The diagnostic value of ultrasound of lower extremity arterial disease in type 2 diabetic patients and analysis of related risk factors

doi:10.3877/cma.j.issn.2095-655X.2021.04.012

Abstract

Abstract:

Objective

To explore the diagnostic value of ultrasound and related risk factors of lower extremity arterial disease in patients with type 2 diabetes mellitus(T2DM).

Methods

From January 2019 to June 2020, 236 T2DM patients with suspected lower extremity arterial disease were selected from the Ultrasound Department of Pidu District People′s Hospital of Chengdu. All patients underwent ultrasound and digital subtraction angiography (DSA). According to the results of DSA, the patients were divided into the lower extremity arterial disease group (n=195) and non-lower extremity arterial disease group (n=41). The results of DSA were used as the gold standard to compare the ultrasound detection rates of patients with lower extremity arterial disease of different severity. Multivariate logistic regression was used to analyze the risk factors of the lower extremity arterial disease in T2DM patients.

Results

A total of 195 cases of 236 patients were diagnosed as lower extremity arterial disease by DSA. The ultrasonic detection rate of grade 1 stenosis was the lowest, only 75.38%(49/65), while grade 2 was 84.72%(61/72), grade 3 was 90.70%(39/43) and grade 4 was 100.00%(15/15). The difference of ultrasonic detection rate of different severity of lower extremity artery disease in T2DM patients was statistically significant (H=5.14, P<0.05). The results of univariate analysis showed that the age [(68.13±7.51)years, (62.07±6.80)years], duration of diabetes [(12.38±3.71) years, (10.17±2.85) years], creatinine levels [(102.17±20.09)μmol/L, (93.54±23.90)μmol/L], urea nitrogen levels [(7.72±2.03)mmol/L, (6.71±1.95)mmol/L], blood uric acid levels[(472.05±94.18 )μmol/L, (421.05±90.58)μmol/L], statins use rates [43.59%(85/195), 21.95%(9/41)], aspirin use rates [63.08%(123/195), 36.59%(15/41)], diabetic peripheral neuropathy rates [47.18%(92/195), 26.83%(11/41)], diabetic nephropathy rates [60.51%(118/195), 34.15%(14/41)] and hypertension [82.05%(160/195), 43.90%(18/41)] were compared between the lower extremity arterial disease group and the non-lower extremity arterial disease group, the differences were statistically significant (t=4.77, 3.60, 2.42, 2.92, 3.17, χ²=6.62, 9.29, 5.70, 9.55, 26.60, all P<0.05). The results of multivariate analysis on a single-factor basis showed that prolonged duration of diabetes (OR=1.435, 95%CI: 1.095-1.880), higher blood uric acid level (OR=1.467, 95%CI: 1.045-2.059), combining with diabetes peripheral neuropathy (OR=1.353, 95%CI: 1.024-1.787) and hypertension (OR=1.458, 95%CI: 1.134-1.874) were risk factors for lower extremity arterial disease in T2DM patients (all P<0.05).

Conclusions

The detection rates of lower extremity arterial lesions in T2DM patients of grade 2, 3 and 4 by ultrasonography are higher than that of grade 1 stenosis. T2DM patients with lower extremity arterial disease are mainly affected by the course of diabetes, serum uric acid level, hypertension and diabetic peripheral neuropathy.

Key words: Ultrasonography, Diabetes mellitus, type 2, Lower extremity arterial disease, Risk factors

Xia Li, Wei He, Xiaoling Sun, Shasha Zheng, Hongyi Chu, Xusheng Zhang. The diagnostic value of ultrasound of lower extremity arterial disease in type 2 diabetic patients and analysis of related risk factors[J]. Chinese Journal of Diagnostics(Electronic Edition), 2021, 09(04): 268-272.

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References 16

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严重程度分级	例数	检出(例)	未检出(例)	检出率(%)
1级	65	49	16	75.38
2级	72	61	11	84.72^a
3级	43	39	4	90.70^a
4级	15	15	0	100.00^a

严重程度分级	例数	检出(例)	未检出(例)	检出率(%)
1级	65	49	16	75.38
2级	72	61	11	84.72^a
3级	43	39	4	90.70^a
4级	15	15	0	100.00^a

