【作者】 张凯；

【导师】 马云龙；

【作者基本信息】 河北医科大学 ， 中西医结合临床， 2013， 硕士

【摘要】 目的：本课题通过对下肢动脉硬化疾病(LEAD)患者的临床资料进行回顾性研究，总结分析糖尿病足（DF）与非糖尿病性动脉硬化闭塞症（ASO）病例的下肢动脉病变分布的临床特点，进一步对DF临床症状分期与膝下动脉病变程度进行相关性分析，以便为临床血管重建提供必要的依据。方法：第一部分选取河北省中医院外科和中国中医科学院西苑医院血管外科2010年10月—2012年10月期间收治的糖尿病足患者130名及非糖尿病性动脉硬化闭塞症患者72名，分别定义为I组和II组，收集入组患肢动脉CTA和/或DSA结果，采用髂、股、腘、膝下动脉4分段法，进行两组之间患肢单节段、双节段、多节段动脉累及情况统计分析。同时根据病变部位登记病变资料，进行分类统计分析。第二部分选取河北省中医院外科和中国中医科学院西苑医院血管外科2010年10月—2012年10月期间收治的仅有单侧膝下动脉病变的糖尿病足患者100名，定义为III组，收集各病例的临床症状、ABI值及生化指标，进行膝下动脉病变包括胫前动脉、胫后动脉、腓动脉及足底动脉环的累及情况与各指标间的统计学分析。结果：1130例糖尿病足（DF）患者（250条患肢、711处病变）和72例非糖尿病性动脉硬化闭塞症（ASO）患者（132条患肢、262处病变）进入第一部分研究。①DF患肢单节段、双节段、多节段动脉累及率分别为49.20%、27.2%和23.6%，而ASO患肢分别为的45.45%、33.33和21.21%，两组不同节段动脉构成比无统计学差异（P>0.05），两组单节段病变膝下动脉累及率有明显统计学差异（P <0.05），两组双节段病变股膝下动脉累及率有明显统计学差异（P <0.05），两组多节段病变股腘膝下动脉累及率无明显统计学差异（P>0.05）。②DF患肢股动脉段和膝下动脉段较髂动脉和腘动脉累及比例高，各组相比较统计学差异明显（P<0.05)，而ASO患肢股动脉段和腘动脉段较髂动脉和膝下动脉累及比例高，各组相比较统计学差异明显（P <0.05）。③DF13.60%的患肢有髂动脉段病变，40.08%的患肢有股动脉段病变,26.80%的患肢有腘动脉段病变，而ASO分别为34.09%，14.91%，37.88%，两组髂、股、腘动脉段病变累及均有显著性差异（P<0.05）。而从两组髂、股、腘动脉病变分布上统计，也有显著性差异（P<0.05）。④DF患肢膝下动脉病变累及率为95.20%，与ASO患肢28.79%的膝下动脉病变累及率相比二者有显著性差异（P<0.05）,DF患肢共有病变711处，ASO患肢病变262处，两组病变分别有70.74%和23.28%病变分布在膝下动脉,有显著性差异（P <0.05）。⑤在DF患肢中，累及膝下动脉有503处(70.74％)，其中多累及胫前、胫后动脉，腓动脉较少累及，差异有明显统计学意义（P＜0.05）。⑥在两组膝下动脉病变中，≥2支动脉病变的比例分别31.58%和69.75%，统计学差异明显（P<0.05）。2100例仅有单侧膝下动脉病变的糖尿病足患者（100条患肢）进入第二部分研究。膝下动脉1支病变的患肢、膝下动脉2支病变的患肢与膝下动脉3支病变的患肢在临床症状（间歇性跛行、静息痛、足部溃疡或坏疽）、ABI值及生化指标（TG、HDL、LDL、HCY、ACE、CRP）上存在显著性差异（P<0.05）,随着膝下动脉累及支数越多，临床症状越重，ABI值越低，血脂、血管介质、炎性指标越偏离正常。按Fontaine分期，足底动脉环病变发生率III期、IV期患肢较II期患肢有明显统计学差异（P<0.05）。结论:1糖尿病足下肢动脉病变以多平面动脉硬化闭塞为主要表现，股动脉和膝下动脉累及最多。2糖尿病足下肢动脉病变多累及膝下小动脉，而非糖尿病性动脉硬化闭塞症好发于下肢大、中型动脉，如髂动脉、股动脉和腘动脉等处。3糖尿病足下肢动脉硬化的发病过程中,胫前和胫后动脉多受累，而腓动脉较少受累。4糖尿病足患者膝下动脉病变多侵犯2支以上的动脉。5糖尿病足膝下动脉病变累及支数越多，临床症状越重，ABI越低，脂代谢紊乱、血管介质异常、炎症反应越重。6糖尿病足下肢临床症状越重，足底动脉环病变发生率越高。更多还原

