Study On The Relationship Between Type 2 Diabetes Mellitus With Vascular Complications And Dorsal Transcutaneous Oxygen Pressure

Background and objective: Diabetic angiopathy is a major complication of diabetes mellitus,including microvascular and macrovascular disease.It is affected by many factors,the dorsalis pedis transcutaneous oxygen pressure as a direct response to the local microcirculation and oxygen supply conditions index,can indirectly reflect the body's microcirculation and blood vessel.This paper discusses the relationship between the dorsal transcutaneous oxygen measurement and diabetic vascular disease,to further expand the clinical application of transcutaneous oxygen tension detection,provide the basis for early diagnosis and treatment of diabetic angiopathy.Methods: Select a random sample of 159 cases of Type 2 diabetes come from The First Affiliated Hospital of Dalian Medical University for treatment from March 2015 to January 2016,92 cases of male?57.86%?,67 cases were female 42.14%)aged 23 to 87 years.According to the diabetic vascular complications,these cases were divided into 4groups: group A?without microvascular or macrovascular disease group?in 11 cases;group B?with simple macroangiopathy group?in 24 cases;group C?with simple microangiopathy group?in 21 cases;group D?associated with microvascular and macrovascular Lesion group?in 103 cases.Record the history data of all patients including: age,sex,duration of diabetes,smoking history,drinking history,history of hypertension,heart disease,cerebrovascular disease,diabetic retinopathy,diabetic nephropathy,and diabetic peripheral neuropathy mergers.Mesure the TcPO₂ values?dorsal foot on both sides ofthe baseline value,the decline in the value after limb elevation?and toe brachial ratio;detection of metabolism: glycosylated hemoglobin,fasting C peptide,total cholesterol,glycerin three greases,high density lipoprotein cholesterol,low density The degree of lipoprotein cholesterol.One-way ANOVA and chi square test were used to analyze the differences between the 4 groups.Use correlation and linear relation to analyse the relationship of all data in the elevation of the limb on the right side of the TcPO₂ decreased value with age,duration of diabetes,fasting C peptide,HbA1 c,TC,TG,HDL-C,LDL-C,right TcPO₂ baseline value,right TBI,right popliteal artery flow velocity,right femoral artery flow velocity,right foot dorsal artery velocity and all these artery IMT.Divide the basline value of TcPO₂ into two classes,as < 40 mmHg and ?40 mmHg,proceeding a binary logistic regression analysis between the right side TcPO₂ basline values with gender,age,duration of diabetes,fasting C peptide,HbA1 c,TC,TG,HDL-C,LDL-C,the right femoral artery flow velocity,right popliteal artery flow velocity,right dorsalis pedis artery flow velocity,all of these artery IMT,TBI,DN,DR,DPN,and PAD,etc;Divide the decling value of TcPO₂ into two categories,as < 10 mmHg and ?10 mmHg,proceeding a binary logistic regression analysis between the right side TcPO₂ decreased values and all the variables introduced abrove.Finally,using the receiver operating characteristic curve to evaluate the diagnostic and predictive value of TcPO₂ about the T2 DM combined chronic vascular complications.Results:1.The age,duration of diabetes,hypertension prevalence,smoking history have significant statistical significance?P?0.01?between the four groups;The gender composition ratio,heart disease,cerebrovascular disease prevalence,history of drinking,fasting C peptide,HbA1 c,TC,TG,HDL-C and LDL-C have no statistical difference.2.The left and right side of TBI was statistically different between the four groups?P< 0.05?;The baseline value of TcPO₂ on left and right side,the decling value of TcPO₂ on the left side when the limbs lifted and the left and right lateral femoral,popliteal,dorsalis pedis artery flow velocity have no difference.But the analysis between two of the four teams indicates that the right basline value of TcPO₂ in microvascular lesion group is higher than in concurrently have macrovascular and microvascular lesion group?P = 0.037?;The decling TcPO₂ values on right side when limbs lifted in the microvascular lesion group and concurrently have macrovascular and microvascular lesion group is larger than normal control group?P values 0.030,0.028 respectly?,the left TcPO₂ decling in value when lims lifted have no difference between the four groups.3.The correlation analysis showing that age,diabetes duration,the right side TBI and the right popliteal artery IMT are related to the right TcPO₂ baseline valuesthe;The right TcPO₂ decling in values when lims lifted are related to the age,fasting C peptide and the right side TBI;Line regression analysis showed that age and the right TBI had a significant effect both on the right TcPO₂ baseline and the right TcPO₂ decreased values after limb elevation?P < 0.05?.4.The binary logistic regression analysis of the decling value of the right TcPO₂ when limbs raised and right TcPO₂ baseline values shows that drinking history,TBI are independent influencing factores of TcPO₂ baseline values;fasting C-peptide,diabetic peripheral vascular disease?PAD?and the diabetic peripheral neuropathy?DPN?have remarkable effect on the decling values of TcPO₂?P < 0.05?,among which DPN is a risk factor,the rest are protective factors.5.The ROC curve analysis showes that the diagnose value of the basline TcPO₂ values to all the diabetic vascular complications is nosense;The diagnose and predictive value of the declined TcPO₂ when limbs lifted to diabetic peripheral arterial disease is no sense?P>0.05?,but it has significant value for the diagnosis of diabetic microvascular lesions?P < 0.05?,and when the decling value of TcPO₂ is 5.5mmhg,the specific and sensitivity are 75% and 48.6% respectively.Among microvascular disease,it has significant value for the judgment of DPN?P< 0.05?,and when the decling value of TcPO₂ takes 4.5mm Hg,the sensitivity and speciality rate of diagnose are 73.8% and38.5% respectively,meanwhile the judgment of DR and DN is meaningless?P > 0.05?.Conclusion:1.The TBI and age are associated with TcPO₂ in T2 DM patients;TBI is the independent influencing factor of TcPO₂ baseline value;DPN?PAD ?TBI are the factors influencing the decling TcPO₂ value when with limbs lifted.2.The TcPO₂ decling in the value after elevation of the limbs has higher sensitivity than the TcPO₂ values when supine position,it can effectivly respond local tissue microcirculation status,and its predictive value on diabetic peripheral neuropathy is most obvious.