Sahli David, Eliasson Björn, Svensson Maria, Blohmé Göran, Eliasson Mats, Samuelsson Pär, Ojbrandt Kristina, Eriksson Jan W
Department of Medicine, Umeå University Hospital, Umeå, Sweden.
Angiology. 2004 Nov-Dec;55(6):641-51. doi: 10.1177/00033197040550i605.
The authors evaluated a screening program for lower extremity arterial disease (LEAD) in diabetic patients and focused on the value of toe blood pressure assessment. They recruited 437 subjects, ages 30-70 years (134 healthy controls, 166 type 1 and 137 type 2 diabetic patients; control [Ctr], DM1, and DM2) with no previous history of LEAD. They were enrolled in a longitudinal study with a planned follow-up of 10 years. Patients were consecutively enrolled from outpatient diabetes units of 2 university hospitals. Subjects were screened with respect to peripheral circulation by use of established noninvasive techniques. These included arm, ankle (AP), and toe (TP) blood pressure measurements; evaluation of peripheral neuropathy; and a standardized physical examination. Results from the baseline examination are presented in this report. The number of patients who presented peripheral pressures or indices below normal (< mean -2 SD for controls) was higher among diabetic patients; 24% of DM1 and 31% of DM2, as compared to 6% of Ctr, had at least 1 lower limb with a low TP, AP, toe/arm index (TI), or ankle/arm index (AI), and these subjects were mainly identified by using the toe/arm index. TI was independently and negatively associated with fasting blood glucose in both patient groups, and with smoking, age, and diabetes duration in DM1. The mean AP was higher in the DM1 and DM2 groups compared to Ctr, whereas overall TP, TI, and AI were similar in the groups. It was also shown that abnormally low TI was significantly more common than low AI among diabetics (p<0.001), and this was true for TP vs AP as well (p<0.05). It is beneficial to include assessment of toe blood pressure and toe/arm blood pressure index to detect early LEAD in diabetic patients. Ankle blood pressure and indices alone are less efficient, owing probably to medial sclerosis in diabetic patients. Up to 30% of diabetic patients with no ischemic symptoms may have signs of impaired arterial circulation.
作者评估了一项针对糖尿病患者下肢动脉疾病（LEAD）的筛查项目，并重点关注趾血压评估的价值。他们招募了437名年龄在30至70岁之间的受试者（134名健康对照者、166名1型糖尿病患者和137名2型糖尿病患者；分别为对照组[Ctr]、DM1组和DM2组），这些受试者既往无LEAD病史。他们参与了一项计划随访10年的纵向研究。患者连续从2所大学医院的门诊糖尿病科室招募。通过使用既定的非侵入性技术对受试者的外周循环进行筛查。这些技术包括测量手臂、脚踝（AP）和脚趾（TP）血压；评估外周神经病变；以及进行标准化体格检查。本报告展示了基线检查的结果。糖尿病患者中出现外周压力或指数低于正常水平（<对照组均值-2标准差）的患者数量更多；DM1组中有24%，DM2组中有31%的患者至少有一条下肢的TP、AP、趾/臂指数（TI）或踝/臂指数（AI）较低, 而对照组中这一比例为6%，这些受试者主要通过趾/臂指数识别出来。在两个患者组中，TI均与空腹血糖呈独立负相关，在DM1组中还与吸烟、年龄和糖尿病病程呈负相关。与对照组相比，DM1组和DM2组的平均AP更高，而各组的总体TP、TI和AI相似。研究还表明，糖尿病患者中TI异常低的情况比AI低更为常见（p<0.001），TP与AP相比也是如此（p<0.05）。评估趾血压和趾/臂血压指数有助于早期发现糖尿病患者的LEAD。仅测量踝血压和相关指数效率较低，这可能是由于糖尿病患者的血管中层硬化所致。高达30%无缺血症状的糖尿病患者可能存在动脉循环受损的迹象。