【Abstract】 Objective: This issue through clinical data of patients with lowerextremity atherosclerotic disease (LEAD) were studied retrospectivelysummary of the analysis of the diabetic foot (DF) and non-diabeticarteriosclerosis obliterans (ASO) cases of lower extremity arterial diseasedistribution clinical features, and further clinical symptoms of DF correlationanalysis with below-knee artery lesions in installments, in order to provide thenecessary basis for the clinical revascularization.Methods: The first part of the select Hebei Province Traditional ChineseMedicine Hospital surgical and Xiyuan Hospital of China Academy ofTraditional Chinese Medicine Vascular Surgery October2010-October2012admitted130patients with diabetic foot and non-diabetic patients witharteriosclerosis obliterans72, respectively, define Group I and Group II,collected into groups limb arterial CTA and/or DSA results, iliac, femoral,popliteal, below-knee arteries segmentation method limb single segmentbetween the two groups, double segment, and more segmental arteriesinvolving statistical analysis. The lesion data registered under the lesionclassification statistical analysis. The second part of the select Hebei ProvinceTraditional Chinese Medicine Hospital surgical and Xiyuan Hospital of ChinaAcademy of Traditional Chinese Medicine Vascular Surgery October2010-October2012admitted only a unilateral infrapopliteal artery lesions inpatients with diabetic foot100, defined as Group III, collected the clinicalsymptoms, ABI values and biochemical parameters, infrapopliteal arterylesions, including statistical analysis between the anterior tibial artery,posterior tibial artery, peroneal artery and plantar artery ring involving eachindex. Results:1、130patients with diabetic foot (DF) patients (250limbs,711lesions)and72patients with non-diabetic arteriosclerosis obliterans (ASO) patients(132limbs,262lesions) into the first part of the study.①DF limb singlesegment, double segment, multi-segment arterial involvement rate was49.20%,27.2%and23.6%, respectively, while the ASO limb were45.45%,33.33%and21.21%, two different sets of segmental arteries constitute twosets of single-segment lesions below-the-knee arteries involving rate than nostatistically significant difference(P>0.05), a statistically significant difference(P<0.05), two double segment disease shares of infrapopliteal arteryinvolvement rate a statistically significant difference (P <0.05), two sets ofmulti-segmental lesions femoropopliteal below-knee artery involvement wasno statistically significant difference (P>0.05).②DF limb femoral arterysegment and infrapopliteal arterial segments compared with iliac artery andpopliteal artery involving a high proportion compared statistically significantdifferences (P<0.05), the ASO limb femoral artery segment, and poplitealartery segment iliac artery and below-the-knee artery involving a highproportion of each group compared to a statistically significant difference(P<0.05).③DF13.60%of the limb iliacartery segment lesions,40.08%ofthe limb femoral artery segment lesions,26.80%of the limb popliteal arterysegment lesions, the ASO were34.09%,14.91%,37.88%, and the two groupsiliac, femoral, popliteal artery segment lesions involving both a significantdifference (P<0.05). From the two groups iliac, femoral, popliteal artery lesiondistribution on the statistics, there are also significant differences (P<0.05).④DF limb below the knee to artery lesions involving rate of95.20%, and bothhave significant differences (P<0.05) as compared with the the ASO limb28.79%infrapopliteal arterial lesions involving rate DF limb Total lesion711ASO limb lesions262the lesions two groups were70.74%and23.28%of thelesions artery in the knees, a significant difference (P<0.05).⑤in DF limb,involving below the knee arteries of503(70.74%), many of them involvingthe anterior tibial, posterior tibial artery, peroneal artery less involved, statistically significant differences (P<0.05).⑥≥2artery disease in twobelow-knee artery lesions, respectively31.58%and69.75%, statisticallysignificant differences (P<0.05).2、100cases only a unilateral below-knee artery disease in diabetic footpatients (100limbs) move on to the second part of the study. Below-kneeartery a diseased limb, below-knee limb arterial lesions2below-knee limbartery lesions3clinical symptoms (intermittent claudication, rest pain, footulcers or gangrene) ABI value and Biochemical indicators (TG, HDL, LDL,HCY, ACE, CRP) on the existence of a significant difference (P<0.05), countthe more, the more severe clinical symptoms, the lower the value of ABI, Themore blood lipids, vascular media involvement with the below-knee arteries,inflammation indicators deviate from the normal. Installments according toFontaine, plantar artery ring lesion incidence Phase III, Phase IV limbcompared with the phase II limb statistically significant difference (P<0.05).Conclusion:1Diabetic foot lower extremity arterial disease as the main performancemulti-plane arteriosclerosis obliterans, involving up the femoral artery andinfrapopliteal arteries.2Diabetic foot lower extremity arterial disease involving the theinfrapopliteal small artery, but not diabetic arteriosclerosis obliteranspredilection in the lower limbs, medium-sized arteries, such as the iliac artery,femoral artery and popliteal arteries, etc.3In the pathogenesis of diabetic foot lower extremity arterial tibialisanterior and posterior tibial artery involvement, the peroneal artery lessaffected.4Patients with diabetic foot below the knee artery artery disease multipleviolations of more than two.5Diabetic foot below the knee arterial lesions involving count the more,the more severe clinical symptoms, ABI lower, lipid metabolism disorders,abnormal vascular media heavier inflammatory response.6The lower limbs of diabetic foot a heavier clinical symptoms, the higher the incidence of plantar artery ring lesions.更多还原