程琦 檀永攀 宋全 何玉芳

[摘要] 目的 研究彩色多普勒超声对糖尿病下肢血管病变的评估价值及其与血清脂蛋白相关磷脂酶A2（Lp-PLA2）、25-羟维生素D3[25（OH）D3]水平的关系。 方法 选取2015年2月～2016年2月石家庄市第一医院收治的糖尿病患者200例，根据彩色多普勒超声检查结果将糖尿病下肢血管病变患者43例作为A组，无下肢病变患者157例作为B组，并选择同期体检健康者40例作为健康对照组。应用彩色多普勒超声检查各组动脉血管內径以及动脉血流量，应用酶联免疫吸附法检测各组血清Lp-PLA2、25（OH）D3水平，应用Pearson相关性分析分析动脉血管内径以及动脉血流量与血清Lp-PLA2、25（OH）D3的相关性。 结果 A组股动脉、腘动脉、足背动脉内径显著低于B组和健康对照组，且股动脉、腘动脉、足背动脉血流量显著低于B组和健康对照组（P < 0.05），以上各指标在健康对照组与B组间差异无统计学意义（P > 0.05）。A组血清Lp-PLA2水平显著高于B组和健康对照组，25（OH）D3水平显著低于B组和健康对照组（P < 0.05），而健康对照组与B组Lp-PLA2和25（OH）D3水平比较差异无统计学意义（P > 0.05）。糖尿病下肢血管病变患者动脉血管内径以及动脉血流量与血清Lp-PLA2水平呈正相关（r = 0.562、0.621，P < 0.05），而与血清25（OH）D3水平均呈负相关（r = -0.663、-0.582，P < 0.05）。 结论 糖尿病下肢血管病变患者存在下肢动脉狭窄、血流速度缓慢情况以及血清Lp-PLA2、25（OH）D3的异常改变，患者动脉血管内径以及动脉血流量与血清Lp-PLA2和25（OH）D3水平密切相关。

[关键词] 糖尿病下肢血管病变；彩色多普勒超声；脂蛋白相关磷脂酶A2；25-羟维生素D3；相关性

[中图分类号] R587.1 [文献标识码] A [文章编号] 1673-7210（2018）08（a）-0123-04

[Abstract] Objective To study the value of color Doppler ultrasonography in the evaluation of diabetic lower extremity vascular disease and its relationship with serum lipoprotein related phospholipase A2 （Lp-PLA2） and 25-hydroxyvitamin D3 [25（OH）D3] levels. Methods From February 2015 to February 2016， 200 patients with diabetes in the First Hospital of Shijiazhuang were divided into group A with 43 cases of diabetic lower extremity vascular disease， group B with 157 cases of no diabetic lower extremity vascular disease according to color Doppler ultrasonography examination results. And 40 cases of healthy check-up were selected as healthy control group. The arterial diameter and arterial blood flow in each group was examined by color Doppler ultrasonography， and serum Lp-PLA2， 25（OH）D3 levels were detected by enzyme-linked immunosorbent assay， Pearson correlation analysis was used to analyze the association between artery diameter and blood flow， serum Lp-PLA2， 25 （OH）D3. Results The femoral artery， popliteal artery， dorsalis pedis artery diameter of group A were significantly lower than those of group B and healthy control group， and femoral artery， popliteal artery， dorsalis pedis artery blood flow were significantly lower than those of group B and healthy control group （P < 0.05）， the above indexes were not statistically different between the healthy control group and the group B （P > 0.05）. The level of serum Lp-PLA2 in group A was significantly higher than that of group B and control group， 25 （OH）D3 level was significantly lower than group B and healthy control group （P < 0.05）， while there was no significant difference in levels of Lp-PLA2 and 25 （OH）D3 between the healthy control group and group B （P > 0.05）. The vascular diameter and blood flow of patients with lower extremity arterial disease related to diabetic were positively correlated with the level of serum Lp-PLA2 （r = 0.562， 0.621， P < 0.05）， and was negatively correlated with the level of 25 （OH）D3 （r = -0.663， -0.582， P < 0.05）. Conclusion Patients with diabetic lower extremity vascular disease show the presence of lower extremity arterial stenosis， slow flow of blood， and abnormal changes in serum Lp-PLA2 and 25 （OH）D3 levels. The intra arterial diameter and arterial blood flow are closely related to the levels of serum Lp-PLA2 and 25 （OH）D3.

[Key words] Diabetic lower extremity vascular disease； Color doppler ultrasound； Lipoprotein related phospholipase A2； 25-hydroxyvitamin D3； Correlation

糖尿病是临床上常见的代谢紊乱性疾病，严重危害患者生命健康。其中下肢血管病變是糖尿病患者最为常见的慢性大血管并发症之一[1]。近年来研究发现，炎性反应在糖尿病下肢血管病变发病中起到促进作用[2]。而脂蛋白相关磷脂酶A2（Lp-PLA2）是目前临床上新发现的一种炎症标志物，参与了粥样斑块形成的起始、进展、稳定性丧失和最终破裂等阶段，与糖尿病下肢血管病变有密切关系[3-4]。……