iga肾病合并抗gbm病1例病例报告.docVIP

糖尿病上肢动脉病变并指端坏疽1例及文献复习 华中科技大学同济医学院附属同济医院 尚伟锋 张本平2 王玉成3 张静2 邓明4 刘娜5 缪学宇6 胡蜀红2*，武汉 430030 摘要：目的：探讨糖尿病上肢动脉病变的临床表现、诊断、治疗及预后。方法：对我院1例糖尿病合并指端坏疽患者的临床资料进行回顾性分析，并对相关文献进行复习。结果：患者，29岁，男，以“左手食指及中指指端坏疽2月余，发现血糖增高1月余”为主要表现，入院行口服糖耐量试验（OGTT）、血管B超及左侧上肢的CTA，诊断2型糖尿病合并上肢远端动脉粥样硬化及指端坏疽，给予改善循环，积极抗感染及强化控制血糖治疗，患者坏疽有所改善。结论：糖尿病上肢动脉病变少见，及早发现、及早诊治，可有助于避免指端坏疽，截肢及挽救患者生命。 关键词：糖尿病；上肢动脉病变，指端坏疽；诊断；治疗 A case report of diabetic upper limb artery disease and gangrene and literature review SHANG Wei-feng1，ZHANG Ben-ping2, Wang Yu-cheng3, ZHANG Jing2, Deng Ming4, LIU Na5, MIAO Xue-yu6, HU Shu-hong2*. Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030，China Abstract：Objective To explore the clinical manifestation, diagnosis, treatment and prognosis of diabetic upper limb artery disease and gangrene. Methods The clinical data of one case of diabetic upper limb artery disease combined with digital gangrene was analyzed retrospectively, and the related literature was reviewed. Results The patient was a 29-year-old man with the complaint of dry gangrene of the left index finger and middle finger and elevated blood glucose.Given the results of oral glucose tolerance test (OGTT),vascular ultrasound and the CTA of the left upper limb,a diagnosis of diabetic upper limb artery disease and gangrene was made. He was treated with the drug of improving the microcirculation, intravenous combination antibiotics and insulin regimen. Finally, his symptoms improved. Conclusions Early detection of diabetic upper limb artery disease and gangrene helps in risk factor modification, which may avoid amputation and save lives. Key words: diabetic; upper limb artery disease; limb gangrene; diagnosis; treatment 目前2型糖尿病患病率越来越高，2010年中国慢性病监测糖尿病专题调查中国成人糖尿病患病率为11.6%，糖尿病前期人群达50.1%[1]。大血管并发症包括心脑血管和周围动脉病变（PAD）是糖尿病患者致死和致残的主要病因。PAD、周围神经病变和继发感染是糖尿病患者发生肢端坏疽的三大病因。糖尿病患者的PAD和肢端坏疽多见于下肢，而上肢指端坏疽很少见，现报道我院内分泌科收治的第一例糖尿病合并指端坏疽，并对相关文献进行复习。 病例资料 患者，男，29岁，农民，因“左手食指及中指指端坏疽2月余，发现血糖升高1月余” 于2014年10