糖尿病下肢动脉内中膜厚度与血流剪切率及相关危险因素研究
|
摘要
目的：探讨2型糖尿病(DM)患者下肢动脉内-中膜厚度(IMT)与血流剪切率(SR)及相关危险因素之间的关联性及其意义。为DM患者治疗及早期预防提供新的思路和理论依据。
方法：随机研究已经确诊为2型糖尿病108例患者,超声观察下分为病变组(内膜增厚组)67例及非病变组(内膜正常范围组)41例,并同期观察正常对照组57例,用彩色多普勒超声(CDFI)检查下肢动脉血管,观察双下肢股总动脉股浅动脉、胭动脉、胫前动脉、胫后动脉、足背动脉,逐条纪录各动脉内中膜厚度、管径(D)及收缩期峰值流速(PSV),于后期计算SR；观察斑块情况；彩色多普勒及频谱多普勒超声观察动脉血管内彩色血流充盈情况及频谱形态；同时抽取空腹静脉血测定相关生化指标并对每个受试者进行详细体格检查。将3组数据分别进行比较,分析其与糖尿病下肢动脉病变的关系。
结果：
1.DM组与对照组相比SR均降低,有明显差异(P<0.05)；
2.DM下肢动脉病变有关的危险因素包括：病程、年龄、空腹血糖、2小时餐后血糖、糖化血红蛋白、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、全血黏度高切、纤维蛋白原、收缩压及腰围(P<0.05)；
3.代谢综合征(MS)与DM下肢动脉病变关系密切。
结论：
1.2型糖尿病患者在出现IMT增厚之前已有SR的降低,SR是动脉粥样硬化的重要形成因素；
2.2型糖尿病下肢动脉病变与MS的多种危险因素密切相关,互为因果,应引起足够重视,汁意早期预防。
Objective:
To investigate the relevance between intima-media thickness (IMT) of the lower peripheral arteries, shear rate (SR) and related factors in TypeⅡdiabetic patients. And propose new standpoint and theoretical foundation to diabetic patients for the prevention and therapy.
Methods:
A total of 108 random TypeⅡdiabetic patients and 57 control groups were recruited for the investigation. The TypeⅡdiabetic patients were divided into two groups:67 patients with thickening Intima and 41 patients with normal Intima. Following factors will be observed at the same time:common femoral artery, superficial femoral artery, popliteal artery, arterial tibial anterior, posterior tibial artery and dorsal pedis artery of double legs with all patients. The intima-media thickness, diameter (D) and PSV (Peak Systole Velocity) of the lower peripheral arteries were measured with CDFI (Color Doppler Flow Imaging), and this data will be used to calculate SR (Shear Rate)-. Meanwhile, observe the condition of plaques, color flow and spectrum shape. Analyze the relationship of lower peripheral arteries judged by Doppler ultrasonic, biochemical parameters and detailed physical examination of the three groups that were used for this investigation.
Results:
1. In diabetes patients groups, the SR was lower than that are in control group (P＜0.05).
2.The risk factors related to the lower peripheral arteries of diabetic patients included years of disease, ages, the fasting plasma glucose,2hour-fasting blood glucose,HbAlc, total cholesterol, triglyceride. high density lipoprotein, low density lipoprotein, whole blood viscosity at high shear rate, fibrinogen, systolic blood pressure, and waist (P＜0.05).
3. There is a close relation between MS (Metabolic Syndrome) and lower peripheral arteries of diabetic patients.
Conclusion:
1. The decrease of SR in diabetes patients can be found before the IMT thicker, and it is one of the important factors that lead to atherosclerosis.
2.The lower peripheral arteries of diabetic patient was related to various risk factors of metabolic syndrome, should be early prevented and paid more attention.