项目		下肢动脉病变组(n＝195)	无下肢动脉病变组(n＝41)	统计量	P值
性别(例，%)				χ²＝0.15	0.702
	男	84(43.08)	19(46.34)
	女	111(56.92)	22(53.66)
年龄(岁，±s)		68.13±7.51	62.07±6.80	t＝4.77	0.000
糖尿病病程(年，±s)		12.38±3.71	10.17±2.85	t＝3.60	0.000
吸烟史(例，%)				χ²＝0.17	0.682
	无	144(73.85)	29(70.73)
	有	51(26.15)	12(29.27)
BMI(kg/m²，±s)		24.81±4.29	25.09±4.51	t＝-0.38	0.707
LDL-C(mmol/L，±s)		2.75±0.84	2.80±0.79	t＝-0.35	0.727
HDL-C(mmol/L，±s)		1.13±0.25	1.15±0.31	t＝-0.45	0.656
甘油三酯(mmol/L，±s)		4.61±1.39	4.66±1.33	t＝-0.21	0.833
总胆固醇(mmol/L，±s)		1.47±0.39	1.52±0.34	t＝-0.76	0.223
肌酐(μmol/L，±s)		102.17±20.09	93.54±23.90	t＝2.42	0.016
尿素氮(mmol/L，±s)		7.72±2.03	6.71±1.95	t＝2.92	0.004
血尿酸(μmol/L，±s)		472.05±94.18	421.05±90.58	t＝3.17	0.002
空腹血糖(mmol/L，±s)		8.52±2.61	8.35±2.37	t＝0.39	0.701
糖化血红蛋白(%，±s)		8.51±2.09	8.62±2.11	t＝-0.28	0.781
药物使用(例，%)
	他汀类	85(43.59)	9(21.95)	χ²＝6.62	0.010
	阿司匹林	123(63.08)	15(36.59)	χ²＝9.29	0.002
合并疾病(例，%)
	糖尿病视网膜病变(例，%)	82(42.05)	21(51.22)	χ²＝1.16	0.282
	糖尿病周围神经病变(例，%)	92(47.18)	11(26.83)	χ²＝5.70	0.017
	糖尿病肾病(例，%)	118(60.51)	14(34.15)	χ²＝9.55	0.002
	原发性高血压病(例，%)	160(82.05)	18(43.90)	χ²＝26.60	0.000

项目		下肢动脉病变组(n＝195)	无下肢动脉病变组(n＝41)	统计量	P值
性别(例，%)				χ²＝0.15	0.702
	男	84(43.08)	19(46.34)
	女	111(56.92)	22(53.66)
年龄(岁，±s)		68.13±7.51	62.07±6.80	t＝4.77	0.000
糖尿病病程(年，±s)		12.38±3.71	10.17±2.85	t＝3.60	0.000
吸烟史(例，%)				χ²＝0.17	0.682
	无	144(73.85)	29(70.73)
	有	51(26.15)	12(29.27)
BMI(kg/m²，±s)		24.81±4.29	25.09±4.51	t＝-0.38	0.707
LDL-C(mmol/L，±s)		2.75±0.84	2.80±0.79	t＝-0.35	0.727
HDL-C(mmol/L，±s)		1.13±0.25	1.15±0.31	t＝-0.45	0.656
甘油三酯(mmol/L，±s)		4.61±1.39	4.66±1.33	t＝-0.21	0.833
总胆固醇(mmol/L，±s)		1.47±0.39	1.52±0.34	t＝-0.76	0.223
肌酐(μmol/L，±s)		102.17±20.09	93.54±23.90	t＝2.42	0.016
尿素氮(mmol/L，±s)		7.72±2.03	6.71±1.95	t＝2.92	0.004
血尿酸(μmol/L，±s)		472.05±94.18	421.05±90.58	t＝3.17	0.002
空腹血糖(mmol/L，±s)		8.52±2.61	8.35±2.37	t＝0.39	0.701
糖化血红蛋白(%，±s)		8.51±2.09	8.62±2.11	t＝-0.28	0.781
药物使用(例，%)
	他汀类	85(43.59)	9(21.95)	χ²＝6.62	0.010
	阿司匹林	123(63.08)	15(36.59)	χ²＝9.29	0.002
合并疾病(例，%)
	糖尿病视网膜病变(例，%)	82(42.05)	21(51.22)	χ²＝1.16	0.282
	糖尿病周围神经病变(例，%)	92(47.18)	11(26.83)	χ²＝5.70	0.017
	糖尿病肾病(例，%)	118(60.51)	14(34.15)	χ²＝9.55	0.002
	原发性高血压病(例，%)	160(82.05)	18(43.90)	χ²＝26.60	0.000

变量	B	SE	Wald χ ²值	P值	OR值	OR值95%CI
变量	B	SE	Wald χ ²值	P值	OR值	下限	上限
年龄	0.295	0.159	3.442	0.059	1.343	0.983	1.834
糖尿病病程	0.361	0.138	6.843	0.011	1.435	1.095	1.880
肌酐	0.277	0.179	2.395	0.104	1.319	0.929	1.874
尿素氮	0.293	0.162	3.271	0.063	1.340	0.976	1.841
血尿酸	0.383	0.173	4.901	0.041	1.467	1.045	2.059
使用他汀类药物	-0.278	0.155	3.217	0.065	0.757	0.559	1.026
使用阿司匹林	-0.339	0.175	3.753	0.060	0.712	0.506	1.004
合并糖尿病周围神经病变	0.302	0.142	4.523	0.045	1.353	1.024	1.787
合并糖尿病肾病	0.287	0.182	2.487	0.091	1.332	0.933	1.904
合并高血压病	0.377	0.128	8.675	0.000	1.458	1.134	1.874

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