踝以下动脉疾病：糖尿病合并足部溃疡患者的冠状动脉疾病的新标志物。
Below-the-ankle arterial disease: a new marker of coronary artery disease in patients with diabetes and foot ulcers.
机构信息
Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy.
出版信息
Acta Diabetol. 2022 Oct;59(10):1331-1338. doi: 10.1007/s00592-022-01932-w. Epub 2022 Jul 21.
AIM
The aim of the current study is to evaluate the association between below-the-ankle (BTA) arterial disease and coronary artery disease (CAD) in patients with diabetic foot ulcers (DFUs).
METHODS
The study group was composed of patients with an active neuro-ischaemic DFUs managed in a tertiary care diabetic foot clinic. All patients received a pre-set limb salvage protocol including lower limb revascularization. By a retrospective analysis of individual angiograms, patients were divided in two groups: below-the-ankle (BTA) and above-the-ankle (ATA) arterial disease groups. The rate of CAD at baseline assessment and the new events of acute myocardial ischaemia (AMI) during 1-year of follow-up were evaluated and compared between the two groups.
RESULTS
Two hundreds seventy-two (272) patients were included, 120 (44.1%) showed BTA arterial disease while 152 (55.9%) ATA arterial disease. The mean age was 68.9 ± 9.6 years, 198 (72.8%) were male, 246 (90.4%) had type 2 diabetes, the mean diabetes duration was 20.7 ± 11.6 years, the mean HbA1c was 7.8 ± 4.2% (62 ± 22 mmmol/mol). The whole population reported CAD in 172 cases (63.4%), and the rate in the BTA group was significantly higher than in ATA group, respectively, 90 (75.4%) vs 82 (54.1%), p < 0.0001. During the follow-up, BTA group had 5% of new cases of AMI in comparison to 1.3% in ATA group (p < 0.001). At the multivariate analysis BTA resulted an independent marker of CAD [OR 1.9 CI 9 5% (1.3-4.5) p = 0.0001].
CONCLUSION
The current study shows a significant association between BTA arterial disease and CAD. A close cardiovascular screen should be required in patients with DFUs.
目的
本研究旨在评估糖尿病足溃疡（DFU）患者踝下动脉（BTA）疾病与冠状动脉疾病（CAD）之间的关联。
方法
研究组由在三级保健糖尿病足诊所接受治疗的活动神经缺血性 DFU 患者组成。所有患者均接受下肢血运重建的预设肢体挽救方案。通过对个体血管造影的回顾性分析，将患者分为踝下（BTA）和踝上（ATA）动脉疾病两组。评估并比较两组患者在基线评估时 CAD 的发生率和 1 年随访期间新发急性心肌缺血（AMI）事件的发生率。
结果
共纳入 272 例患者，120 例（44.1%）存在 BTA 动脉疾病，152 例（55.9%）存在 ATA 动脉疾病。平均年龄为 68.9±9.6 岁，198 例（72.8%）为男性，246 例（90.4%）为 2 型糖尿病患者，糖尿病病程平均为 20.7±11.6 年，平均 HbA1c 为 7.8±4.2%（62±22 mmmol/mol）。所有患者中共有 172 例（63.4%）报告存在 CAD，BTA 组的发生率明显高于 ATA 组，分别为 90 例（75.4%）和 82 例（54.1%），p<0.0001。在随访期间，BTA 组新发 AMI 病例占 5%，而 ATA 组占 1.3%（p<0.001）。多变量分析显示，BTA 是 CAD 的独立标志物[比值比 1.9，95%可信区间（1.3-4.5），p=0.0001]。
结论
本研究表明，BTA 动脉疾病与 CAD 之间存在显著关联。DFU 患者应进行密切的心血管筛查。
Zotero 插件