方法：随机研究已经确诊为2型糖尿病108例患者,超声观察下分为病变组(内膜增厚组)67例及非病变组(内膜正常范围组)41例,并同期观察正常对照组57例,用彩色多普勒超声(CDFI)检查下肢动脉血管,观察双下肢股总动脉股浅动脉、胭动脉、胫前动脉、胫后动脉、足背动脉,逐条纪录各动脉内中膜厚度、管径(D)及收缩期峰值流速(PSV),于后期计算SR；观察斑块情况；彩色多普勒及频谱多普勒超声观察动脉血管内彩色血流充盈情况及频谱形态；同时抽取空腹静脉血测定相关生化指标并对每个受试者进行详细体格检查。将3组数据分别进行比较,分析其与糖尿病下肢动脉病变的关系。
结果：
1.DM组与对照组相比SR均降低,有明显差异(P<0.05)；
2.DM下肢动脉病变有关的危险因素包括：病程、年龄、空腹血糖、2小时餐后血糖、糖化血红蛋白、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、全血黏度高切、纤维蛋白原、收缩压及腰围(P<0.05)；
3.代谢综合征(MS)与DM下肢动脉病变关系密切。
结论：
1.2型糖尿病患者在出现IMT增厚之前已有SR的降低,SR是动脉粥样硬化的重要形成因素；
2.2型糖尿病下肢动脉病变与MS的多种危险因素密切相关,互为因果,应引起足够重视,汁意早期预防。
Objective:
To investigate the relevance between intima-media thickness (IMT) of the lower peripheral arteries, shear rate (SR) and related factors in TypeⅡdiabetic patients. And propose new standpoint and theoretical foundation to diabetic patients for the prevention and therapy.
Methods:
A total of 108 random TypeⅡdiabetic patients and 57 control groups were recruited for the investigation. The TypeⅡdiabetic patients were divided into two groups:67 patients with thickening Intima and 41 patients with normal Intima. Following factors will be observed at the same time:common femoral artery, superficial femoral artery, popliteal artery, arterial tibial anterior, posterior tibial artery and dorsal pedis artery of double legs with all patients. The intima-media thickness, diameter (D) and PSV (Peak Systole Velocity) of the lower peripheral arteries were measured with CDFI (Color Doppler Flow Imaging), and this data will be used to calculate SR (Shear Rate)-. Meanwhile, observe the condition of plaques, color flow and spectrum shape. Analyze the relationship of lower peripheral arteries judged by Doppler ultrasonic, biochemical parameters and detailed physical examination of the three groups that were used for this investigation.
Results:
1. In diabetes patients groups, the SR was lower than that are in control group (P＜0.05).
2.The risk factors related to the lower peripheral arteries of diabetic patients included years of disease, ages, the fasting plasma glucose,2hour-fasting blood glucose,HbAlc, total cholesterol, triglyceride. high density lipoprotein, low density lipoprotein, whole blood viscosity at high shear rate, fibrinogen, systolic blood pressure, and waist (P＜0.05).
3. There is a close relation between MS (Metabolic Syndrome) and lower peripheral arteries of diabetic patients.
Conclusion:
1. The decrease of SR in diabetes patients can be found before the IMT thicker, and it is one of the important factors that lead to atherosclerosis.
2.The lower peripheral arteries of diabetic patient was related to various risk factors of metabolic syndrome, should be early prevented and paid more attention.
