多普勒超声与炎症指标诊断T2DM患者下肢血管病变的价值

doi:10.3760/cma.j.cn441417-20240829-08022

摘要/Abstract

摘要：

目的　探讨多普勒超声联合炎症指标诊断2型糖尿病（type 2 diabetes mellitus，T2DM）患者下肢血管病变的价值。方法　选取2019年1月至2024年1月延安市中医医院收治的T2DM合并下肢血管病变患者185例为观察组，选取同期T2DM无下肢血管病变患者50例为对照组。对照组男26例（52.00%），女24例（48.00%），年龄（65.24±3.64）岁，病程（8.53±1.64）年。观察组男102例（55.14%），女83例（44.86%），年龄（65.57±3.57）岁，病程（8.64±1.35）年。两组研究对象均接受多普勒超声检查。比较两组下肢血流动力学指标、下肢动脉粥样硬化斑块形成率、斑块发生位置及足背动脉狭窄情况。采集两组研究对象血液样本，检测血清生化指标及炎症指标水平。采用受试者操作特征曲线（ROC）对多普勒超声指标及炎症因子水平诊断T2DM患者下肢血管病变的价值进行分析。采用χ²检验、t检验进行统计分析。结果　观察组股动脉、腘动脉、足背动脉血流峰值流速均低于对照组［（120.88±0.95）cm/s比（135.15±0.88）cm/s、（71.93±0.45）cm/s比（79.65±0.31）cm/s、（33.64±1.11）cm/s比（42.42±1.35）cm/s］，差异均有统计学意义（t=95.679、114.122、47.300，均P<0.05）。观察组股动脉、腘动脉、足背动脉的搏动指数均高于对照组（5.56±1.22比4.59±1.12、6.31±1.12比5.54±1.23、8.21±1.14比7.52±1.05），差异均有统计学意义（t=5.073、4.223、3.860，均P<0.05）。对照组胫前动脉、胫后动脉、足背动脉、股动脉、腘动脉狭窄血管段数少于观察组，足背动脉狭窄程度低于观察组，差异均有统计学意义（χ²=44.023、165.489，均P<0.05）。观察组低密度脂蛋白胆固醇、糖化血红蛋白水平分别为（3.55±0.51）mmol/L、（8.78±1.12）%，均高于对照组的（2.78±0.47）mmol/L、（7.57±0.85）%，差异均有统计学意义（t=9.626、7.102，均P<0.05）。观察组血清白蛋白、25羟基维生素D3［25（OH）D］水平分别为（33.21±4.38）g/L、（19.37±3.65）μg/L，均低于对照组的（39.34±5.31）g/L、（25.12±4.38）μg/L，差异均有统计学意义（t=8.377、9.456，均P<0.05）。观察组血清白细胞介素-6（interleukin-6，IL-6）、肿瘤坏死因子α（tumor necrosis factor-α，TNFα）、C反应蛋白（C-reactive protein，CRP）、免疫球蛋白A（IgA）水平均高于对照组［（140.63±20.14）mg/L比（118.65±16.65）mg/L、（25.64±5.11）ng/L比（18.32±4.41）ng/L、（9.63±3.65）mg/L比（5.97±2.10）mg/L、（1.12±0.29）g/L比（0.55±0.20）g/L］，差异均有统计学意义（t=7.087、9.239、6.787、16.110，均P<0.05）。多普勒超声参数联合血清低密度脂蛋白胆固醇、白蛋白、糖化血红蛋白、25（OH）D、IL-6、TNFα、CRP、IgA诊断T2DM患者下肢血管病变的ROC下面积（AUC）为0.980，诊断价值最高，其灵敏度为99.50%，特异度为98.00%，约登指数为0.975。结论　多普勒超声检查联合炎症指标能够有效提高T2DM患者下肢血管病变的诊断准确性，有助于早期识别和干预高危患者，进而改善临床治疗策略和患者预后。

关键词:

2型糖尿病, 下肢血管病变, 多普勒超声, 炎症指标, 诊断价值

Abstract:

