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
Öz
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.
Anahtar Kelimeler
Periferik arter hastalığı diabetes mellitus ayak bileği-kol indeksi
Kaynakça
- REFERENCES
- 1- Türkiye Endokrinoloji ve Metabolizma Derneği DM ve komplikasyonlarının tanı, tedavi ve izlem kılavuzu 2019
- 2- Ronald A. Codario. Çeviri: Karşıdağ K, Sağlam H.Tip 2 Diyabet, Pre-Diyabet ve Metabolik Sendrom: Birinci Basamak Tanı ve Tedavi Rehberi- Bölüm 8. Humana Press 2005
- 3- Hiatt WR. Medical treatment of peripheral arterial disease and claudication. N Engl J Med 2001;344:1608-21
- 4- Oser RF, Picus D, Hicks ME, et al. Accuracy of DSA in the evaluation of patency of infrapop¬liteal vessels. J Vasc Interv Radiol 1995; 6: n589–594
- 5- Sorensen KE, Kristensen IB, Celermajer DS. Atherosclerosis in the human mbrachial artery. J Am Coll Cardiol 1997; 29: 318–322.
- 6- Welten GM, Schouten O, Chonchol M, et al. Prognosis of patients with peripheral arterial disease. J Cardiovasc Surg (Torino)2009;50:109-21.
- 7- Matthews DR, Hosker JP, Rudenski AS, et al. "Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28 (7): 412–9.
- 8- Marso SP, Hiatt WR. Peripheral arterial disease in patients with diabetes. J Am Coll Cardiol 2006;47:921-9.
- 9-Chou CK, Weng SW, Chang HW, et al. Analysis of traditional and nontraditional risk factors for peripheral arterial disease in elderly type 2 diabetic patients in Taiwan. Diabetes Res Clin Pract 2008; 81: 331-337.
- 10-Thomas GN, Critchley JA, Tomlinson B, et al. Peripheral vascular disease in type 2 diabetic Chinese patients: associations with metabolic indices, concomitant vascular disease and genetic factors. Diabet Med 2003; 20: 988-995
- 11-Tseng CH. Prevalence and risk factors of peripheral arterial obstructive disease in Taiwanese type 2 diabetic patients. Angiology 2003; 54: 331-338.
- 12- Criqui MH, Fronek A, Klauber MR, et al. The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from noninvasive testing in a defined population. Circulation 1985; 71:516–522
- 13- Wang Li, Du Fan, MAO Hong, et al. Prevalence and related risk factors of peripheral arterial disease in elderly patients with type 2 diabetes in Wuhan, Central China
- 14- Yu J, Hwang J, Shin M, et al. The Prevalence of Peripheral Arterial Disease in Korean Patients with Type 2 Diabetes Mellitus Attending a University Hospital; Diabetes Metab 2011; n35:543 -550
- 15-Schroder F, Diehm N, Kareem S, et al. A modified calcula¬tion of ankle–brachial npressure index is far more sensitive in the detection of peripheral arterial ndisease. J Vasc Surg 2006; 44: 531–536.
- 16- Niazi K, Khan TH, Easley KA. Diagnostic utility of the two methods of ankle brachial index in the detection of peripheral arterial disease of lower nextremities. Catheter Cardiovasc Interv 2006; 68: 788–792.
- 17- Klein S, Hage JJ. Measurement, calculation, and normal range of the ankle–arm nindex: a bibliometric analysis and recommendation for standardization. Ann Vasc Surg 2006; 20: 282–292.
- 18- Fowkes FG, Murray GD, Butcher I, et al. Ankle brachial index combined with Framingham risk score to predict cardiovascular events and mortality: a meta-analysis. JAMA 2008, 300:197-208.
- 19- Price JF, Stewart MC, Douglas AF, et al. Frequency of a low ankle brachial index in the general population by age, sex and deprivation: cross-sectional survey of 28,980 men and women. Eur J Cardiovasc Prev Rehabil 2008, 15(3):370-5.
- 20- Monteiro R, Marto R, Neves M. Risk Factors Related to Low Ankle-Brachial Index Measured by Traditional and Modified Definition in Hypertensive Elderly Patients
- 21-Al-Delaimy WK, Merchant TA, Rimm EB, et al. Effect of type 2 diabetes and its duration on the risk of peripheral arterial disease among men. Am J Med. 2004;116(4):236-240.
- 22- Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis: glycosylated nhemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med. n2004;141(6):421-431.
