The Assessment Of Color Doppler Ultrasound On Peripheral Artery Disease In Diabetic Patients

ObjectivePeripheral arterial disease is a common complication of diabetic patients.There are not evident clinical symptoms when the lesions are not serious.Once intermittent claudication ,resting pain or ischemic gangnene appears,the treatment will become difficult and most of these need trama treatment even amputation.Such trearments bring patients not only physical and mental pain,but heavy financial burden.Atherosclerotic vascular disease is probably present (at lest in a sub-clinical form) in all patients with diabetes of long duration. Peripheral arterial disease is characterized by a gradual reduction in blood flow to one or more limbs secondary to atherosclerosis.Therefore,it is necessary to detect the peripheral artery disease early in order to take early treatment.The study is to detect peripheral artery disease of diabetes early so that it can not develop into chronic foot ulcers and to find out the related factors to peripheral artery disease in diabetic patients.Material and Methods:Material: There were two groups included in this study, diabetes group andcontrol(health) group.The diabetes group was divided into two subgroups. The patients in the first subgroup were those type 2 diabetic with intermittent claudication or other much more serious arteiral disease,and the patients in the second subgroup were those type 2 diabetic without clinical symptoms of lower extremity vascular .Each group had sixty patients.The second subgroup were divided into old (≥60 years) and young (< 60 years) group. The control group was normal-glycemic subjects without history of smoking,diabetes mellitus, hypertensions, hyperlipidemic and ischemic heart disease,and it also had 60 patients.The study used single-blind method.People's age distribution,gender composition are comparable.Methods: GEVivid7pro type digital color Doppler system was used for ultrasoundscanning. Probe frequency is 4.0-11.0 MHz. Lower extremity arteries were divided into eight segments.common femorllis,superficial femoral,profunda femoris,posterior tibial,anterior tibial,peroneal and dorsalis pedis.Bilateral of artery segments of all subjects were detected.Using two-dimensional to image and measure the vessel diameter,the intima-media thickness(IMT),the arthersclerotic plaques thickness and the rate of vessel stenosis.Color flow imaging and pulsed Doppler were used to view the blood flow in the vessel,detected and recorded the pead systolic velocity(PSV),end diastolic velocity(EVD) of each arterial segment.Statistical analysis:Data were expressed as mean±SD. x~2 test was used to assess differences in stenosis rate of lower extremity arteries between old age group and young age group.The ANOVA was performed to assess differences of arterial diameter,wall thickness and stenosis rate among three group patients. The x~2 test was used to determine the arterial atherosclerosis and neuropathy cases between the first and second group.The statistical significance was accepted when the P value was<0.05.The SPSS 10.0 statistical package was used for all analysis.Results:1. The result of general materials:There were 108 men of 180 patients in this study.There were two groups.Diabetes group had 120 patients and control group had 60 patients.The patients age (mean±SD) were 56.5±12.6 years, 56.2 + 13.8 years.There were no significant differences in age and sex distribution among two group patients.Duration of dabetes mellitus was no significant differences between diabetes group(13.6±7.5years )and control group(14.1±7.8).2. Among patients in two subgroups and control group::(1) The diameter of common femoral,posterior tibial,anterior tibial.and dorsalis pedis had no significant difference in three group patients (ANOVA,P>0.05). The other segments of the first subgroup was increased than the second subgroup and control group (ANOVA,P>0.05).(2) The thickness of walls had significant difference among three group patients,rank as:the first subgroup>the second subgroup>the control group. (ANOVA,P<0.05).(3) The diameter reduction percentage in most of segments was the first group>the second group>the third group( ANOVA,P<0.05),excluded common femorallis,but these segments in the first subgroup and second subgroup>the control group(ANOVA,P<0.05)3. The second subgroup was divided into old and young groups . Compare the thickness of walls between old and young group.There was significance in the two groups and old group>young group(t test,P<0.05).The result shew that the longer duration of dabetes was,the more serious artery diseases were.4. The thickness of walls was dependent variable, and TGF-β1, TC, TG, apoA1, HDL was variables. Multiple stepwise regression analysis shew that TG was a significant determinant for thickness of walls.Conclusions:1. The duration of dabetes perhaps could impact the incidence of artery diseases in diabetes patients.2. The diabetes who did not show any clinical symptoms also had abnormal change of lower extremity arteries.So pay more attention to the early detections and treatments.3. The study has comfirmed that the diabetes group had much worse arterial disease than control group.The artery diameter ,thickness of walls and diameter reduction percentage of lower extremity artery in the diabetes group were more than control group.4. The thickness of walls was dependent variable, and TGF-β1, TC, TG, apoA1, HDL was variables. Multiple stepwise regression analysis shew that TG was a significant determinant for thickness of walls.5. Color Doppler ultrasound is noninvasive,reproducible and cost-effective procedure.It is a first choice instrumental examination for the diagnosis and staging of peripheral arterial occlusive disease in diabetic patients.