1、129临床研究 2023 年 09 月第 31 卷第 09 期作者简介：杨继正，男，主治医师，本科。研究方向：超声诊断。*通讯作者：张红，副主任医师，。13贾红飞,牛宁宁,张学娜.超声弹性成像技术联合血清uPA检测对甲状腺结节良恶性鉴别诊断的价值分析J.中华地方病学杂志,2020,39(7):516-520.14沈倩倩,刘晓芳,任志翔,等.剪切波弹性成像和超声造影联合评分鉴别不同大小BI-RADS4类乳腺肿块良恶性的临床价值J.临床超声医学杂志,2022,24(7):521-526.15刘婉君,方毅,刘辉,等.经直肠超声造影和直肠超声剪切波弹性成像联合血清前列腺特异性抗原诊断早期前列腺癌的价值
2、J.中华实用诊断与治疗杂志,2022,36(6):608-611.16段国荣,符元春,张军辉,等.剪切波弹性成像定量参数对乳腺肿块良恶性的鉴别价值及其与组织Ki-67和C-erbB-2表达的关系研究J.现代生物医学进展,2022,22(12):2383-2386.17吕玲,赵树樊,牛惠萍.甲状腺影像报告与数据系统分类和超声弹性成像技术及其联合诊断甲状腺结节研究进展J.中国医学影像技术,2021,37(8):1238-1241.18李小利,周钟力,陈欣欣,等.超声弹性成像联合细针穿刺细胞学检查诊断桥本氏甲状腺炎背景下结节良恶性的价值J.临床超声医学杂志,2021,23(12):955-958.1
3、9付遵峰,沈雯怡,郭筱,等.剪切波弹性成像与微细血管成像在KwaK版本的TI-RADS分类中4类以上甲状腺结节的鉴别诊断研究J.中国超声医学杂志,2022,38(5):501-505.20徐可,石波,邓楠,等.实时剪切波弹性成像定量参数结合C-TIRADS指南在甲状腺结节鉴别诊断中的价值J.中国医疗设备,2023,38(3):78-82.临床化验与检查彩色多普勒超声与踝臂指数在糖尿病足患者下肢动脉病变诊断中的应用杨继正,田禧禧,杜梅,张红*(南阳油田总医院 超声科，河南 南阳 473132)摘要：目的 分析彩色多普勒超声(CDFI)与踝臂指数(ABI)在糖尿病足(DF)患者下肢动脉病变中的诊断
4、效能。方法 将 2021 年 1 月至 12 月就诊于南阳油田总医院的 100 例 DF 患者作为 DF 组，另选同期 50 例健康体检者作为对照组。所有受检者均接受 CDFI、ABI 检查，比较两组不同部位 CDFI 参数(动脉内径、内膜-中层膜厚度、阻力指数)、CDFI 阳性率、ABI 阳性率，将数字减影血管造影结果作为金标准，评估 CDFI、ABI 及二者联合对 DF 患者伴下肢动脉病变的诊断效能。结果 DF 组胫后动脉、胫前动脉、足背动脉内径显著低于对照组；DF 组股深动脉、胫后动脉、股浅动脉、腘动脉、胫前动脉与足背动脉的内膜-中层膜厚度、阻力指数显著高于对照组；数字减影血管造影结果显
5、示，DF 组 100 例患者中出现下肢动脉病变 85 例(85.00%)，其中闭塞 34 例，斑块 41 例，狭窄 10 例；DF 组内-中膜增厚、斑块、闭塞检出率显著高于对照组；DF 组 ABI 0.9 阳性率显著高于对照组，0.9-1.3 阳性率显著低于对照组；CDFI与ABI联合诊断DF患者伴下肢动脉病变的敏感度、阴性预测值与准确度均高于单一诊断，差异有统计学意义(P0.05)。结论 CDFI 可反映管腔内膜增厚程度、动脉管腔大小、管腔内血流动力学改变，与 ABI 联合检查可提升 DF 患者下肢动脉病变的诊断效能。关键词：糖尿病足；下肢动脉病变；彩色多普勒超声；踝臂指数中图分类号：R44
6、5文献标志码：B DOI：10.12385/j.issn.2096-1278(2023)09-0129-04Color Doppler Ultrasound and Ankle-Arm Index in the Diagnosis of Lower Extremity Arteriopathy in Patients with Diabetic FootYANG Jizheng,TIAN Xixi,DU Mei,ZHANG Hong*(Department of Ultrasound,Nanyang Oilfield General Hospital,Nanyang Henan 473132,
7、China)Abstract:Objective To evaluate the efficacy of color Doppler ultrasound(CDFI)and ankle-arm index(ABI)in the diagnosis of lower extremity arteriopathy in patients with diabetic foot(DF).Methods A total of 100 DF patients who were admitted to Nanyang Oilfield General Hospital from January to Dec
8、ember 2021 were selected as the DF group,and 50 healthy subjects in the same period were selected as the control group.All subjects were examined by CDFI and ABI.CDFI parameters(arterial diameter,intima-media thickness,resistance index),positive rate of CDFI and positive rate of ABI in different par
