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Objective:To investigate the influence of T2DM Spleen-qi Deficiency syndrome on Ankle-Brachial Index (ABI).Methods:The clinical data of 298 patients with T2DM who were hospitalized in Dongzhimen Hospital, Beijing University of Chinese Medicine from January 2019 to December 2021 were retrospectively analyzed. According to the diagnostic criteria of spleen-qi deficiency syndrome, the patients were divided into two groups: spleen-qi deficiency syndrome group and non-spleen-qi deficiency syndrome group. There were 142 patients in the spleen-qi deficiency syndrome group and 156 patients in the non-spleen-qi deficiency syndrome group. The differences of ABI between the two groups were compared, and the correlation between spleen-qi deficiency syndrome and clinical indicators (gender, age, body mass index, course of diabetes, history of hypertension, smoking history, fasting glucose, total cholesterol, triglyceride, platelet, hemoglobin, serum albumin, blood urea nitrogen, serum creatinine, estimated glomerular filtration rate) and ABI in T2DM patients was analyzed.Results:The left ABI [1.09 (1.00, 1.19) vs. 1.13 (1.03, 1.22)] and the right ABI [1.09 (0.96, 1.17) vs. 1.12 (1.02, 1.20)] in T2DM spleen-qi deficiency syndrome group were significantly lower than those in non-spleen-qi deficiency group ( P<0.05).The left ABI was significantly correlated with spleen-qi deficiency syndrome ( r=0.122, P=0.035) and estimated glomerular filtration rate ( r=0.137, P=0.018), and the right ABI was significantly correlated with spleen-qi deficiency syndrome ( r=0.123, P=0.034) and PLT ( r=-0.115, P=0.047). After correcting for other confounding factors by multiple linear regression analysis, there was significantly correlation between spleen-qi deficiency syndrome and ABI. Conclusion:Compared with the non-spleen-qi deficiency syndrome group, T2DM patients in the spleen-qi deficiency group had a lower ankle-brachial index and were more likely to develop peripheral arterial disease.
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OBJECTIVE@#To investigate the clinical characteristics of lower extremity arterial disease (LEAD) and its risk factors in patients with diabetic foot ulcer (DFU).@*METHODS@#We retrospectively collected the clinical and follow-up data of 650 patients with DFU treated in the Department of Endocrinology and Metabolism of Nanfang Hospital between January, 2017 and December, 2019. We compared the data between patients who had LEAD and those without LEAD and used a multivariate logistic regression model to analyze the risk factors of LEAD in DFU patients.@*RESULTS@#Among the 650 DFU patients, 470 (72.4%) had LEAD. The patients were followed up for a mean of 3.5 months, and the mean healing time of DFU was 2.55 months; healing of DFU occurred in 453 patients and 183 patients received amputation. The patients with LEAD and those without LEAD differed significantly in age, hospitalization costs, diastolic blood pressure (DBP), glycated hemoglobin, blood lipid levels, disease course, ankle brachial index, healing time, smoking history, clinical outcomes, Wagner grade and imaging results (P < 0.05). Multivariate logistic regression analysis identified age (OR=1.070, 95% CI: 1.049-1.091), smoking history (OR= 2.013, 95% CI: 1.268-3.195), and a decreased DBP (OR=0.980, 95% CI: 0.963-0.997) as independent risk factors for LEAD in DFU patients. A prolonged healing time was a prominent clinical feature of DFU complicated by LEAD.@*CONCLUSION@#DFU patients have a high incidence of LEAD, which leads to high rates of disability and mortality and is associated with an advanced age, high smoking rate and longer healing time. A decreased DBP is also a risk factor for LEAD in DFU patients.