引文
[1]Fujii K, Mintz GS, Carlier SG,et al.Intravascular ultrasound profile analysis of ruptured coronary plaques [J].Am J Cardiol,2006,98 (4):429-435
[2]Milne WK, Worster A. Evidence-based Emergency Medicine/Rational Clinical Examination Abstract.Does the clinical examination predict lower extremity peripheral arterial disease [J]?Annals of Emergency Medicine, 2009,54(5):748-750
[3]潘长玉,高妍,袁申元,等.2型糖尿病下肢血管发生率及相关因素[J].中国糖尿病杂志,2001,9(6)：323-332
[4]Goldsmith HL, Turitto VT. Rheological aspects of thrombosis and heamostasis: basic principles and applications[J]. Thromb Haemost,1986,55 (3):415-435
[7]孙立涛,窦新颖,等.应用高频超声研究血流剪切力对兔早期动脉粥样硬化的影响[J].中国超声医学杂志,2010,26(2)：100-103
[8]吴峻,何兆初,等.高脂血症患者血流剪切率的变化及对血管功能的影响[J].中国病理生理杂志,2008,24(1)：76-79
[9]Esper RJ, Nordaby RA, Vilarino Jo, et al. The endothelial dysfunction[J]. Cardiovasc Diabetol,2006,23(1):4-9
[10]廖琳,徐德凤.糖尿病下肢血管病变的彩色多普勒检查及治疗[J].中华内分泌代谢杂志,1996,12(3)：186-187
[11]Gnosso A,Irace C,Carallo C, et al.Invivoassociation between low wall shear stress and plaque in srbiects with asymmetrical carotid atherosclerosis[J].Stroke,1997,28:993-998
[12]Kao CH, Chen JK, Kuo js, et al. Visualization of the transport pathways of low density lipoproteim across the endothelial cells in the branched regions of rat arteries[J]. Atherosclerosis,1995,116(1):27-41
[13]杨锦茹,刘华胜,闫利华.血流剪切率与颈动脉粥样硬化斑块的关系[J]中国临床医学影像杂志,2004,15(1)：10-12
[14]Glagov S,Weisenberg E,Zarins C,et al.Compensatory enlargement of human atherosclerotic coronary arteries[J]. N Engl J Med 1987;316:1371-1375
[15]Hagenaars T,Gussenhoven EJ,Athanassopoulos P,et al.Intravascular ultrasound evidence for stabilization of compensatory enlargement of the femoropopliteal segment after endograft placement[J]. Endovasc Ther,2001;8:308-314.
[16]Jandeleit-Dahm K, Watson A, Soro-Paavonen A. The AGE/RAGE axis in diabetes-accelerated atherosclerosis[J]. Clin Exp Pharmacol Physiol,2008, 35(3):329-334
[17]梁燕华,吕安林,等.2型糖尿病下肢血管病变易患因素分析[J].实用心脑肺血管病杂志,2007,15(12)：924-925
[18]Howard BV. Insulin resistance and lipid metabolism[J]. Am J Cardiol 1999,84(1):28-32
[19]Imanaga Y, Sakatan, Takebayasir S, et al. In vivo and in vitro evidence for the glycoxidation of low density lipoprotein in human atherosclerotic plaques[J].Atherosclerosis,2000,150:343-345
[20]胡金麟.细胞流变学[M].北京：科学出版社,2000：133-1351
[21]Naito M.Effects of fibrinogen, fibrin and their degradation products on the behaviour of vascular smooth muscle cells[J]. Nippon Ronen Igakkai Zasshi,2000,37 (6):458-463
[22]Maat M P,Bladbjerg E M, Drivsholm T,et al.Inflammation thrombosis andatherosclerosis:results of the Glostrup study[J]. Thromb Haemost,2003,1:950-957