Objective　To explore the value of color Doppler ultrasound combined with inflammatory markers in the diagnosis of lower limb vascular lesions in patients with type 2 diabetes mellitus (T2DM). Methods　From January 2019 to January 2024, 185 patients with T2DM and lower limb vascular lesions treated at Yan'an City Traditional Chinese Medicine Hospital were selected as an observation group, and 50 T2DM patients without lower limb vascular lesions a control group. There were 26 males (52.00%) and 24 females (48.00%) in the control group; they were (65.24±3.64) years old; their disease course was (8.53±1.64) years. There were 102 males (55.14%) and 83 females (44.86%) in the observation group; they were (65.57±3.57) years old; their disease course was (8.64±1.35) years. Both groups underwent color Doppler ultrasound examination. The lower limb hemodynamic parameters, the rates of lower limber atherosclerotic plaque formation, plaque locations, and dorsalis pedis arterial stenosis were compared between the two groups. The blood samples from both groups were detected for serum biochemical and inflammatory marker levels. The diagnostic value of Doppler ultrasound parameters and levels of inflammatory markers for lower limb vascular lesions in the patients was assessed using the receiver operating characteristic curve (ROC). χ² and t tests were used for the statistical analysis. Results　The peak flow velocities of the femoral, popliteal, and dorsalis pedis arteries in the observation group were lower than those in the control group [(120.88±0.95) cm/s vs. (135.15±0.88) cm/s, (71.93±0.45) cm/s vs. (79.65±0.31) cm/s, and (33.64±1.11) cm/s vs. (42.42±1.35) cm/s], with statistical differences (t=95.679, 114.122, and 47.300; all P<0.05). The pulsatility indices of the femoral, popliteal, and dorsalis pedis arteries in the observation group were higher than those in the control group (5.56±1.22 vs. 4.59±1.12, 6.31±1.12 vs. 5.54±1.23, and 8.21±1.14 vs. 7.52±1.05), with statistical differences (t=5.073, 4.223, and 3.860; all P<0.05). The stenotic segments of anterior tibial artery, posterior tibial artery, dorsal artery of foot, femoral artery, and femoral artery in the control group was fewer than that in the observation group, and the stenotic degree of dorsal artery of foot was lower, with statistical differences (χ²=44.023 and 165.489; both P<0.05). The levels of low-density lipoprotein cholesterol and glycated hemoglobin in the observation group were higher than those in the control group [(3.55±0.51) mmol/L vs. (2.78±0.47) mmol/L and (8.78±1.12)% vs. (7.57±0.85)%], with statistical differences (t=9.626 and 7.102; both P<0.05). The serum levels of albumin and 25(OH)D in the observation group were lower than those in the control group [(33.21±4.38) g/L vs. (39.34±5.31) g/L and (19.37±3.65) μg/L vs. (25.12±4.38) μg/L], with statistical differences (t=8.377 and 9.456; both P<0.05). The serum levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNFα), C-reactive protein (CRP), and immunoglobulin (IgA) in the observation group were higher than those in the control group [(140.63±20.14) mg/L vs. (118.65±16.65) mg/L, (25.64±5.11) ng/L vs. (18.32±4.41) ng/L, (9.63±3.65) mg/L vs. (5.97±2.10) mg/L, and (1.12±0.29) g/L vs. (0.55±0.20) g/L], with statistical differences (t=7.087, 9.239, 6.787, and 16.110; all P<0.05). The area under the ROC (AUC) for the diagnosis of lower limb vascular lesions in the patients using color Doppler ultrasound parameters combined with serum levels of low-density lipoprotein cholesterol, albumin, glycated hemoglobin, 25(OH)D, IL-6, (TNFα), (CRP), and IgA was 0.980, with a sensitivity of 99.50%, a specificity of 98.00%, and a Youden index of 0.975. Conclusion　Color Doppler ultrasound combined with inflammatory markers can improve the diagnostic accuracy for lower limb vascular lesions in patients with T2DM, which helps in the early identification and intervention of high-risk patients, improving clinical treatment strategies and their outcomes.

Key words:

Type 2 diabetes mellitus, Lower limb vascular lesions, Doppler ultrasound, Inflammatory markers, Diagnostic value

刘雪妮惠容容　邓庆.

多普勒超声与炎症指标诊断T2DM患者下肢血管病变的价值 [J]. 国际医药卫生导报, 2025, 31(8): 1337-1342.

Liu Xueni, Hui Rongrong, Deng Qing.

Value of Doppler ultrasound and inflammatory markers in diagnosis of lower limb vascular lesions in patients with type 2 diabetes mellitus [J]. International Medicine and Health Guidance News, 2025, 31(8): 1337-1342.

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