本文選題：2型糖尿病　切入點(diǎn)：介入治療　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的糖尿病下肢血管病變是糖尿病常見(jiàn)的一種并發(fā)癥,現(xiàn)已成為糖尿病患者截肢的主要原因。臨床上干預(yù)措施主要包括內(nèi)科藥物、外科手術(shù)和導(dǎo)管介入等。介入治療現(xiàn)已在臨床上開(kāi)展,但介入后的療效尤其是遠(yuǎn)期效果仍存爭(zhēng)議。本研究旨在探討糖尿病下肢血管病變介入治療的效果及影響血管再狹窄的危險(xiǎn)因素,期以給予臨床指導(dǎo)。研究方法選取自2006年1月至2015年12月在齊魯醫(yī)院內(nèi)分泌科及血管外科住院的2型糖尿病下肢血管病變患者71例,采集患者的病歷資料并進(jìn)行隨訪,包括一般資料:性別,年齡,體重質(zhì)量指數(shù)(BMI),踝肱指數(shù)(ABI);病史:糖尿病病程,高血壓病程,腦梗塞病程,冠狀動(dòng)脈粥樣硬化病程,吸煙史;實(shí)驗(yàn)室指標(biāo):低密度脂蛋白,高密度脂蛋白,甘油三脂,總膽固醇,肌酐,尿素氮,尿酸,糖化血紅蛋白,尿微量白蛋白、C反應(yīng)蛋白、同型半胱氨酸等,召集患者來(lái)齊魯醫(yī)院行下肢動(dòng)靜脈超聲檢查,分析糖尿病下肢血管病變患者行介入治療后1年、2年、3年、5年、8年下肢血管通暢率,分析截肢率、全因死亡率,并探討影響患者行下肢血管介入治療后再狹窄的可能相關(guān)危險(xiǎn)因素。結(jié)果本研究共隨訪71例行下肢血管介入治療的糖尿病患者,隨訪時(shí)間最長(zhǎng)8年,最短1年,平均隨訪時(shí)間2.80年。其中失訪10例,失訪率為14.08%,最終納入該研究的為61例。其中男性41例,女性20例,男:女=2:1;平均年齡(68.11±8.88)歲,年齡最大84歲,最小49歲;年齡小于50歲的為3人,占4.90%;51-60歲的為12人,占19.700%;61-70歲的為21人,占34.40%;71-80歲的為21人,占34.40%;80歲以上的為4人,占6.60%。詳見(jiàn)表1,圖1。1.根據(jù)Fontaine分級(jí),Ⅰ級(jí)有10例,Ⅱ級(jí)有13例,Ⅲ級(jí)有18例,Ⅳ級(jí)有20例。各組資料行統(tǒng)計(jì)學(xué)分析顯示,年齡、性別、高血壓病程等未見(jiàn)明顯統(tǒng)計(jì)學(xué)差異(P0.05),吸煙史、FPG、LDL-C、CRP、尿Alb、Hcy之間差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。詳見(jiàn)表2。2.按泛大西洋協(xié)作組織(TASC)對(duì)下肢動(dòng)脈硬化病變程度分級(jí)方法,將61例糖尿病下肢血管病變患者為A、B、C、D四型。四組經(jīng)統(tǒng)計(jì)學(xué)分析顯示,年齡、性別構(gòu)成比相當(dāng),糖尿病病程、肌酐、尿素氮等代謝指標(biāo)組間無(wú)明顯差異(P0.05);四組間比較,吸煙史、LDL-C、CRP、尿Alb、Hcy之間有統(tǒng)計(jì)學(xué)差異(P0.05)。詳見(jiàn)圖2,圖3,表3。3.隨訪期間截肢共11人,男性7人,女性4人,截肢率為18.03%。按照TASC對(duì)糖尿病下肢血管病變患者進(jìn)行分組,在隨訪過(guò)程中A組患者截肢1例,B組患者截肢2例,C組患者截肢4例,D組患者截肢4例,分別占各組的4.34%,11.76%,36.36%,40.00%,經(jīng)統(tǒng)計(jì)學(xué)分析顯示A組與B組之間截肢率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),C組、D組與A組、B組之間截肢率差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。詳見(jiàn)表4,圖4。4.隨訪期間死亡共9例,全因死亡率為14.70%,男性5例,女性4例,其中因心肌梗死去世的有2例,因肺癌去世的有1例,因肺部感染去世的有1例,因多臟器功能衰竭去世的有1例,因過(guò)敏性休克搶救無(wú)效去世的有1例,不明原因去世的有3例。死亡病例中從實(shí)施介入后生存5年的有6例,占67.67%;生存5年以上的有3例,占33.33%。5.61例糖尿病下肢血管病變患者當(dāng)中,其中髂動(dòng)脈閉塞5例,占所有閉塞的8.20%;股總動(dòng)脈閉塞為8例,占13.11%;股深動(dòng)脈閉塞為13例,占21.31%;股淺動(dòng)脈閉塞為14例,占22.92%;乆動(dòng)脈閉塞為10例,占16.39%;脛前動(dòng)脈閉塞為5例,占8.20%;脛后動(dòng)脈閉塞為6例,占9.83%。隨訪一年原閉塞部位保持通暢的為30例,通暢率為49.18%;隨訪2年通暢的有22例,通暢率為36.07%;三年通暢的有21例,通暢率為34.43%;5年通暢的有11例,通暢率為18.03%;8年通暢的有6例,通暢率為9.83%。隨著介入時(shí)間的延長(zhǎng),血管發(fā)生再狹窄的概率增大。詳見(jiàn)圖5,圖6。6.根據(jù)患者行介入治療后1年是否發(fā)生再狹窄情況,分為再狹窄組(n=31),無(wú)狹窄組(n=30),對(duì)兩組患者年齡,性別,HbA1c,尿A1b,糖尿病病程,高血壓,吸煙史,腦梗,冠心病,血脂,Hcy,CRP行二元Logistic回歸分析,采用向前選擇法變量篩選方法,選入水準(zhǔn)為0.05,剔除水準(zhǔn)為0.10,分析顯示尿A1b、Hcy、CRP是影響介入術(shù)后發(fā)生再狹窄的獨(dú)立影響因素。詳見(jiàn)表5,表6,表7,表8。結(jié)論1.吸煙史,血糖,血脂等在一定程度上影響著糖尿病下肢血管病變的發(fā)生發(fā)展,糖尿病下肢血管病變?cè)街?CRP與Hcy水平越高。2.隨著介入治療時(shí)間的延長(zhǎng),下肢血管發(fā)生再狹窄的可能性增大,尿A1b、CRP、Hcy是血管發(fā)生再狹窄的獨(dú)立影響因素,減少尿A1b的排泄,維持CRP與Hcy的較低水平可以在一定程度上減少再狹窄,關(guān)于介入后發(fā)生再狹窄的具體機(jī)制還有待進(jìn)一步探索。3.介入治療能較好改善患者下肢血管閉塞情況,防止血管遠(yuǎn)期發(fā)生再狹窄將是臨床上的重中之重。