[23]苏静.糖尿病患者纤维蛋白原水平与下肢动脉病变关系的研究[J].黑龙江医学,2008,32(6)：401-402
[24]李春霖,田慧,孙毅宏,等.老年男性糖尿病患者血压控制水平的影响因素以及与血管并发症的关系[J].中国临床康复,2004,8(18)：3540-3542
[25]Hoy W, Light A, Megill D. Cardiovasular disease in Navajo Indians with type 2 diabetes[J]. Public Health Rep,1995,110(1):87-94
[26]辛朝晖,赵淑芝,等.血流剪切应力和剪切率与动脉粥样硬化斑块形成的关系[J].医学影像学杂志,2005,15(8)：655-657
[27]Banerji MA, Lebowitz J,Chaiken RL, et al. Relationship of visceral adipose tissue and glucose disposal is independent of sex in black NIDDM subjects[J].Am J Physiol 1997;273:425-432
[28]Montague CT, O'Rahilly S. The perils of portliness:Causes and consequences of visceral adiposity[J].Diabetes 2000;49:883-888
[29]Kelley DE. The impact of obesity, regional adiposity and ectopic fat on the pathophysiology of type 2 diabetes[J].Council on Obesity Diabetes Education,2003; 12-20
[30]DeFronzo RA. Pathogenesis of type 2 diabetes mellitus:metabolic and molecular implications for identifying diabetes genes[J].Diabetes Rev,1997;5:177-269
[31]王文娟,王克安,李天麟,等.体重指数、腰围和腰臀比预测高血压、高血糖的实用价值及其建议值探讨[J].中华流行病学杂志,2002,23(1)：16
[32]祝之明,祝善俊,等.代谢综合征病因探索与临床实践[M].北京：人民军医出版社,2005：32-33
[33]田慧,潘长玉,陆菊明,等.老年男性人群2型糖尿病与代谢综合征情况调查[J].中华老年多器官疾病杂志,2002,1(1)：19
[34]赵琳,张霞,王颖,等.代谢综合征与2型糖尿病慢性并发症的相关性[J].中国糖尿病杂志,2008,16(5)：271-273
[35]曾永红,张景莉,林伟茹.中心性肥胖与多代谢异常的关系[J].实用预防医学,2008,15(1)：88-89
[1]Nish Ikawa T, Edel steind, Duxl,et al.Normalizing mitochondrial superoxide production blocks three pathways of heperglycemia damage[J].Nature,2000,404:787-790
[2]黄岚,黄德嘉,等.血管损伤性疾病—从分子到临床[M].北京：人民卫生出版社,2008,191
[3]柴萌,张海涛,罗惠兰,等.MRA在糖尿病下肢血管病变中的诊断价值：与DSA对照研究[J].中国医学影像技术,2006,22(12)：1870-1872
[4]Giattina SD, Courtney BK, Herz PR,et al. Assessment of coronary plaque collagen with polarization sensitive optical coherence tomography (PS-OCT) [J]. Inern J Cardiol,2006,107(3):400-409
[5]张代富.糖尿病与心血管疾病[M].北京：人民卫生出版社,2006：448-449
[6]Fujii K, Mintz GS, Carlier SG,et al.Intravascular ultrasound profile analysis of ruptured coronary plaques [J].Am J Cardiol,2006,98 (4):429-435
[7]Milne WK, Worster A. Evidence-based Emergency Medicine/Rational Clinical Examination Abstract.Does the clinical examination predict lower extremity peripheral arterial disease? [J] Annals of Emergency Medicine,2009,54(5)：748-750
[8]李馨,高云华.动脉粥样硬化的超声检测及其应用前景[J].中国医学影像学杂志,2004,12(1)：56-57
[9]潘长玉,高妍,袁申元,等.2型糖尿病下肢血管发生率及相关因素[J].中国糖尿病杂志,2001,9(6)：323-332
[10]Pignoli P, Tremoli E, Poli A, et al. Intimal plus medial thickness of the arterial wall:a direct measurement with ultrasound imaging[J]. Circulation,1986,74 (6):1399-1406
