CT EVALUATION OF DIABETIC TIBIAL ARTERY CALCIFICATION

描述(申请人提供)：糖尿病患者截肢的终生风险是非糖尿病人群的15倍。一旦患者发展为终末期周围血管病变(PVD)，糖尿病足溃疡的治疗选择就变得有限，通常结果是截肢。开发新的方法来检测和治疗糖尿病患者的早期PVD仍然是我们限制糖尿病相关截肢的最大希望。目前的非侵入性研究不能灵敏地识别早期血管疾病，也不能跟踪其进展。基于研究冠状动脉钙化的研究人员所做的工作，我们试图回答以下问题：在II型糖尿病患者中，胫骨动脉中发现的钙化量与PVD的严重程度之间是否存在类似的关系？如果是这样，那么胫骨钙化可以作为动脉粥样硬化性疾病严重程度和高危患者识别的替代标记物。我们将检验多层螺旋CT得出的胫动脉钙化评分与糖尿病患者群体中血管病变的临床严重程度相关的假设。我们将首先(特定目的1)探讨II型糖尿病患者胫动脉钙化与PVD临床类型的关系，然后(特定目标2)检测这些患者的胫动脉钙化积分与血管造影确定的胫动脉闭塞症的数量之间的相关性。我们将招募三组II型糖尿病患者：第一组-没有临床证据的PVD，第二组-临床证据的PVD但没有脚踏缺血，以及第三组-临床证据的PVD和脚踏缺血。我们还将招募年龄和性别匹配的对照组，以更充分地了解II型糖尿病对胫骨钙化的具体影响。对于目标1，每组的平均TAC分数将使用病例对照设计和方差分析统计方法进行比较。对于目标2，患者将通过CT血管成像对其血管解剖进行评估，并计算相关系数(R)和预测值(P)。这项初步调查的结果将支持更大规模的病例对照研究、队列研究和随机试验，以测试在治疗II型糖尿病患者中使用TAC评分的有效性。我们的最终目标是预防糖尿病的大血管并发症，并减少导致患者残疾的下肢截肢的发生率。

DESCRIPTION (provided by applicant): The lifetime risk of amputation in patients with diabetes is 15-fold higher than that of the non-diabetic population. Once patients develop end-stage peripheral vascular disease (PVD), the treatment options for diabetic foot ulcers become limited and amputation is commonly the result. Developing new methods to detect and treat early-stage PVD in patients with diabetes remains our best hope for limiting diabetes-related amputation. Current non-invasive studies do not sensitively identify early-stage vascular disease or serve to track its progression. Based on work done by investigators studying coronary calcification, we seek to answer the following question: Is there a similar relationship between the amount of calcification found in tibial arteries and the severity of PVD in patients with type II diabetes? If this is the case, then tibial calcification could be used as a surrogate marker for the severity of athero-occlusive diseases and for the identification of high risk patients. We will test the hypothesis that tibial artery calcification scores derived by multi-slice CT are related to the clinical severity of vascular disease in a diabetic patient population. We will first (specific aim 1) explore the relationship between tibial artery calcification and clinical category of PVD in patients with type II diabetes, and then (specific aim 2) examine the correlation between the tibial artery calcification score and the amount of angiographically-determined tibial artery occlusive disease in these patients. We will recruit three groups of patients with type II diabetes: Group 1- no clinical evidence of PVD, Group 2 -- clinical evidence of PVD but no pedal ischemia, and Group 3 -clincial evidence of PVD and pedal ischemia. We will also recruit an age and gender matched control group to more fully understand the specific effect of type II diabetes on tibial calcification. For Aim 1, mean TAC scores in each of these groups will be compared using a case-contol design and ANOVA statistical methods. For Aim 2, patients will undergo evaluation of their vascular anatomy by CT angiography and we will calculate a correlation coefficient (r) and predictive value (P). Results from this preliminary inquiry would support larger case-control studies, cohort studies, and randomized trials to test the utility of using TAC scoring in the care of patients with type II diabetes. Our ultimate goal is to prevent the marco-vascular complications of diabetes, and to decrease the incidence of lower extremity amputation that causes disability in our patients.