[Abstract]:Objective to study diabetic lower extremity arterial disease is a common complication of diabetes, has become the main reason for amputation in diabetes mellitus. Clinical interventions include medical, surgical and interventional. Interventional therapy is now in clinical development, but the effect after the intervention especially long-term effect is still controversial. And the effects of risk the purpose of this study is to investigate the vascular interventional treatment of diabetic lower extremity vascular disease factors of restenosis, to give clinical guidance. The research methods from January 2006 to December 2015 in 71 cases of type 2 diabetic patients with lower extremity vascular disease and vascular surgery in Department of endocrinology of Qilu Hospital, collecting medical records of the patients were followed up, including general information: gender, age and the body mass index (BMI), ankle brachial index (ABI); History: the duration of diabetes, hypertension, cerebral infarction, coronary disease. The course of atherosclerosis, smoking history; laboratory index: low density lipoprotein, high density lipoprotein, glycerin three fat, total cholesterol, creatinine, urea nitrogen, uric acid, glycosylated hemoglobin, urinary albumin, C reactive protein, homocysteine, called patients to Qilu Hospital of lower extremity venous ultrasonography of diabetic lower limb vascular patients with lesions of 1 years, after the intervention of 2 years, 3 years, 5 years, 8 years of lower extremity vascular patency rate analysis, amputation rate, all-cause mortality, and to explore the effect of patients with lower extremity vascular restenosis after interventional therapy may be related risk factors. The results of this study were followed up 71 cases of lower extremity vascular intervention in patients with diabetes mellitus for the longest follow-up period of 8 years, the shortest 1 years, the average follow-up time of 2.80 years. Among them 10 cases were lost, the lost rate was 14.08%, finally enrolled in this study were 61 cases. 41 patients were male, 20 were female, male: female =2:1; average 騫撮緞(68.11鹵8.88)宀，

本文編號(hào)：1597755