糖尿病慢性下肢静脉病变特点及其风险因素分析

doi:10.3969/j.issn.1009-976X.2023.01.007

摘要/Abstract

摘要： 目的观察糖尿病静脉病变患者的临床特点,探讨与慢性静脉疾病病情加重相关的危险因素。方法收集 2018年9月至2019年1月于中山大学孙逸仙纪念医院血管外科住院的合并糖尿病（DM组）或非合并糖尿病（NC组）的慢性下肢静脉疾病患者共44例,对比两组患者的静脉病变临床表现。按静脉病变程度将患者分为4组,对比各组间基线资料,采用有序多分类Logistic回归分析与慢性下肢静脉疾病加重相关的危险因素。结果糖尿病患者的静脉病变较非糖尿病患者更为严重;合并糖尿病和高水平肌酸激酶同工酶（CM-KB）是慢性静脉病变加重的风险因素。结论糖尿病患者的慢性静脉疾病较非糖尿病患者更严重;合并糖尿病、高水平CK-MB可以作为慢性静脉疾病加重高风险的评估因素。

关键词: 糖尿病, 慢性下肢静脉疾病, CK-MB

Abstract: Objective To observe the clinical characteristics of diabetic patients with venous disease （VD）. Methods A total of 44 VD patients with （DM group） or without （NC group） diabetes hospitalized in the department of vascular surgery, Sun Yat-sen Memorial hospital, Sun Yat-sen University from September 2018 to January 2019 were enrolled in this study, and the clinical manifestations of VD patients in these two groups were compared. The patients were further divided into 4 groups according to the degree of VD. The baseline data of each group were compared, and the orderly multivariate logistic regression was conducted to analysis the risk factors related to the severity of VD. Results DM Patients presented to have more severe VD. The complication of DM and high level of creatine kinase isoenzyme （CM-KB） were clarified to be risk factors related to the severity of venous lesions. Conclusion Patients with diabetes presented to have more severe venous lesions than those without; the combination of DM and high level of CK-MB are evaluation factors for the high risk of exacerbation of chronic venous disease.

Key words: diabetes mellitus, chronic venous disease, CK-MB

中图分类号:

R654.3

朱天欣, 陈红星, 黄楷, 尤丽丽, 杨川, 刘丹, 严励, 任萌. 糖尿病慢性下肢静脉病变特点及其风险因素分析[J]. 岭南现代临床外科, 2023, 23(01): 35-41.

ZHU Tian-xin, CHEN Hong-xing, HUANG Kai, YOU Li-li, YANG Chuan, LIU Dan, YAN Li, REN Meng. Analysis of the characteristics and risk factors of chronic lower extremity venous diseases in diabetes[J]. Lingnan Modern Clinics In Surgery, 2023, 23(01): 35-41.