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Humans , Amputation, Surgical , Diabetes Mellitus , Diabetic Foot/epidemiology , Lower Extremity , Retrospective Studies , Risk FactorsABSTRACT
Objective:To observe the clinical effect of modified Huangqi Guizhi Wuwu Tang on patient with lower-extremity arterial disease (LEAD) with deficiency of Qi and Yin and blood stasis syndrome, and study the antioxidant mechanism. Method:One hundred and twenty-eight patients were randomly divided into control group (64 cases) and observation group (64 cases) by random number table. Patients in control group was treated for controlling blood sugar, blood pressure and blood fat, and got probucol in the morning and evening, 0.5 g/time, 2 times/days, aspirin enteric-coated tablets for 3 months, 100 mg·d-1, and alprostadil injection diluted with 10 mL normal saline for 15 days, 10 μg·d-1, 1 time/day. A course of the treatment in control group was 15 days, and there were 4 courses. In addition to the therapy of control group, patients in observation group were additionally given modified Huangqi Guizhi Wuwu Tang, 1 dose/day, for 3 months. Before and after treatment, ankle brachial index (ABI) and toe branch index (TBI) were detected, and internal diameter of dorsal artery of foot, peak velocity and blood flow were detected by color Doppler ultrasound. Main symptoms and sign were scored. And levels of interleukin-1 (IL-1), Homocysteine (Hcy), tumor necrosis factor-α (TNF-α), high sensitive C reactive protein (hs-CRP), cystatin C (CysC), malondialdehyde (MDA), superoxide dismutase (SOD) and oxidized low density lipoprotein (OX-LDL) were detected. Result:According to the rank test, clinical effect in observation group was better than that in control group (PPα, hs-CRP, Cys-C and Ox-LDL were lower than those in control group (PConclusion:Modified Huangqi Guizhi Wuwu Tang can relieve symptoms and signs, lower limb vascular function and hemodynamic, with certain anti-inflammatory effect and oxidative stress. It can also reduce vascular endothelial cell injury, and relieve and postpone the progress of LEAD
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Objective To investigate the relationship among retinol binding protein 4(RBP-4), 25-hydroxy vitamin D [25(OH)D]concerntrations and lower extremity arterial disease (LEAD)in type 2 diabetes mellitus (T2DM) patients. Methods A total of 197 T2DM patients and 80 healthy subjects were recruited in this study.The diabetic patients were assigned to group without complications (non-LEAD)and group complicated with LEAD (LEAD).Biochemical indications,serum RBP4 and 25(OH)D concentrations were measured. Results Serum RBP4 levels in LEAD group[(39.14 ± 2.14) μg/ml] increased as compared with that in group non-LEAD [(30.01 ± 2.09)μg/ml]and NC group [(14.09 ± 1.88)μg/ml](P<0.01).Serum 25(OH)D concentrations in LEAD group [(11.63 ± 6.83)ng/ml]were lower than that in Non-LEAD group [(18.02 ± 6.42)ng/ml]and NC group[(23.39 ± 4.68)ng/ml](P<0.05).Serum RBP-4 was positively associated with triglycerides (TG),low density lipoprotein cholesterol (LDL-C),homeostasis model assessment for insulin resistance (HOMA-IR),body mass index (BMI), waist-hip ratio (WHR)and negatively associated with 25(OH)D and high density lipoprotein cholesterol (HDL-C).Serum 25(OH)D had a negative correlation with RBP-4,HbA1c,fasting plasma glucose(FPG),HOMA-IR and duration.Logistic regression analysis showed that HDL-C and 25(OH)D were protective factors of LEAD. Conclusion Increased serum RBP-4 levels and reduced 25(OH)D concentrations are significantly associated with the occurrence of LEAD in patients with T 2DM.
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Objective:To evaluate the relationship between large artery elastic function and coronary heart disease (CHD) or lower extremity arterial disease (LEAD) in patients with carotid plaque.Methods:A total of 491 patients with carotid plaque were enrolled into the study with complete data of arterial stiffness detection and blood test [male:208 and female:283,and mean age:(61.66 11.60) years].All the subjects were divided into 2 groups according to CHD or LEAD,namely non-CHD&LEAD group (neither CHD nor LEAD) and CHD/LEAD group (either CHD or LEAD).According to the mean age level (age ＜61.66 years or age ＞61.66 years),the independent association was analyzed between higher large arterial stiffness (carotid-femoral pulse wave velocity,CF-PWV,CF-PWV ＞ 9 m/s) and CHD/LEAD.Results:In the present research population,the mean level of arterial stiffness was high (the mean CF-PWV was 10.71 m/s),and 76.6％ of them had arteriosclerosis,and 36.9％ CHD/LEAD.The age,male and smoking proportion,systolic blood pressure (SBP),glycosylated hemoglobin (HbA1c),homocysteine (Hcy),creatinine (Cr),CF-PWV,prevalence rate of hypertension and diabetes mellitus,medication on hypertension,diabetes and hyperlipidemia were higher in CHD/LEAD group,and total cholesterol (TC),high density lipoprotein cholesterol (HDL-C),and low density lipoprotein cholesterol (LDL-C) were lower in CHD/LEAD group than in non-CHD&LEAD group (all P ＜ 0.05).In multivariate Logistic regression analysis,the results showed that in the patients with age below 61.66 years,large artery stiffness (CF-PWV ＞ 9 m/s) was an independent risk factor of CHD/LEAD (OR =3.229,95％ CI 1.156-9.022,P ＜ 0.05);In the patients with age above 61.66 years,there was no independent association between large artery stiffness and CHD/LEAD (P ＞ 0.05).Conclusion:The large artery elasticity function in the patients with carotid plaque was poor.In the patients with carotid plaque and higher large artery stiffness below 61.66 years,the risk of the prevalence of CHD/LEAD was increased significantly than with normal arterial stiffness.In the patients with carotid plaque below or above 61.66 years,the independent influencing factors on the prevalence of CHD/LEAD were different.