- 23- Zeeuw D, Parving HH, Henning RH. Microalbuminuria as an early marker for cardiovascular disease. J Am Soc Nephrol. 2006 Aug;17(8):2100- 2105. Epub 2006 Jul 6
- 24- Adler A, Stevens R, Neil A. UKPDS 59: Hyperglycemia and Other Potentially Modifiable Risk Factors for Peripheral Vascular Disease in Type 2 Diabetes
- 25-M. Langlois, D. De Bacquer, D. Duprez, et al. “Serum uric acid in hypertensive patients with and without peripheral narterial disease,”Atherosclerosis, vol. 168, no. 1, pp. 163–168, 2003
- 26- Jorge Escobedo J, S. Rana, Lombardero M, et al.Association Between Albuminuria and Duration of Diabetes and Myocardial Dysfunction and Peripheral Arterial Disease Among Patients With Stable Coronary Artery Disease in the BARI 2D Study
- 27- Uzun Ş, Vural H, Uzun M, et al. Koroner kalp hastalığı ciddiyetinin tahmininde kolay bir fiziksel değerlendirme bulgusu olan ayak bileği-kol indeksinin kullanılması, Gülhane Tıp Dergisi 2005; 47: 279-281.
- 28- Heald CL, Fowkes FG, Murray GD, Price JF; Ankle Brachial Index Collaboration. Risk of mortality and cardiovascular disease associated with the nankle-brachial index: Systematic review. Atherosclerosis 2006; 189:61–69.
- 29-Filippella M, Lillaz E, Ciccarelli A, et al. Ankle brachial pressure index usefulness as predictor factor for coronary heart disease in diabetic patients. J Endocrinol Invest 2007, 30:721-725.
- 30-Onufrak SJ, Bellasi A, Shaw LJ, et al. Phosphorus levels are associated with subclinical atherosclerosis in the general population. Atherosclerosis. 2008;199(2):424–431.
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
Öz
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).
Anahtar Kelimeler
Peripheral artery disease diabetes mellitus ankle-brachial index
Kaynakça
- REFERENCES
- 1- Türkiye Endokrinoloji ve Metabolizma Derneği DM ve komplikasyonlarının tanı, tedavi ve izlem kılavuzu 2019
- 2- Ronald A. Codario. Çeviri: Karşıdağ K, Sağlam H.Tip 2 Diyabet, Pre-Diyabet ve Metabolik Sendrom: Birinci Basamak Tanı ve Tedavi Rehberi- Bölüm 8. Humana Press 2005
- 3- Hiatt WR. Medical treatment of peripheral arterial disease and claudication. N Engl J Med 2001;344:1608-21
- 4- Oser RF, Picus D, Hicks ME, et al. Accuracy of DSA in the evaluation of patency of infrapop¬liteal vessels. J Vasc Interv Radiol 1995; 6: n589–594
- 5- Sorensen KE, Kristensen IB, Celermajer DS. Atherosclerosis in the human mbrachial artery. J Am Coll Cardiol 1997; 29: 318–322.
- 6- Welten GM, Schouten O, Chonchol M, et al. Prognosis of patients with peripheral arterial disease. J Cardiovasc Surg (Torino)2009;50:109-21.
- 7- Matthews DR, Hosker JP, Rudenski AS, et al. "Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28 (7): 412–9.
- 8- Marso SP, Hiatt WR. Peripheral arterial disease in patients with diabetes. J Am Coll Cardiol 2006;47:921-9.
- 9-Chou CK, Weng SW, Chang HW, et al. Analysis of traditional and nontraditional risk factors for peripheral arterial disease in elderly type 2 diabetic patients in Taiwan. Diabetes Res Clin Pract 2008; 81: 331-337.
- 10-Thomas GN, Critchley JA, Tomlinson B, et al. Peripheral vascular disease in type 2 diabetic Chinese patients: associations with metabolic indices, concomitant vascular disease and genetic factors. Diabet Med 2003; 20: 988-995
- 11-Tseng CH. Prevalence and risk factors of peripheral arterial obstructive disease in Taiwanese type 2 diabetic patients. Angiology 2003; 54: 331-338.
- 12- Criqui MH, Fronek A, Klauber MR, et al. The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from noninvasive testing in a defined population. Circulation 1985; 71:516–522
- 13- Wang Li, Du Fan, MAO Hong, et al. Prevalence and related risk factors of peripheral arterial disease in elderly patients with type 2 diabetes in Wuhan, Central China
- 14- Yu J, Hwang J, Shin M, et al. The Prevalence of Peripheral Arterial Disease in Korean Patients with Type 2 Diabetes Mellitus Attending a University Hospital; Diabetes Metab 2011; n35:543 -550
- 15-Schroder F, Diehm N, Kareem S, et al. A modified calcula¬tion of ankle–brachial npressure index is far more sensitive in the detection of peripheral arterial ndisease. J Vasc Surg 2006; 44: 531–536.
- 16- Niazi K, Khan TH, Easley KA. Diagnostic utility of the two methods of ankle brachial index in the detection of peripheral arterial disease of lower nextremities. Catheter Cardiovasc Interv 2006; 68: 788–792.