参考文献

[1] Yang W, Lu J, Weng J, et al.Prevalence of diabetes among men and women in China[J]. N Engl J Med, 2010, 362(12): 1090-1101.
[2] Li Y, Teng D, Shi X, et al.Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study[J]. BMJ, 2020, 369: m997.
[3] 钟学礼(执笔).全国14省市30万人口中糖尿病调查报告[J]. 中华内科杂志, 1981, 20(11): 678-683.
[4] Bergan JJ, Schmid-Schönbein GW, Smith PD, et al.Chronic venous disease[J]. N Engl J Med, 2006, 355(5): 488-498.
[5] Vuylsteke ME, Thomis S, Guillaume G, et al.An Epidemiological Survey of Venous Disease Among General Practitioner Attendees in Different Geographical Regions on the Globe: The Final Results of the Vein Consult Program[J]. Angiology, 2018, 69(9): 779-785.
[6] Mani R, Yarde S, Edmonds M.Prevalence of deep venous incompetence and microvascular abnormalities in patients with diabetes mellitus[J]. Int J Low Extrem Wounds, 2011, 10(2): 75-79.
[7] Fejfarova V, Jirkovska A, Dragomirecka E, et al.The relationship between chronic venous insufficiency and diabetes mellitus[J]. Int Angiol, 2017, 36(1): 90-91.
[8] Matic P, Matic A, Gajinov Z, et al.Chronic Venous Disease and Comorbidities[J]. Angiology, 2015, 66(6): 539-544.
[9] 中华医学会外科学分会血管外科学组, 中国医师协会血管外科医师分会, 中国医疗保健国际交流促进会血管外科分会, 等. 中国慢性静脉疾病诊断与治疗指南[J]. 中华医学杂志, 2019, 99(39): 3047-3061.
[10] American Diabetes Association.Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2019[J]. Diabetes Care, 2019, 42(Suppl 1): S13-S28.
[11] National Institute for Health and Care Excellence (UK). Lipid Modification: Cardiovascular Risk Assessment and the Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease [M/OL]. National Institute for Health and Clinical Excellence: Guidance, 2014, London.https://www.ncbi.nlm.nih.gov/books/NBK248067/
[12] 李瑞杰. 中国高血压防治指南(2010年修订版)重点内容介绍[J]. 中国临床医生, 2012, 40(02): 69-72.
[13] 中国心血管健康联盟. 中国成人血脂异常防治指南(2016年修订版)补充说明[J]. 中国循环杂志, 2017, 32(01): 53.
[14] 邵思顺, 王锦山, 王云. 高尿酸血症和痛风治疗的中国专家共识[J]. 中华内分泌代谢杂志, 2013, 29(11): 913-920
[15] Matic P, Ribeiro M, Novak M, et al.Chronic Venous Disease and Comorbidities[J]. Angiology, 2015, 66(6): 539-544.
[16] Zhong J, Liu Y, Li Q, et al.Diabetes mellitus is associated with early chronic venous disorder of the lower extremities in Chinese patients with cardiometabolic risk factors[J]. Diabetes Metab Res Rev, 2014, 30(6): 505-512.
[17] Leung JY, Ng EW, Lau TY, et al.Attenuated alpha-adrenoceptor-mediated arterial and venous constrictions in rat models of diabetes[J]. Eur J Pharmacol, 2010, 642(1-3): 128-133.
[18] Purewal TS, McKeown PP, Bonner G, et al. Lower limb venous pressure in diabetic neuropathy[J]. Diabetes Care, 1995, 18(3): 377-381.
[19] Uccioli L, Giacomini PG, Monticone G, et al.Lower limb arterio-venous shunts, autonomic neuropathy and diabetic foot[J]. Diabetes Res Clin Pract, 1992, 16(2): 123-130.
[20] Mani R, Yarde S, Edmonds M.Prevalence of deep venous incompetence and microvascular abnormalities in patients with diabetes mellitus[J]. Int J Low Extrem Wounds, 2011, 10(2): 75-79.
[21] Echegaray M, Rivera MA.Role of creatine kinase isoenzymes on muscular and cardiorespiratory endurance: genetic and molecular evidence[J]. Sports Med, 2001, 31(13): 919-934.
[22] Brewster LM.Creatine kinase, energy reserve, and hypertension: from bench to bedside[J]. Ann Transl Med, 2018, 6(15): 292.
[23] Graber NA, Ellington WR.Gene duplication events producing muscle (M) and brain (B) isoforms of cytoplasmic creatine kinase: cDNA and deduced amino acid sequences from two lower chordates[J]. Mol Biol Evol, 2001, 18(7): 1305-1314.
[24] Johnsen SH, Joakimsen O, Mathiesen EB, et al.Creatine kinase activity and blood pressure in a normal population: the Tromso study[J]. J Hypertens, 2011, 29(1): 36-42.
[25] Brewster LM, Mairuhu G, Bindraban NR, et al.Creatine kinase activity is associated with blood pressure[J]. Circulation, 2006, 114(19): 2034-1039.
[26] Taherzadeh Z, Brewster LM, van Montfrans GA, et al. The Effect of Creatine Kinase Inhibition on Contractile Properties of Human Resistance Arteries[J]. Am J Hypertens, 2016, 29(2): 170-177.
[27] Brewster LM, Mairuhu G, Bindraban NR, et al.Ethnic differences in resistance artery contractility of normotensive pregnant women[J]. Am J Physiol Heart Circ Physiol, 2010, 299(2): H431-436.
[28] Clark JF. The creatine kinase system in smooth muscle [J]. Mol Cell Biochem, 1994, 133-134: 221-232.