The Using Of Ankle-Brachial Index And High Risk Factors In Diabetic Lower Extremity Artery Disease

1 BACKGROUND & AIMDiabetic lower extremity artery disease is a key risk factor for diabetic foot disease. It is the leading cause of lower extremity amputation. Digital subtraction angiography (DSA) is the gold standard for diagnosing lower extremity artery disease. However, for the invasiveness and high cost of DSA, the application in clinical and epidemiological studies is limited. Ankle-brachial index (ABI), which is the ratio of ankle systolic blood pressure to brachial systolic blood pressure, is one of the methods for assessing diabetic lower extremity artery disease. The advantages of ABI are non-invasiveness, simplicity, cheapness and repetitiveness. The present, study utilized ABI to detect 40 diabetes, and compared the resuls with that examined by using color Doppler flow imaging of artery of lower extremity, aiming to confirm whether ABI can be used to effectively diagnose and evaluate lower extremity artery disease of diabetes, and find out the risk factors relevant.2 SUBJECTS & METHODS2.1 Subjects 40 type 2 diabetic inpatints from January 2008 to December 2009 were enrolled in the study. Among them,22 were male and 18 were female.2.2 methods:(1) All patients were examined in ABI and color Doppler flow imaging of artery of lower extremity.(2) The patients were divided into two groups according to ABI:abnormal ABI group (ABI≤0.9), normal ABI group (ABI>0.9)(3) Skin defects were defined according to Wagner. Wagner approach was used for the grading of foot diseases.(4) Details regarding sex, age, smoking, duration of diabetes, hypertension, cardiovascular and cerebrovascular events were obtained from patients' self-reports. The blood pressure was recorded by special messengers. A fasting blood sample was taken. Fasting plasma glucose (FPG), serum total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apoprotein A (apo-A), apoprotein B(apo-B), glycosylated hemoglobin A1c (HbA1c), creatinine (Cr), uric acid (UA), half-cysteine C (cys C) and hypersensitivity C reactive protein (hsCRP) were measured. A 2-h post glucose sample was collected, and then 2-h plasma glucose was measured. Semi-quantification of urine protein was done as well. All of the data were compared between these two groups.3 RESULTS(1) There were 24 patients whose ABI is not more than 0.9 in 40 patients (60%). There were 25 patients that were found patch or narrow of lower artery according to color Doppler flow imaging in 40 patients (62.5%). We found P=0.81 according to the test of x2, which revealed no significant difference of the sensitivity for detecting diabetic lower extremity artery disease using ABI and color Doppler flow imaging of artery. There are 22 cases (91.67%) suffering foot ulcer in the abnormal ABI group (n=24), while there are 7 cases (43.75%) in the other group (n=16). Compared to diabetic patients with normal ABI, those with abnormal ABI is easier to get foot ulcer (p<0.01).(2) Sex ratio, age, duration of diabetes, duration of hypertension, diastolic blood pressure, smoking and urine protein were not significantly different between two groups. Systolic blood pressure, cardiovasular and cerebrocascular events were statistically significant between two groups. Hypertension and smoking in the abnormal ABI group were higher than that of the other group.(3) Serum UA, Cr, TC, TG, HDL-c, LDL-c, apo-A, apo-B, cysC were not significantly different between two groups. There were statistical difference for FPG,2-h plasma glucose, HbAlc, hsCRP in these two groups.4 CONCLUSIONABI provides a window for effective diagnosis diabetic lower extremity artery disease in early stage. And it has correlation with foot ulcers. ABI is a simple, non-invasive, cheap and reproduciable way to assess lower extremity artery abnormality. Therefore, it shuld be used widely in clinical and epidemiological studies. The high risk factors for diabetic lower extremity artery disease are FPG,2-h plasma glucose, HbA1c, hsCRP, systolic blood pressure, cardiovascular and cerebrovascular events. Hypertension and smoking have correlation with diabetic lower extremity artery disease. It is helpful to prevent and heal diabetic lower extremity disease by interfering in these high risks, which in turn reduces the ptrvalencs of it and amputation.