供早期无创诊断线索和干预治疗依据。 方法 选取2004.4－2005.1本科收治的T2DM患者（无高血压及DM慢性并发症）26例与年龄和性别及血压相匹配的健康者26例作为对照；DM合并高血压24例与年龄和性别及血压相匹配的非DM高血压24例作为对照；再随机选取54例糖尿病患者，入选者全部进行血管超声检查，同时记录所有糖尿病患者的DM病程，检测所有入选者的血压水平、血脂谱及纤维蛋白原（fibrinogen Fg）、高敏C反应蛋白（high-sensitive C-reactive protein hs-CRP））①DM人的下肢血管IMT测定对DM下肢动脉粥样硬化诊断较CCA IMT更有意义，尤以POA IMT为明显。②随动脉IMT增厚，血管炎症标志物相应增加，且二者存在明显相关关系。③ 单条血管（CCA 或CFA或 POA）IMT测定对DMF诊断均有意义，但三条血管联合测定时诊断的特异性更高。 关键词 2型糖尿病 动脉粥样硬化 动脉内膜中层厚度 低度炎症 Abstract Objective- to study the crural arterial IMT (intima-media thickness) of the patients with type 2 diabetes and the contribution of a range of vascular risk factors to their IMT. Research design and methods-IMT were determined using ultrasound B-mode imaging in 104 subjects with diabetes and 50 nondiabetic subjects.And their major cardiovascular risk factors,including plasma lipids , WBC count, plasma high-sensitive C-reactive protein (hs-CRP)and fibrinogen(Fg), were measured respectively by enzymatic assays and other methods. Their clinical data (eg. blood pressure and diabetic period and age et al) were recorded too. Results- Patients’ CFA (common femoral artery) IMT and POA (popliteal artery)IMT were correlated with their CCA(common carotid artery) IMT. And diabetic patients had higher IMT of CCA and CFA and POA than normal nondiabetic subjects ,especially in CFA and POA(CCA IMT 0.76±0.18mm VS 0.5±0.15mm，p=0.000；CFA IMT 0.87±0.56 mm VS 0.49±0.13 mm，p= 0.003；POA IMT 0.87±0.59 mm VS 0.45±0.09mm，p=0.003).IMT were correlated with Fg and WBC and hs-CRP（CFA and Fg, r=0.216，p=0.007; CFA and WBC r=0.210，p=0.033 ; CFA and hs-CRP r=0.190，p=0.045.POA and Fg,r=0.174，p=0.031 ; POA and WBC r=0.235p=0.003; POA and hs-CRP r=0.220，p=0.048）.The presences of diabetic foot are positively correlated with patient’s age and duration of DM and the marks of lower-grade inflammation (p0.05). Conclusions-Diabetic patient’s