- 17- Klein S, Hage JJ. Measurement, calculation, and normal range of the ankle–arm nindex: a bibliometric analysis and recommendation for standardization. Ann Vasc Surg 2006; 20: 282–292.
- 18- Fowkes FG, Murray GD, Butcher I, et al. Ankle brachial index combined with Framingham risk score to predict cardiovascular events and mortality: a meta-analysis. JAMA 2008, 300:197-208.
- 19- Price JF, Stewart MC, Douglas AF, et al. Frequency of a low ankle brachial index in the general population by age, sex and deprivation: cross-sectional survey of 28,980 men and women. Eur J Cardiovasc Prev Rehabil 2008, 15(3):370-5.
- 20- Monteiro R, Marto R, Neves M. Risk Factors Related to Low Ankle-Brachial Index Measured by Traditional and Modified Definition in Hypertensive Elderly Patients
- 21-Al-Delaimy WK, Merchant TA, Rimm EB, et al. Effect of type 2 diabetes and its duration on the risk of peripheral arterial disease among men. Am J Med. 2004;116(4):236-240.
- 22- Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis: glycosylated nhemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med. n2004;141(6):421-431.
- 23- Zeeuw D, Parving HH, Henning RH. Microalbuminuria as an early marker for cardiovascular disease. J Am Soc Nephrol. 2006 Aug;17(8):2100- 2105. Epub 2006 Jul 6
- 24- Adler A, Stevens R, Neil A. UKPDS 59: Hyperglycemia and Other Potentially Modifiable Risk Factors for Peripheral Vascular Disease in Type 2 Diabetes
- 25-M. Langlois, D. De Bacquer, D. Duprez, et al. “Serum uric acid in hypertensive patients with and without peripheral narterial disease,”Atherosclerosis, vol. 168, no. 1, pp. 163–168, 2003
- 26- Jorge Escobedo J, S. Rana, Lombardero M, et al.Association Between Albuminuria and Duration of Diabetes and Myocardial Dysfunction and Peripheral Arterial Disease Among Patients With Stable Coronary Artery Disease in the BARI 2D Study
- 27- Uzun Ş, Vural H, Uzun M, et al. Koroner kalp hastalığı ciddiyetinin tahmininde kolay bir fiziksel değerlendirme bulgusu olan ayak bileği-kol indeksinin kullanılması, Gülhane Tıp Dergisi 2005; 47: 279-281.
- 28- Heald CL, Fowkes FG, Murray GD, Price JF; Ankle Brachial Index Collaboration. Risk of mortality and cardiovascular disease associated with the nankle-brachial index: Systematic review. Atherosclerosis 2006; 189:61–69.
- 29-Filippella M, Lillaz E, Ciccarelli A, et al. Ankle brachial pressure index usefulness as predictor factor for coronary heart disease in diabetic patients. J Endocrinol Invest 2007, 30:721-725.
- 30-Onufrak SJ, Bellasi A, Shaw LJ, et al. Phosphorus levels are associated with subclinical atherosclerosis in the general population. Atherosclerosis. 2008;199(2):424–431.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Orijinal Makale |
| Yazarlar | |
| Yayımlanma Tarihi | 19 Mart 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 3 Sayı: 2 |
Kaynak Göster
Cited By
The effect of blood gas analysis and Charlson comorbidity index evaluation on the prediction of hospitalization period in patients with diabetic hyperglycemic crisis
Journal of Health Sciences and Medicine
Nihat Mujdat HOKENEK
https://doi.org/10.32322/jhsm.953157
Üniversitelerarası Kurul (ÜAK) Eşdeğerliği: Ulakbim TR Dizin'de olan dergilerde yayımlanan makale [10 PUAN] ve 1a, b, c hariç uluslararası indekslerde (1d) olan dergilerde yayımlanan makale [5 PUAN]
Dahil olduğumuz İndeksler (Dizinler) ve Platformlar sayfanın en altındadır.
Not: Dergimiz WOS indeksli değildir ve bu nedenle Q olarak sınıflandırılmamıştır.
Yüksek Öğretim Kurumu (YÖK) kriterlerine göre yağmacı/şüpheli dergiler hakkındaki kararları ile yazar aydınlatma metni ve dergi ücretlendirme politikasını tarayıcınızdan indirebilirsiniz. https://dergipark.org.tr/tr/journal/2316/file/4905/show
Dergi Dizin ve Platformları
Dizinler; ULAKBİM TR Dizin, Index Copernicus, ICI World of Journals, DOAJ, Directory of Research Journals Indexing (DRJI), General Impact Factor, ASOS Index, WorldCat (OCLC), MIAR, EuroPub, OpenAIRE, Türkiye Citation Index, Türk Medline Index, InfoBase Index, Scilit, vs.
Platformlar; Google Scholar, CrossRef (DOI), ResearchBib, Open Access, COPE, ICMJE, NCBI, ORCID, Creative Commons vs.