[11]Shigehiko Fujiwara,Masanori Emoto, et al. Arterial wall thickness is associated with insulin resistance in type 2 diabetic patients [J] Journal of Atherosclerosis and Thrombosis,2003,10(4):246-52
[12]Prisant LM, Zemel PC, Nichols FT, et al. Carotid plaque Associations among hypertensive patients [J]. Arch Intern Med,1993,153:501-508
[13]鲍缦夕,邹大进.c肽、血脂水平与2型糖尿病下肢血管病变的关系[J].陕西医学杂志,2006,35(3)：316-318
[14]Kantarci F, Mihmanli I,Albayram MS,et al.Islak Follow-up of extracranial vertebral artery stents with Doppler sonography[J].Am J Roentgenol,2006,187(3):779-787
[15]袁光华,张武.超声诊断基础与临床检查规范[M].北京：科学技术文献出版社,2005：232
[16]曹铁生,段云友.多普勒超声诊断学[M].北京：人民卫生出版社,2004：333
[17]Coppola.Gl Increased hs-CRP levels and fibrinogen influence vascular event risk in diabetes mellitus[J].Health insurance Law Weekly,2006,26:1511
[18]苏静.糖尿病患者纤维蛋白原水平与下肢动脉病变关系的研究[J].黑龙江医学,2008,6(32)：401-402
[19]Fujiwara S, Emoto M,et al. Arterial wall thickness is associated with insulin resistance in type 2 diabetic patients[J]. Atheroscler Thromb,2003,10(4):246-52
[20]李唐瑛,李伟,等.2型糖尿病下肢血管病变发生率及相关危险因素分析[J].中国热带医学,2008,8(2)：254-256
[21]张旭艳,毛红.2型糖尿病下肢血管病变相关危险因素分析[J].武汉大学学报,2007,28(4)：532-534
[22]唐芙蓉。糖尿病患者下肢动脉病变及相关因素分析[J].中国动脉硬化杂志,2002,10(6)：533-534
[23]刘慧颖,李红,等.2型糖尿病下肢血管病变发生率及危险因素分析[J].中国实用内科杂志,2005,25(9)：825-826
[24]邵岩,吴慧敏,等.2型糖尿病下肢血管病变相关危险因素分析[J].中国慢性病预防与控制,2006,14(4)：262-264
[25]刘小明,许亮,等.2型糖尿病患者动脉内膜中层厚度与血液流变学的相关性研究.浙江中西医杂志,2009,19(2)：77-78
[26]范虹,钟历勇.老年2型糖尿病患者下肢血管病变相关因素分析[J].首都医科大学学报,2007,28(3)：307-309
[27]Leiter L A, Ceriello A,Davidson J A,et al. Postprandial glucose regulation: new data and new implications[J].Clin Ther,2005,27:542-56
[28]奚悦,刘桂兰.2型糖尿病下肢血管病变的早期发现及其相关危险因素的探讨[J].中国厂矿医学,2007,20(2)：147-148
[29]梁燕华,吕安林,等.2型糖尿病下肢血管病变易患因素分析[J].实用心脑肺血管病杂志,2007,15(12)：924-925
[30]章法香.2型糖尿病下肢血管病变及相关因素分析[J].基层医学论坛,2006,10(1) ：26-27
[31]Wentzel JJ, Gijsen FJ, Schuurbiers JC, et al. Geometry guided data avera-ging enables the interpretation of shear stress related plaque development in human coronary arteries[J].Journal of Biomechanics,2005,38(7):1551-1555
[32]翟林,张丹,刘惠兰,等.血流剪切率对血液透析患者动脉粥样硬化的评估[J].中国血液净化,2007,6(4)：195-198
[33]陈祥华,冯向飞,等.兔腹主动脉粥样硬化斑块与血流剪切率关系研究[J].中国临床医学影像杂志,2006,5(17)：260-263
[34]Gnosso A,Irace C,Carallo C,et al.Invivoassociation between low wall shear stress and plaque in srbiects with asymmetrical carotid atherosclerosis[J].Stroke,1997,28:993-998
[35]Kao CH,Chen JK,Kuo Js,et al.Visualization of the transport pathways of low density lipoproteins across the endothelial cells in the branched regions of rat arteries[J].Atherosclerosis,1995,116(1):27-41
[36]姚世发,夏稻子.2型糖尿病患者颈动脉血流最大剪切率、内-中膜厚度及踝臂指数的关联性[J].中国超声医学杂志,2009,25(8)：785-787
[37]张建兴,沈嫱,邓法权,等.彩超对下肢动脉闭塞部位诊断价值的研究[J].现代诊断与治疗,2001,12：24-25
