| Objective: Color doppler ultrasound(CDU)was used to grade the degree of atherosclerosis in lower limb(LEAD)of type 2 diabetes mellitus(T2DM),to analyze the correlation between LEAD grading and cardiovascular and cerebrovascular diseases in T2 DM patients,and to explore the risk factors for the formation of arterial plaque in lower limb of T2 DM patients.Methods: A total of 6,000 patients with T2 DM who were hospitalized in the third affiliated hospital of anhui medical university from January 2010 to December 2016 in endocrinology were collected.Complete clinical data were selected and those who did not meet the standards were excluded.Finally,2824 patients with T2 DM were included in this study.Collected the clinical data of these patients,including gender,age,course of the disease,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),drinking,smoking and other general information;Family history of T2 DM,history of hypertension,history of coronary heart disease,history of cerebral infarction and other related medical history;alanine transaminase(ALT),creatinine(Cr),uric acid(UA),triglycerides(TG),total cholesterol(TC),low density lipoprotein-cholesterol(LDL-C),high density lipoprotein-cholesterol(HDL-C),white blood cells(WBC),glycosylated hemoglobin A1c(Hb A1c),fasting plasma glucose(FPG),fasting serum insulin(INS),7-point daily fingertip self-glucose monitoring,homeostasis model assistion-insulin resistance(HOMA-IR),standard deviation of blood glucose(SDBG)of 7 points in a day,and other laboratory indicators were calculated;Results of lower extremity artery CDU.According to the diagnostic criteria of coronary heart disease is divided into coronary heart disease group and no coronary heart disease group,according to the diagnostic criteria of cerebral infarction is divided into cerebral infarction group and no cerebral infarction group.The clinical data of T2 DM combined with cardio-cerebrovascular disease group were compared with that of the corresponding non-pathological group,and the differences between the T2 DM combined with cardio-cerebrovascular disease group and the non-pathological disease group were summarized.According to the lower limb CDU results,it was graded according to the degree of atherosclerosis,and logstic regression was used to study the correlation between LEAD grading and cerebral infarction and coronary heart disease in T2 DM patients,and to analyze the risk factors for the formation of lower limb arterial plaque in T2 DM patients.Results: 1.The comparison of clinical data between T2 DM patients with cerebral infarction group and those without cerebral infarction group indicated statistically significant differences in gender,age,family history of T2 DM,course of disease,SBP,ALT,Cr,UA,WBC,Hb A1 c and FBG between the two groups(p < 0.05),while the remaining indicators were not statistically significant.2.The comparison of clinical data between T2 DM patients with coronary heart disease group and those without coronary heart disease group in T2 DM patients indicated that there were statistically significant differences in gender,age,family history,course of disease,SBP,ALT,LDL-C and HOMA-IR between the two groups(p < 0.05),while the remaining indicators were not statistically significant.3.In T2 DM group with cerebral infarction,56.9% of LEAD 3-4 patients in T2 DM group were significantly higher than 28.0% in T2 DM group without cerebral infarction(p < 0.05).In the T2 DM group with coronary heart disease,52.1% of the LEAD 3-4 patients were significantly higher than 23.9% in T2 DM group without coronary heart disease(p< 0.05).4.The presence of cerebral infarction as the dependent variable,in order to LEAD classification as independent variables,after adjustment for gender,age,family history of T2 DM,course of diseases,SBP,ALT,Cr and UA,WBC,Hb A1 c,FBG variables,the results showed that LEAD in T2 DM patients in level 1,level 2,level 3 and level 4 OR values were 1.000,0.986,2.423,2.661,respectively.Compared with T2 DM patients without LEAD,the risk of cerebral infarction in T2 DM patients with grade 3(OR= 2.423)and grade 4(OR=2.661)was increased,and the difference was statistically significant(p < 0.05).5.The presence of coronary heart disease as dependent variable,in order to LEAD classification as independent variables,after adjustment for gender,age,family history of T2 DM,course of diseases,SBP,ALT,LDL-C,HOMA-IR variables,the results showed that LEAD in T2 DM patients in level 1,level 2,level 3 and level 4 OR values were 1.000,0.994,1.174,2.120,respectively.Compared with T2 DM patients without LEAD,the risk of cerebral infarction in T2 DM patients with grade 3(OR = 1.174)and grade 4(OR = 2.120)was increased,and the difference was statistically significant(p < 0.05).6.The incidence of arterial stenosis in lower extremities was higher than that of occlusion in T2 DM LEAD patients,and stenosis and occlusion most frequently involved the anterior tibial artery.7.Arterial plaque formation in lower limb of T2 DM patients was associated with age(OR=1.089,p=0.000),systolic blood pressure(OR=1.008,p=0.001),serum creatinine(OR=1.007,p=0.000),and LDL cholesterol(OR=1.157,p=0.003).Conclusion: 1.T2 DM patients with cardiovascular and cerebrovascular diseases often have severe LEAD.2.The higher the LEAD grade in T2 DM patients,the higher the risk of cerebral infarction and coronary heart disease will gradually increase when critical limb ischemia(CLI)occurs.3.The patients with T2 DM complicated with lower limb artery plaque,lower limb artery stenosis,lower limb artery occlusion,etc.Usually,the diseased vessels are distal arteries below the popliteal artery,and the anterior tibial artery is the most obvious.4.Age,SBP,Cr and LDL-C are related risk factors for arterial plaque formation in lower limb of T2 DM patients. |
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