Motsumi M J, Naidoo N G
Vascular Surgery Unit, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
S Afr J Surg. 2017 Sep;55(3):48-54.
This study investigated the pattern and distribution of peripheral arterial disease in diabetic patients with critical limb ischaemia (CLI) and to stratify the findings according to the patients' risk factor profile, gender and age group.
We conducted a one-year prospective descriptive study (January 2014 to December 2014) at Groote Schuur Hospital, University of Cape Town. The research protocol and the informed consent were approved by the Institutional Review Board, and all subjects included in this study gave an informed consent. We included all diabetic patients over the age of 18 years with critical limb ischemia who had pre and post-intervention vascular imaging. The calculated minimum sample size was 63 limbs. We hypothesize that the proportions of arterial segment patency categories and the arterial foot arch status varies according to gender, age group and risk factor combinations in diabetic patients. The Null hypothesis (N0) assumes that the proportions of arterial segment patency categories and arch status are the same in diabetic patients irrespective of gender, age group and risk factor combination. The equality of distribution was analysed using the One Sample Chi-square test. Three risk factor combination groups were analysed: Group 1 (diabetes mellitus, hypertension, dyslipidemia), Group 2 (diabetes mellitus, hypertension, dyslipidemia, ex-smoker) and Group 3 (diabetes mellitus, hypertension, dyslipidemia, smoker).
Seventy-one patients were analysed (38 females and 33 males). We recorded the patency grades (ranging from normal to occlusion) of arteries in all 3 lower extremity arterial segments (aortoiliac; femoropopliteal and tibioperoneal segments). Altogether the patency grades of 820 lower extremity arteries were recorded. Diabetics, collectively, were found to have more severe occlusive disease in the tibioperoneal segment (P < .001). Group 3 patients however, had more severe occlusive disease in the femoropopliteal segment compared to the other subgroups (P < .001). Group 1 and Group 2 patients had more severe occlusive disease in the tibioperoneal segment (P < .001). Females were more likely to have complete foot arches (22/37; P = .004) while males tended to have more incomplete foot arches (17/32; P = .048).
Diabetic patients collectively have severe tibioperoneal occlusive disease. However, Group 3 patients tend to have disproportionately more occlusive disease in the femoropopliteal segment (P < .001). Diabetic female patients with CLI are more likely to have a complete arterial foot arch than males (P = .004).
本研究调查了患有严重肢体缺血（CLI）的糖尿病患者外周动脉疾病的模式和分布情况，并根据患者的风险因素概况、性别和年龄组对研究结果进行分层。
我们于2014年1月至2014年12月在开普敦大学格罗特舒尔医院进行了为期一年的前瞻性描述性研究。研究方案和知情同意书均获得机构审查委员会的批准，本研究纳入的所有受试者均签署了知情同意书。我们纳入了所有年龄在18岁以上、患有严重肢体缺血且有干预前后血管成像的糖尿病患者。计算得出的最小样本量为63条肢体。我们假设糖尿病患者动脉节段通畅类别和动脉足弓状态的比例会因性别、年龄组和风险因素组合而有所不同。零假设（N0）假定糖尿病患者动脉节段通畅类别和足弓状态的比例与性别、年龄组和风险因素组合无关。使用单样本卡方检验分析分布的均等性。分析了三个风险因素组合组：第1组（糖尿病、高血压、血脂异常）、第2组（糖尿病、高血压、血脂异常、既往吸烟者）和第3组（糖尿病、高血压、血脂异常、吸烟者）。
共分析了71例患者（38例女性和33例男性）。我们记录了所有3个下肢动脉节段（主-髂动脉；股-腘动脉和胫-腓动脉节段）动脉的通畅等级（从正常到闭塞）。总共记录了820条下肢动脉的通畅等级。总体而言，发现糖尿病患者在胫-腓动脉节段有更严重的闭塞性疾病（P <.001）。然而，与其他亚组相比，第3组患者在股-腘动脉节段有更严重的闭塞性疾病（P <.001）。第1组和第2组患者在胫-腓动脉节段有更严重的闭塞性疾病（P <.001）。女性更有可能拥有完整的足弓（22/37；P =.004），而男性往往有更多不完整的足弓（17/32；P =.048）。
总体而言，糖尿病患者有严重的胫-腓动脉闭塞性疾病。然而，第3组患者在股-腘动脉节段往往有不成比例的更多闭塞性疾病（P <.001）。患有CLI的糖尿病女性患者比男性更有可能拥有完整的动脉足弓（P =.004）。