[38]范虹,钟历勇.133例2型糖尿病下肢血管病变相关因素分析[J].中国医师杂志,2006,8：1065-1066
[2]Milne WK, Worster A. Evidence-based Emergency Medicine/Rational Clinical Examination Abstract.Does the clinical examination predict lower extremity peripheral arterial disease [J]?Annals of Emergency Medicine, 2009,54(5):748-750
[3]潘长玉,高妍,袁申元,等.2型糖尿病下肢血管发生率及相关因素[J].中国糖尿病杂志,2001,9(6)：323-332
[4]Goldsmith HL, Turitto VT. Rheological aspects of thrombosis and heamostasis: basic principles and applications[J]. Thromb Haemost,1986,55 (3):415-435
[7]孙立涛,窦新颖,等.应用高频超声研究血流剪切力对兔早期动脉粥样硬化的影响[J].中国超声医学杂志,2010,26(2)：100-103
[8]吴峻,何兆初,等.高脂血症患者血流剪切率的变化及对血管功能的影响[J].中国病理生理杂志,2008,24(1)：76-79
[9]Esper RJ, Nordaby RA, Vilarino Jo, et al. The endothelial dysfunction[J]. Cardiovasc Diabetol,2006,23(1):4-9
[10]廖琳,徐德凤.糖尿病下肢血管病变的彩色多普勒检查及治疗[J].中华内分泌代谢杂志,1996,12(3)：186-187
[11]Gnosso A,Irace C,Carallo C, et al.Invivoassociation between low wall shear stress and plaque in srbiects with asymmetrical carotid atherosclerosis[J].Stroke,1997,28:993-998
[12]Kao CH, Chen JK, Kuo js, et al. Visualization of the transport pathways of low density lipoproteim across the endothelial cells in the branched regions of rat arteries[J]. Atherosclerosis,1995,116(1):27-41
[13]杨锦茹,刘华胜,闫利华.血流剪切率与颈动脉粥样硬化斑块的关系[J]中国临床医学影像杂志,2004,15(1)：10-12
[14]Glagov S,Weisenberg E,Zarins C,et al.Compensatory enlargement of human atherosclerotic coronary arteries[J]. N Engl J Med 1987;316:1371-1375
[15]Hagenaars T,Gussenhoven EJ,Athanassopoulos P,et al.Intravascular ultrasound evidence for stabilization of compensatory enlargement of the femoropopliteal segment after endograft placement[J]. Endovasc Ther,2001;8:308-314.
[16]Jandeleit-Dahm K, Watson A, Soro-Paavonen A. The AGE/RAGE axis in diabetes-accelerated atherosclerosis[J]. Clin Exp Pharmacol Physiol,2008, 35(3):329-334
[17]梁燕华,吕安林,等.2型糖尿病下肢血管病变易患因素分析[J].实用心脑肺血管病杂志,2007,15(12)：924-925
[18]Howard BV. Insulin resistance and lipid metabolism[J]. Am J Cardiol 1999,84(1):28-32
[19]Imanaga Y, Sakatan, Takebayasir S, et al. In vivo and in vitro evidence for the glycoxidation of low density lipoprotein in human atherosclerotic plaques[J].Atherosclerosis,2000,150:343-345
[20]胡金麟.细胞流变学[M].北京：科学出版社,2000：133-1351
[21]Naito M.Effects of fibrinogen, fibrin and their degradation products on the behaviour of vascular smooth muscle cells[J]. Nippon Ronen Igakkai Zasshi,2000,37 (6):458-463
[22]Maat M P,Bladbjerg E M, Drivsholm T,et al.Inflammation thrombosis andatherosclerosis:results of the Glostrup study[J]. Thromb Haemost,2003,1:950-957
[23]苏静.糖尿病患者纤维蛋白原水平与下肢动脉病变关系的研究[J].黑龙江医学,2008,32(6)：401-402