9、ts of the two groups were compared.The results of digital subtraction angiography were used as the gold standard to evaluate the diagnostic efficacy of CDFI,ABI and their combination in DF patients with lower extremity arterial disease.Results The inner diameters of posterior tibial artery,anterior
10、tibial artery,and dorsalis pedis artery in DF group were significantly lower than those in control group.Intima-media thickness and resistance index of deep femoral artery,posterior tibial artery,superficial femoral artery,popliteal artery,anterior tibial artery and dorsalis pedis artery in DF group
11、 were significantly higher than those in control group.The results of digital subtraction angiography showed that 85 cases(85.00%)of lower extremity arterial disease were found in 100 patients in DF group,including 34 cases of occlusion,41 cases of plaque,and 10 cases of stenosis.The detection rates
12、 of intima-media thickening,plaque and occlusion in DF group were significantly higher than those in control group.The positive rate of ABI 0.9 in DF group was significantly higher than that in control group,and the positive rate of 0.9-1.3 in DF group was significantly lower than that in control gr
13、oup.The sensitivity,negative predictive value and accuracy of CDFI combined with ABI in the diagnosis of DF patients with lower extremity arterial disease were higher than those of single diagnosis,and the 130Clinical Research,Sept.2023,Vol.31 No.09difference was statistically significant(P 0.05).Co
14、nclusion CDFI can reflect the degree of intimal thickening,arterial lumen size,and luminal hemodynamic changes,and combined with ABI can improve the diagnostic efficacy of lower extremity artery lesions in patients with DF.Key Words:diabetic foot;lower extremity arteriopathy;color doppler ultrasound
15、;ankle brachial index糖尿病足(DF)是糖尿病严重的慢性并发症之一。糖尿病患者长期处于高血糖状态，会导致自主神经紊乱、营养障碍与神经变性，累及交感神经后纤维，从而降低排汗功能，易诱发皮肤皲裂、干燥等症状1。同时，感觉神经病变可导致足底承载受力错位，压力阈值上升，造成足部创伤，进而诱发 DF2。DF 早期临床表现以夜间痛、间歇性跛行、肢端发凉、足皮肤萎缩等为主，随着病情加重可累及患者皮肤、骨与关节各层组织，严重者可出现下肢动脉病变、溃疡、全足坏疽等，甚至需要截肢3-4。因此，早发现、早诊断 DF 患者下肢动脉病变在改善预后中尤为关键。数字减影血管造影是判断 DF患者是否伴有下
16、肢动脉病变的公认金标准，但具有重复性差、费用高、有创等不足5。彩色多普勒超声(CDFI)操作简便、定位准确、无痛苦，有助于精确显示血管病变具体位置与病变程度6。国内研究发现7，踝臂指数(ABI)是血管外科一种常见、简单的检查方式，通过测量肱动脉、胫前动脉、足背动脉的收缩压可获得踝部动脉压与肱动脉压间比值，可用于下肢外周动脉疾病的辅助诊断。为进一步提升DF患者下肢动脉病变的检出率，本研究分析 CDFI、ABI 及二者联合的诊断效能。本研究已获南阳油田总医院医学伦理委员会批准同意。1资料与方法1.1一般资料将 2021 年 1 月至 12 月就诊于南阳油田总医院的100 例 DF 患者作为 DF 组，其中男 46 例，女 54 例；年龄 41 78 岁，平均(58.636.02)岁；Wagner 分级，0 级 0 例，级 30 例，级 31 例，级 18 例，级 15 例，级 6 例；病程 3 8 年，平均(5.161.54)年。另选同期 50 例健康体检者作为对照组，其中男 23 例，女 27例；年龄 38 75 岁，平均(57.865.81)岁。DF 组、对照组年龄、性别比较，差异无统
