·糖尿病足病·

　　畅坚 许樟荣 张磊 王玉珍 杨丽娜

　　作者单位：100101北京，解放军第306医院放射科(畅坚、张磊、杨丽娜)，糖尿病中心(许樟荣、王玉珍)

　　【摘要】目的分析足踝部血管网(APVN)与DF溃疡/坏死的关系及对DF截肢率和截肢类型的影响。方法对89例T2DM患者共146侧患肢行动脉数字减影血管造影(DSA)检查。在DSA动态影像下观察APVN显影状况和血流方向，根据参与侧支组合的APVN数目，分为无侧支组(0N)、1组侧支组(1N)、2组侧支组(2N)、3组侧支组(3N)，统计各组DF溃疡/坏死的发生率;将未给予外科或介入治疗干预的132侧患肢，按参与侧支的血管网数目≤1或≥2分为A、B两组，统计两组截肢率和大、小截肢率。结果0N、1N、2N、3N各组DF溃疡/坏死发病率分别为83.9%、89.4%、60.5%、8.0%，除0N和1N无组间差异外，其余各组间均存在统计学差异(P<0.05或P<0.01);A、B两组截肢率分别为63.8%和30.2%(P<0.01，OR=4.076，95%CI 1.967~8.443)，大截肢率分别为68.2%和26.3%(P<0.01，OR=6.000, 95%CI 1.967~8.443)。结论APVN侧支组合数目的多少可影响DF溃疡/坏死的发病率，当3组APVN均参与侧支形成时，DF溃疡/坏死的发病率可明显降低;较少的APVN参与侧支循环是与DF截肢率和大截肢率关联较强的危险因素。

　　【关键词】血管造影术;外周动脉病变;糖尿病足;溃疡/坏死;截肢

　　doi:10.3969/j.issn.1006-6187.2012.03.010

　　Ankle-pedal vascular network and diabetic foot: Angiographic study CHANG Jian, XU Zhang-rong, ZHANG Lei，et al. Department of Radiology, 306 Hospital of PLA, Beijing 100101, China

　　【Abstract】ObjectiveTo investigate the correlation between foot ulceration/gangrene (UG) and ankle-pedal vascular networks (APVN), and to explore impacting factors on the prevalence and types of amputation in patients with diabetic foot. Methods89 diabetic patients with 146 lower limbs with peripheral arterial disease underwent successful digital subtraction arteriography (DSA), of which 132/146 limbs did not receive surgical and interventional treatments. All limbs were divided into 4 APVN groups: group 0N with no collateral circulation network (CCN=0) , group 1N (CCN=1), group 2N (CCN=2), group 3N (CCN=3). 132 limbs without surgical and interventional treatment were divided into 2 goups. Group A with one or no APVN, group B with 2 or 3 APVN. ResultsThe prevalence of UG among the group 0N, 1N, 2N, and 3N was 83.9%, 89.4%, 60.5%, 8.0% respectively (P<0.05 or P<0.01). The prevalence of amputation in group A and B was 63.8%, 30.2% respectively (P<0.01，OR=4.076). The prevalence of major amputation in group A and B was 68.2%, 26.3% respectively (P<0.01，OR=6.000).ConclusionsThe collateral circulation from APVN can affect the prevalence of UG and the rate and type of amputation in the patients with diabetic foot.

　　【Key words】Angiography; Peripheral artery disease; Diabetes foot; Pedal ulceration/gangrene; Amputation