[24]李春霖,田慧,孙毅宏,等.老年男性糖尿病患者血压控制水平的影响因素以及与血管并发症的关系[J].中国临床康复,2004,8(18)：3540-3542
[25]Hoy W, Light A, Megill D. Cardiovasular disease in Navajo Indians with type 2 diabetes[J]. Public Health Rep,1995,110(1):87-94
[26]辛朝晖,赵淑芝,等.血流剪切应力和剪切率与动脉粥样硬化斑块形成的关系[J].医学影像学杂志,2005,15(8)：655-657
[27]Banerji MA, Lebowitz J,Chaiken RL, et al. Relationship of visceral adipose tissue and glucose disposal is independent of sex in black NIDDM subjects[J].Am J Physiol 1997;273:425-432
[28]Montague CT, O'Rahilly S. The perils of portliness:Causes and consequences of visceral adiposity[J].Diabetes 2000;49:883-888
[29]Kelley DE. The impact of obesity, regional adiposity and ectopic fat on the pathophysiology of type 2 diabetes[J].Council on Obesity Diabetes Education,2003; 12-20
[30]DeFronzo RA. Pathogenesis of type 2 diabetes mellitus:metabolic and molecular implications for identifying diabetes genes[J].Diabetes Rev,1997;5:177-269
[31]王文娟,王克安,李天麟,等.体重指数、腰围和腰臀比预测高血压、高血糖的实用价值及其建议值探讨[J].中华流行病学杂志,2002,23(1)：16
[32]祝之明,祝善俊,等.代谢综合征病因探索与临床实践[M].北京：人民军医出版社,2005：32-33
[33]田慧,潘长玉,陆菊明,等.老年男性人群2型糖尿病与代谢综合征情况调查[J].中华老年多器官疾病杂志,2002,1(1)：19
[34]赵琳,张霞,王颖,等.代谢综合征与2型糖尿病慢性并发症的相关性[J].中国糖尿病杂志,2008,16(5)：271-273
[35]曾永红,张景莉,林伟茹.中心性肥胖与多代谢异常的关系[J].实用预防医学,2008,15(1)：88-89
[1]Nish Ikawa T, Edel steind, Duxl,et al.Normalizing mitochondrial superoxide production blocks three pathways of heperglycemia damage[J].Nature,2000,404:787-790
[2]黄岚,黄德嘉,等.血管损伤性疾病—从分子到临床[M].北京：人民卫生出版社,2008,191
[3]柴萌,张海涛,罗惠兰,等.MRA在糖尿病下肢血管病变中的诊断价值：与DSA对照研究[J].中国医学影像技术,2006,22(12)：1870-1872
[4]Giattina SD, Courtney BK, Herz PR,et al. Assessment of coronary plaque collagen with polarization sensitive optical coherence tomography (PS-OCT) [J]. Inern J Cardiol,2006,107(3):400-409
[5]张代富.糖尿病与心血管疾病[M].北京：人民卫生出版社,2006：448-449
[6]Fujii K, Mintz GS, Carlier SG,et al.Intravascular ultrasound profile analysis of ruptured coronary plaques [J].Am J Cardiol,2006,98 (4):429-435
[7]Milne WK, Worster A. Evidence-based Emergency Medicine/Rational Clinical Examination Abstract.Does the clinical examination predict lower extremity peripheral arterial disease? [J] Annals of Emergency Medicine,2009,54(5)：748-750
[8]李馨,高云华.动脉粥样硬化的超声检测及其应用前景[J].中国医学影像学杂志,2004,12(1)：56-57
[9]潘长玉,高妍,袁申元,等.2型糖尿病下肢血管发生率及相关因素[J].中国糖尿病杂志,2001,9(6)：323-332
[10]Pignoli P, Tremoli E, Poli A, et al. Intimal plus medial thickness of the arterial wall:a direct measurement with ultrasound imaging[J]. Circulation,1986,74 (6):1399-1406
[11]Shigehiko Fujiwara,Masanori Emoto, et al. Arterial wall thickness is associated with insulin resistance in type 2 diabetic patients [J] Journal of Atherosclerosis and Thrombosis,2003,10(4):246-52
