Kırk yaş üzeri tip 2 diabetes mellituslu hastalarda ayak bileği kol indeksinin periferik arter hastalığını saptamadaki değeri ve periferik arter hastalığının diyabetin kronik komplikasyonları ile ilişkisi

Year 2020, Volume: 3 Issue: 2, 115 - 120, 19.03.2020

Tuğçe Nur Yiğenoğlu Medine Kebapçı Hülya Özen

https://doi.org/10.32322/jhsm.668754

Cited By: 1

Abstract

Giriş: Periferik arter hastalığı (PAH); serebrovasküler ve
kardiyovasküler hastalıklarda mortalite ve morbiditenin önemli bir
prediktörüdür. Diyabetik ve diyabetik olmayan hastalar karşılaştırıldığında
diyabetik hastalarda PAH insidansının 2 ila 4 kat daha fazla olduğu bildirilmiştir.
ayak bileği-kol indeksi (ABI), PAH tanısında kullanılan kolay uygulanabilir bir
yöntemdir. Çalışmamızda merkezimizde takip edilen 40 yaş üzeri tip 2 diabetes mellitus
(DM) hastalarında ABI ile PAH prevalansını saptamak, alt ekstremite arteryel
doppler ultrasonografi(USG) bulgularıyla kıyaslamak ve tip 2 DM’nin kronik
komplikasyonları ile PAH arasındaki ilişkileri ortaya koymak amaçlanmıştır.

Gereç ve Yöntem: Çalışmaya 40 yaş üzeri 111 tip 2 DM hastası
alındı. ABI; her iki ayak bileği seviyesinden alınan sistolik kan
basınçlarından (SKB) daha BÜYÜK olanının, her 2 koldan ölçülen SKB’larından
daha büyük olanına bölünmesiyle hesaplandı ve "ABI-1" olarak
tanımlandı. Her iki ayak bileği seviyesinden alınan SKB’larından daha DÜŞÜK
olanının, her iki koldan ölçülen SKB’larından daha büyük olanına bölünmesi ile
de ABI-2 hesaplandı. Daha sonra her iki yöntemle de hesaplanan ABI değerleri,
aralık değerlerine göre üç gruba ayrıldı. Grup 1’de 0,9 ve altı ABI değerleri,
Grup 2’de 0,9 ve 1,30 arası dışındaki, Grup 3’te 0,9 ve 1,40 arası dışındaki değerler PAH lehine yorumlandı (Tablo).
Arada boşluk

Bulgular: Kırk yaş üzeri diyabetik hastalarda PAH prevalansı %19,8
olarak bulundu. PAH’ı saptamada en spesifik ABI-2G1 grubu, en sensitif ise
ABI-1G2 ve ABI-2G2 grupları oldu. PAH ile klopidogrel kullanımı, azalmış
vibrasyon hissi, yaş, DM süresi, insülin direnci, glomerüler filtrasyon hızı,
albuminüri, homosistein ve ürik asit düzeyleri arasında anlamlı bir ilişki
bulundu.

Sonuç: ABI, DM hastalarında PAH tanısı için sensitif bir yöntemdir.
Çalışmamızın diğer çalışmalara göre üstün tarafı ABI’nın her iki yöntemle de
hesaplanması ve ABI değerlerinin kesim noktalarına göre üçer gruba ( ≤0,9 ;
≤0,9 - >1,30 ; ≤0,9 - >1,40) ayrılmasıdır. Diyabetik hastalarda PAH tanısını
koymak için ABI’nın özellikle ikinci hesaplama yöntemiyle (ABI-2)  değerlendirilmesi, gelecekte oluşması
beklenen komplikasyonların önüne geçilmesi açısından önem taşır.

Keywords

Periferik arter hastalığı, diabetes mellitus, ayak bileği-kol indeksi

The significance of ankle-brachial index in determining peripheral artery disease in patients with type 2 diabetes mellitus over 40 years of age and the relationship of peripheral artery disease with chronic complications of diabetes

Abstract

Introduction: Peripheral artery disease
(PAD) acts as an important predictor of mortality and morbidity in
cerebrovascular and cardiovascular diseases. The incidence of PAD was reported
to be 2 to 4 times higher in diabetic patients compared with non-diabetic
patients. Ankle brachial  index (ABI) is
an easily applicable method for the diagnosis of PAD. The aim of this study is
to determine the prevalence of PAD by using ABI in patients with Type 2
Diabetes Mellitus (DM) over 40 years of age, compare the results with lower
extremity arterial Doppler ultrasonography (USG) and to reveal the relationship
between chronic complications of DM and PAD.

Material and Method: The study included
111 DM patients over 40 years of age. ABI; was calculated by dividing the
higher systolic blood pressures (SBP) taken from both ankle levels to the
higher SBPs measured in both arms and defined as "ABI-1". ABI-2 was
calculated by dividing the lower SBPs taken from both ankle levels to the
higher SBPs measured from both arms. ABI values ​​calculated by both methods
were divided into 3 groups according to cut off values. ABI values ​​of 0.9 and
less in Group 1, ​​between 0.9 and 1.30 in Group 2, ​​between 0.9 and 1.40 in
Group 3 were interpreted in favor of PAD.

Results: The prevalence of PAD was
19.8%. The most specific group for detecting PAD was ABI-2G1, and the most
sensitive groups were ABI-1G2 and ABI-2G2. A significant relationship was found
between PAD and clopidogrel use, decreased vibration sensation, age, duration
of DM, insulin resistance, glomerular filtration rate, albuminuria,
homocysteine ​​and uric acid levels.

Conclusion: ABI is a sensitive method
for detecting PAD. The
superior side of our study compared to the other studies is that the ABI is
calculated by 2 methods and ABI values are divided into 3 groups according to
cut off values (≤0,9 ; ≤0,9 - >1,30 ; ≤0,9 - >1,40).

Keywords

Peripheral artery disease, diabetes mellitus, ankle-brachial index

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