上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

重症肢体缺血的缺血性溃疡患者足部动脉弓病变的影响因素分析

谢 辉，叶 猛，陈佳佺，吕 磊，袁 凯，张纪蔚，张 岚   

  1. 上海交通大学  医学院附属仁济医院血管外科， 上海 200127
  • 出版日期:2014-10-28 发布日期:2014-10-28
  • 通讯作者: 张 岚, 电子信箱: lucky200207@aliyun.com。
  • 作者简介:谢 辉（1981—）， 男， 主治医师， 学士; 电子信箱: xiehui0002068@163.com。

Analysis of influencing factors of pathological changes of pedal arch for critical limb ischemia patients with ischemic ulcers

XIE Hui, YE Meng, CHEN Jia-quan, LÜ Lei, YUAN Kai, ZHANG Ji-wei, ZHANG Lan   

  1. Department of Vascular Surgery， Renji Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200127, China
  • Online:2014-10-28 Published:2014-10-28

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摘要：

目的 分析影响重症肢体缺血（CLI）的缺血性溃疡患者足部动脉弓病变的因素。方法 对152例CLI缺血性溃疡患者的临床资料进行回顾性研究，记录患者的年龄、性别、吸烟史、高血压病史、糖尿病病程、体质量以及血液生化指标等。根据足部动脉弓造影结果将患者分为2组：足部动脉弓良好组（n=37）和足部动脉弓不良组（n=115）。采用单因素和多因素Logistic 回归模型分析影响足部动脉弓病变的因素。结果 足部动脉弓不良组的空腹血糖（FBG）浓度和平均血小板体积（MPV）均显著高于足部动脉弓良好组（P<0.05，P<0.01）。足部动脉弓不良组患者中糖尿病病程≥10年者所占比例显著高于足部动脉弓良好组（P<0.001）。Logistic回归分析发现FBG、MPV、糖尿病病程≥10年是足部动脉弓不良的独立危险因素（P<0.05）。根据受试者工作特征(ROC)曲线获得FBG预测足部动脉弓不良的最佳临界值为6.60 mmol/L，曲线下面积为0.805（P<0.05）。MPV的最佳临界值为11.70 fl，曲线下面积为0.907（P<0.05）。再分别以FBG、MPV临界点以及糖尿病病程≥10年为条件，将患者分为2组，Logistic回归分析结果显示FBG浓度≥6.60 mmol/L、MPV≥11.70 fl和糖尿病病程≥10年患者发生足部动脉弓不良的危险度分别是FBG浓度＜6.60 mmol/L、MPV＜11.70 fl和糖尿病病程＜10年患者的8.684倍（95%CI=3.496～21.571，P<0.05）、12.737倍（95%CI=5.358～30.232，P<0.05）和7.75倍（95%CI=2.996～20.048，P<0.05）。结论 FBG浓度升高、MPV增大、糖尿病病程≥10年分别是预测CLI缺血性溃疡患者足部动脉弓不良的独立危险因素。

关键词: 重症肢体缺血, 缺血性溃疡, 足部动脉弓, 糖尿病, 空腹血糖, 平均血小板体积

Abstract:

Objective To analyze the factors that influence pathological changes of pedal arch for patients with critical limb ischemia (CLI) who suffer from ischemic ulcers. Methods The clinical data of 152 CLI patients with ischemic ulcers were retrospectively analyzed. The age, sex, smoking history, hypertension history, course of diabetes, body mass, and blood biochemical indexes were recorded. According to angiography results of the pedal arch, patients were divided into two groups, i.e. the good pedal arch group (n=37) and poor pedal arch group (n=115). The factors that influenced pathological changes of pedal arch were analyzed by single variate and multi-variate Logistic regression models. Results The fasting blood glucose (FBG) and mean platelet volume (MPV) of the poor pedal arch group were significantly higher than those of the good pedal arch group (P<0.05, P<0.01). The number of patients of the poor pedal arch group who suffered from diabetes for more than 10 years was far more than that of the good pedal arch group (P<0.001). The Logistic regression analysis showed that FBG, MPV, and diabetes history ≥10 years were independent risk factors of poor pedal arch (P<0.05). The receiver operating characteristic (ROC) curve indicated that the best cut-off value and the area under the ROC curve of FBG for predicting poor pedal arch were 6.60 mmol/L and 0.805 (P<0.05). The best cut-off value and the area under the ROC curve of MPV were 11.70 fl and 0.907 (P<0.05). Patients were divided into two groups based on cut-off points of FBG and MPV and diabetes duration ≥10 years. The results of Logistic regression analysis showed that the risk of incidence of poor pedal arch for patients with FBG≥6.60 mmol/L, MPV≥11.70 fl, and diabetes duration≥10 years was 8.684 times higher than that of patients with FBG<6.60 mmol/L (95%CI=3.496-21.571, P<0.05), 12.737 times higher than that of patients with MPV＜11.70 fl (95%CI=5.358-30.232, P<0.05), and 7.75 times higher than that of patients with diabetes duration<10 years (95%CI=2.996-20.048, P<0.05). Conclusion Increased FBG and MPV, and diabetes duration ≥10 years are independent risk factors of predicting poor pedal arch for CLI patients with ischemic ulcers.

Key words: critical limb ischemia, ischemic ulcer, pedal arch, diabetes, fasting blood glucose, mean platelet volume