[12]Prisant LM, Zemel PC, Nichols FT, et al. Carotid plaque Associations among hypertensive patients [J]. Arch Intern Med,1993,153:501-508
[13]鲍缦夕,邹大进.c肽、血脂水平与2型糖尿病下肢血管病变的关系[J].陕西医学杂志,2006,35(3)：316-318
[14]Kantarci F, Mihmanli I,Albayram MS,et al.Islak Follow-up of extracranial vertebral artery stents with Doppler sonography[J].Am J Roentgenol,2006,187(3):779-787
[15]袁光华,张武.超声诊断基础与临床检查规范[M].北京：科学技术文献出版社,2005：232
[16]曹铁生,段云友.多普勒超声诊断学[M].北京：人民卫生出版社,2004：333
[17]Coppola.Gl Increased hs-CRP levels and fibrinogen influence vascular event risk in diabetes mellitus[J].Health insurance Law Weekly,2006,26:1511
[18]苏静.糖尿病患者纤维蛋白原水平与下肢动脉病变关系的研究[J].黑龙江医学,2008,6(32)：401-402
[19]Fujiwara S, Emoto M,et al. Arterial wall thickness is associated with insulin resistance in type 2 diabetic patients[J]. Atheroscler Thromb,2003,10(4):246-52
[20]李唐瑛,李伟,等.2型糖尿病下肢血管病变发生率及相关危险因素分析[J].中国热带医学,2008,8(2)：254-256
[21]张旭艳,毛红.2型糖尿病下肢血管病变相关危险因素分析[J].武汉大学学报,2007,28(4)：532-534
[22]唐芙蓉。糖尿病患者下肢动脉病变及相关因素分析[J].中国动脉硬化杂志,2002,10(6)：533-534
[23]刘慧颖,李红,等.2型糖尿病下肢血管病变发生率及危险因素分析[J].中国实用内科杂志,2005,25(9)：825-826
[24]邵岩,吴慧敏,等.2型糖尿病下肢血管病变相关危险因素分析[J].中国慢性病预防与控制,2006,14(4)：262-264
[25]刘小明,许亮,等.2型糖尿病患者动脉内膜中层厚度与血液流变学的相关性研究.浙江中西医杂志,2009,19(2)：77-78
[26]范虹,钟历勇.老年2型糖尿病患者下肢血管病变相关因素分析[J].首都医科大学学报,2007,28(3)：307-309
[27]Leiter L A, Ceriello A,Davidson J A,et al. Postprandial glucose regulation: new data and new implications[J].Clin Ther,2005,27:542-56
[28]奚悦,刘桂兰.2型糖尿病下肢血管病变的早期发现及其相关危险因素的探讨[J].中国厂矿医学,2007,20(2)：147-148
[29]梁燕华,吕安林,等.2型糖尿病下肢血管病变易患因素分析[J].实用心脑肺血管病杂志,2007,15(12)：924-925
[30]章法香.2型糖尿病下肢血管病变及相关因素分析[J].基层医学论坛,2006,10(1) ：26-27
[31]Wentzel JJ, Gijsen FJ, Schuurbiers JC, et al. Geometry guided data avera-ging enables the interpretation of shear stress related plaque development in human coronary arteries[J].Journal of Biomechanics,2005,38(7):1551-1555
[32]翟林,张丹,刘惠兰,等.血流剪切率对血液透析患者动脉粥样硬化的评估[J].中国血液净化,2007,6(4)：195-198
[33]陈祥华,冯向飞,等.兔腹主动脉粥样硬化斑块与血流剪切率关系研究[J].中国临床医学影像杂志,2006,5(17)：260-263
[34]Gnosso A,Irace C,Carallo C,et al.Invivoassociation between low wall shear stress and plaque in srbiects with asymmetrical carotid atherosclerosis[J].Stroke,1997,28:993-998
[35]Kao CH,Chen JK,Kuo Js,et al.Visualization of the transport pathways of low density lipoproteins across the endothelial cells in the branched regions of rat arteries[J].Atherosclerosis,1995,116(1):27-41
[36]姚世发,夏稻子.2型糖尿病患者颈动脉血流最大剪切率、内-中膜厚度及踝臂指数的关联性[J].中国超声医学杂志,2009,25(8)：785-787
[37]张建兴,沈嫱,邓法权,等.彩超对下肢动脉闭塞部位诊断价值的研究[J].现代诊断与治疗,2001,12：24-25
[38]范虹,钟历勇.133例2型糖尿病下肢血管病变相关因素分析[J].中国医师杂志,2006,8：1065-1066