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Objectives To explore the relationship between illness perceptions and health behavior in the subjects. Methods Revised illness perception questionnaire and health promoting lifestyle profileⅡ (HPLPⅡ) were used to measure 101 patients′illness perception and health behavior between the groups. Results The HPLPⅡscore of LEAD was(2.17 ± 0.29) with the score of dimension. The course of disease, prognosis and perception of emotion were negatively related to health behaviour; personal control and primaty congtion of drsease were postively related to health behaviour (all P<0.01). Conclusion Medical personnel should pay attention to the relationship between illness perceptions and health behavior in patients with LEAD and effective measures should be taken to improve the patients′illness perceptions, promote their choices and persistence in health behavior and improve the quality of life.
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[Objective] To investigate the clinical characteristics and risk factors of lower-extremity arterial disease in the patients with newly diagnosed type 2 diabetes mellitus combined with nonalcoholic fatty liver disease (NAFLD). [Methods] One hundred fifty-one patients were investigated respectively. The patients were divided into two groups (NAFLD-Group and non-NAFLD group) by liver ultrasonography and disease history, then their clinical data were collected and compared in order to find the differences of biochemical indicators and the morbidity of lower-extremity arterial disease between two groups. [Results] Ninety-two cases (60.93%) were complicated with NAFLD. NAFLD group had higher levels of fast insulin and C peptide level, postprandial insulin and C peptide level, uric acid, body mass index (BMI), homeostasis model assessment (HOMA-IR) and lower level of high-density lipoprotein cholesterol and insulin sensitive index than those of without NAFLD (P<0.05). One hundred and one cases(66.89%) were complicated with lower-extremity arterial disease. The morbidity of lower-extremity arterial diseases was higher in NAFLD group than that of without NAFLD group (75% vs. 54.24%, P<0.01). [Conclusion] Both lower-extremity arterial disease and NAFLD are common complicated with type 2 diabetes. The morbidity of lower-extremity arterial diseases was higher in NAFLD group than that of without NAFLD group.
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Objective To analyze the value of color Doppler ultrasound in the diagnosis of lower extremity arterial disease in patients with type 2 diabetes mellitus.Methods A total of 800 patients with type 2 diabetes mellitus underwent color Doppler ultrasonography to examine anterior tibial artery (ATA),dorsalis pedis artery (DPA) and posterior tibial artery (PTA).Ultrasonic findings including vascular diameter,stenosis ratio and hemodynamics of lower extremity arterial disease were analyzed retrospectively.Results ATA and DPA had more plaques and stenosis than PTA.There was no statistical difference of vascular diameter,stenosis ratio and hemodynamics between left and right lower extremity artery in patients with type 2 diabetes mellitus including diabetic foot.Conclusion Color Doppler ultrasound is a useful method in the diagnosis of lower extremity arterial disease in patients with type 2 diabetes mellitus,providing information of stenosis ratio and hemodynamics of lower extremity artery,so as contributing to the clinical therapy of this disease.
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Objective To prospectively evaluate the sensitivity and specificity of ankle brachial index (ABI) in the diagnosis of lower extremity arterial disease(LEAD)by using conventional digital subtraction angiography (DSA) as the reference standard, and to research the threshold value of ABI screening test for diagnosis. Methods A total of 383 consecutive patients (245 men and 138 women, mean age (64.1±11.7) years] underwent conventional DSA and ABI measurement. Receiver operator characteristics (ROC) analysis was performed to assess possible threshold values for predicting the LEAD in these patients. Results Conventional DSA was used as the gold standard in defining≥50% luminal stenosis for the diagnosis of LEAD. 0. 95 was the overall cutoff of ABI which was associatcd with 93.0% sensitivity, 85.0% specificity, 8.81 positive likelihood ratio(+LR) and 0. 23 negative likelihood ratio(-LR) for detection of hemodynamically significant stenosis (lesions>≥50%) in all 383 subjects (P<0.01). The area under the ROC curve was 0. 953(95%CI 0.920～0.985). Conclusions ABI measurement is an accurate and reliable non-invasive alternative to conventional DSA in the diagnosis of lower extremity arterial disease. And the cut-off 0.95 is the threshold ABI value for detecting LEAD in Chinese population.
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Objective To study the relationship between the levels of uric acid in type 2 diabetic patients aged over forty years and lower extremity arterial disease(LEAD).Methods Lower extremities of 212 patients with type 2 diabetes were detected by high resolution color Doppler ultrasonography,and the levels of uric acid,fasting blood glucose and serum lipid were examined,which were applied to anylaze the relationship with diversity process of lower extremity arterial disease.Results The uric acid,low-density lipoproteins cholesterol(LDL-C),body mass in- dex(BMI),age and course in lower extremity arterial disease group was significantly higher than those without LEAD group(P