Relationship Study On Ankle Brachial Index Of Type2Diabetesmellitus Lower Extremityarterial Disease And C-reactive Protein

Diabetes mellitus (diabetes mellitus,DM) Is a set is characterized by chronicincreased blood glucose levels of metabolic disease, and its pathogenetic basis isinsulin resistance and insulin secretion defect. And Type2Diabetesmellitus (T2DM)is the major type which threatens human health, accounting for about95%of alldiabetics. With the increase of people’s living standard, DM has become a worldwidedisease with the incidence ranking the second in the world. Globally, the prevalenceof diabetes increased rapidly, a growing trend, our country also has more than40million people with diabetes, with the continued increase of diabetes patients, appearall sorts of chronic complications also gradually increased, diabetes people lower limbgangrene and amputation is20times higher compared with non-diabetic population.Diabetic lower extremity arterial lesions (lower extremityarterial diseases, LEAD)also known as peripheral vascular disease, peripheral arterial diseases, PAD), theprevalence of atherosclerosis is higher, increasingly younger onset, rapid progression.Mainly affects coronary and cerebral arteries, limb peripheral artery, etc., especially inclinically found that people with diabetes develop more severe lower extremityarterial pathological changes, if delay the best treatment time or handling can causeimproper methods for rapid progression, and increase the treatment difficulty, andaffect the labor capacity and living standard of diabetics. The influence factors ofdiabetes macroangiopathy include age, duration of diabetes, blood pressure, blood fat,the average of glucose, etc. The clinical study on this disease is of great clinicalsignificance on control enhancement, early diagnosis,effective intervention, prognosisimprovement, Prevent become diabetic lower extremity arterial vascular lesions, hasvery important clinical significance.Diabetic lower extremity arterial lesions as important components of the metabolic syndrome, atherosclerosis known the main susceptible factors such asobesity, high blood pressure, lipid metabolism abnormality was significantly higher inT2DM group, such as, for the further development can lead to lower limb ulcer, theinfection and (or) deep tissue destruction. So early detection and prevention in time,will reduce treatment difficulty, reduce the probability of lower limbamputation.Ankle brachial index (ABI) is the specific value of the systolic pressure ofarteria malleolaris (arteria tibialis posterior or dorsal artery of foot) and brachial artery.Its sensibility comes to95%while specificity approaches100%. ABI is one of theclinical detection methods of LEAD, it has the advantages of noninvasiveness,objectiveness, simple operation, low price, etc., and through the detection of ABI, it isavailable to clarify whether T2DM patient suffers LEAD simultaneously, which is ofgreat significance for the preliminary screening of LEAD and the judging of lesiongrade, progressive disease and prognosis. The development of LEAD is very complex,and it is generally thought of the result of synergistic effect of multi-factor. C-reactiveprotein (CRP) is a kind of acute phase proteins produced by liver after the injury orstimulation of human body and is the main mark of intrinsic system inflammationwhich may boost the development of arteriosclerosis, has been the regular detectionitem of most hospitals and taken as auxiliary judge basis of LEAD. Therefore, thestudy takes ABI as the diadynamic criteria of PAD, elaborates the role of CRP changeon the development of PAD and the relationship with CRP, and provides theoreticalbasis and direction for clinical treatment, which is of great significance for theall-round understanding of DM and LEAD.Method: Select74T2DM cases (38male cases and36female cases) at will fromthe section for outpatients or wards of endocrinology department of the hospitalduring March2011to December2012to carry out ABI detection, these cases shallconform to1999DM Diagnosis and Parting Standard of WHO, and part these T2DMpatients into T2DM Group (NPAD Group) and T2DM&PAD Group. Among thesepatients,38are divided into NPAD Group (Group B), including21males and17females with the average age of (63.3+7.6) years old and the disease course of (5.52±4.38) years, and36are divided into PAD Group (Group C), including17malesand19females with average age of (60.6+7.7) years old and the disease course of(9.54±5.05) years. Health Control Group (Group A): select32healthy persons whotook physical examination in the hospital during the same period, including18malesand14females with the average age of (58.5+5.4) years old. All staff who took thetest on body weight, height, blood pressure, pulse pressure, body mass index (BMI=Kg/m2) is measured and calculated.They shall keep empty stomachs for8-12h fromthe previous night for biochemical detection, and measuring fasting blood-glucose(FBG), postprandial blood glucose2h (PBG2h), hemoglobin A1C (HbA1c), totalcholesterol (TC)，triglyceride (TG), high density lipoprotein cholesterol (HDL-C) andlow density lipoprotein cholesterol (LDL-C); and CRP shall be detected byimmunoturbidimetry. Homeostasis model assessment is adopted to computehomeostasis model assessment of insulin resistance (HOMA-IR)=FPG (mmol/L)×FINS (mU/L)/22.5. All data using statistical software SPSS14.0analysis,measurement data with average standard deviation of plus or minus (x+s) said, usingt test, two variables, a simple linear correlation analysis (Pearson correlation).(P <0.05) is statistically significant.Results: during the statistics and analysis of clinical data:(1) general datacomparison of Group B and C: BMI and diastolic blood pressure (DBP) are not ofstatistics significance (P＞0.05); and age, disease course, systolic blood pressure(SBP), and pulse pressure difference are all of statistics significance (P＜0.05).(2)biochemical data comparison of Group B and C: TC and HDL-C are not of statisticssignificance (P>0.05); and TG, LDL-C, FBG, PBG2h,HbA1c, HOMA-IR, and CRPare all of statistics significance (P＜0.05、P<0.01).(3) CRP comparison of Group A, Band C: comparing with Group A, the CRP level of Group C rises obviously (P<0.01)and that of Group B and C rise dramatically (P＜0.05); comparing with Group B, theCRP level of Group C rises dramatically; and the two groups are of statisticssignificance (P＜0.05).(4) relationship of CRP and ABI of Group B and C: whencarrying out the simple linear correlation analysis of CRP and ABI of Group B, the CRP and ABI show negative relationship (r=－0.345，P＜0.05); and when carryingout that of Group C, the CRP and ABI show conspicuous negative relationship (r=-0.434，P<0.01).Conclusions:(1) ABI may be taken as an important detection index of LEAD.(2) thelevel of c-reactive protein change is an important risk factors of PAD, PAD andseverity are closely related.(3) ABI and CRP are related to cardiovascular diseases,and their joint detection has higher practical value.