简体中文

论著-头颈部

糖尿病足下肢动脉病变的CTA及MRA影像特点及危险因素分析*

作者:余宏建 郭学军 陈在中 阮继银 张 辉

所属单位:北京大学深圳医院影像中心微创介入科(广东 深圳 518036)

PDF

摘要

目的 分析糖尿病足(DF)下肢动 脉病变的CT血管造影(CTA)、磁共振血管 造影(MRA)影像学特点及危险因素。方法 以本院2014年3月-2016年3月确诊的57 例糖尿病足下肢动脉病变患者为研究对 象,均接受血管数字减影(DSA)、CTA、 MRA检查,以DSA为金标准,比较CTA、 MRA诊断敏感度、特异度及准确度;同时 选择同期确诊的50例DF非下肢动脉病变 患者为对照组,单因素及Logistic多因 素回归分析DF下肢动脉病变危险因素。 结果 CTA对膝下动脉、总体诊断敏感度 分别为64.13%、90.78%,准确度分别 为88.89%、94.72%,均显著低于MRA的 98.91%、98.39%,97.66%、98.05%,差 异有统计学意义(P<0.05);CTA、MRA对 膝上动脉诊断敏感度、特异度、准确度 比较均无显著差异(P>0.05);Logistic 多因素回归分析显示DF下肢动脉病变 独立危险因素包括高血压、体重指数 (BMI)、餐后2h血糖(2hPG)。结论 CTA、 MRA对DF下肢动脉病变诊断均有一定的价 值,但MRA对下膝动脉病变诊断敏感度、 准确度显著高,同时需对患者血压、血 糖等指标监测,以了解DF发生、发展情 况。

Objective To analyze the imaging characteristics of CT angiography (CTA) and magnetic resonance angiography (MRA) and risk factors of lower extremity arterial lesions in patients with diabetic foot (DF). Methods Fifty-seven patients with DF and lower extremity arterial lesions treated in our hospital between March 2014 and March 2016 were selected as study subjects. All patients underwent digital subtraction angiography (DSA), CTA and MRA. With DSA as the golden standard, the diagnostic sensitivities, specificities and accuracy rates were compared between CTA and MRA. Another 50 patients with DF and without lower extremity arterial lesions confirmed in the same period were selected as the control group. The risk factors of lower extremity arterial lesions in patients with DF were analyzed by univariate and multivariate Logistic regression analysis. Results The sensitivities and accuracy rates of CTA in the diagnosis of infrapopliteal artery and the overall condition (64.13%, 90.78% and 88.89%, 94.72%) were significantly lower than those of MRA (98.91%, 98.39% and 97.66%, 98.05%) (P<0.05). There were no significant differences in the sensitivities, specificities and accuracy rates between CTA and MRA in the diagnosis of infrapopliteal artery (P>0.05); multivariate Logistic regression analysis showed that the independent risk factors of lower extremity arterial lesions in patients with DF included hypertension, body mass index (BMI) and postprandial 2h blood glucose (2hPG). Conclusion Both of CTA and MRA are of certain value in the diagnosis of lower extremity arterial lesions in patients with DF but the diagnostic sensitivity and accuracy of MRA are significantly higher. Meanwhile, the blood pressure, blood glucose and other indicators of patients need to be monitored to understand the occurrence and development of DF.

【关键词】糖尿病足;下肢动脉病变; CT血管造影

【中图分类号】R781.6+4

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2017.03.040

前言

糖尿病足(DF)典型症状为下肢疼痛,多由下肢动脉病变致使供血 不足引起,若不及时诊治可能出现溃疡、坏疽发生几率,增加截肢 风险[1]。有报道称相比非糖尿病患者,因DF导致非创伤性截肢高达数 倍,给患者身心及日常生活造成极大的伤害[2]。为此早期诊治DF具有 十分重要的意义。目前临床诊断下肢动脉血管病变方法包括血管数字 减影(DSA)、CT血管造影(CTA)、磁共振血管造影(MRA)等,其中DSA被 称为“金标准”,但其为有创操作,临床应用受限。目前关于CTA、 MRA诊断DF下肢血管病变研究报道较多[3-4],但关于两者对下肢血管病 变诊断哪个更佳研究较少。为了早期正确判断DF下肢动脉病变,以及 时治疗、改善其预后,本研究一方面以DSA为金标准,比较CTA、MRI对 DF下肢动脉病变的诊断价值,另一方面通过与DF无下肢动脉病变患者 比较,探讨其发生危险因素。