Eiken Frederik L, Pedersen Brian L, Bækgaard Niels, Eiberg Jonas P
Department of Vascular Surgery, Rigshospitalet 3111, Copenhagen, Denmark.
Department of Vascular Surgery, Rigshospitalet 3111, Copenhagen, Denmark -
Int Angiol. 2019 Feb;38(1):62-69. doi: 10.23736/S0392-9590.18.04051-8.
Measurement of systolic ankle and to some extent toe pressure in patients suffering from combined type 2 diabetes mellitus (T2DM) and peripheral arterial disease (PAD) face several obstacles due to complex changes in the vascular bed. The aim of this review was to address the current literature on blood flow during exercise in patients with PAD and T2DM and assess the feasibility of these methods to diagnose and grade arterial insufficiency.
A systematic review of the PubMed and EMBASE databases, supplemented by hand searching was performed according to PRISMA guidelines. Clinical studies evaluating methods to investigate peripheral blood flow in patients with PAD and T2DM during exercise were included.
In total nine eligible studies consisting of 1105 non-diabetic PAD patients, 336 diabetic PAD patients, 161 diabetic patients without PAD and 69 healthy controls were included in the review. Near-infrared spectroscopy (NIRS) was described in three studies, transcutaneous oxygen pressure measurement (TcpO2) in two and the following methods described in single studies: thermodilution, contrast enhanced ultrasound (CEUS), scintigraphy and TcpO2 in combination with ultrasound. These studies shows that patients with PAD and T2DM compared with patients with only PAD suffers different atherosclerotic lesions characterised by increased arterial stiffness and microcirculation abnormalities, not well differentiated by pressure measurement alone. Investigating patients with PAD and T2DM during exercise reveals that NIRS, TcpO2, CEUS, and scintigraphy have distinct advantages over ankle and toe-pressure.
Using methods like NIRS, TcpO2, CEUS and scintigraphy, peripheral blood flow during exercise can be measured at a detailed level and potentially improve future severity grading in patients with combined T2DM and PAD.
对于患有2型糖尿病（T2DM）和外周动脉疾病（PAD）的患者，由于血管床的复杂变化，测量收缩期踝部压力以及在一定程度上测量趾部压力面临若干障碍。本综述的目的是阐述关于PAD和T2DM患者运动期间血流的当前文献，并评估这些方法用于诊断和分级动脉供血不足的可行性。
根据PRISMA指南，对PubMed和EMBASE数据库进行了系统综述，并辅以手工检索。纳入了评估在运动期间研究PAD和T2DM患者外周血流方法的临床研究。
本综述总共纳入了9项符合条件的研究，包括1105名非糖尿病PAD患者、336名糖尿病PAD患者、161名无PAD的糖尿病患者和69名健康对照。三项研究描述了近红外光谱法（NIRS），两项研究描述了经皮氧分压测量法（TcpO2），单项研究描述了以下方法：热稀释法、对比增强超声（CEUS）、闪烁扫描法以及TcpO2与超声联合使用。这些研究表明，与仅患有PAD的患者相比，患有PAD和T2DM的患者存在不同的动脉粥样硬化病变，其特征为动脉僵硬度增加和微循环异常，仅通过压力测量无法很好地区分。对运动期间的PAD和T2DM患者进行研究发现，NIRS、TcpO2、CEUS和闪烁扫描法相对于踝部和趾部压力测量具有明显优势。
使用NIRS、TcpO2、CEUS和闪烁扫描法等方法，可以详细测量运动期间的外周血流，并有可能改善未来对合并T2DM和PAD患者的严重程度分级。
