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1、中西醫(yī)結(jié)合治療下肢動(dòng)脈硬化閉塞癥IntegrativeMedicinearteriosclerosisobliterans作者:鄭煥金、艾發(fā)元、王麗娟苗志勃、賈巖author:HuanJinZheng,Ai-fayuan,WangLijuan,MiaoZhiBo,JiaYan一、概述隨著社會(huì)整體生活水平的提高和人口的老齡化,下肢動(dòng)脈硬化閉塞癥的發(fā)病和下肢動(dòng)脈硬化閉塞癥就診的患者將越來越多,最新一項(xiàng)統(tǒng)計(jì)結(jié)果顯示全美國(guó)下肢動(dòng)脈硬化閉塞癥共有一千兩百萬患者。Withtheimprovementoflivingstandardsof
2、societyasawholeandtheagingofthepopulation,Theincidenceofarteriosclerosisobliteransandarteriosclerosisobliteranspatientswillseektreatmentformoreandmore.ThelatestfindingsofasurveythroughouttheUnitedStatesatotalofarteriosclerosisobliteransinpatientswithtwelvemillion。一、
3、概述MeijerW等研究結(jié)果顯示,下肢動(dòng)脈硬化閉塞癥若以踝/肱指數(shù)(ankle-brachialpressureindex,ABPI)小于0.9%為診斷標(biāo)準(zhǔn),55歲以上人群的下肢動(dòng)脈硬化閉塞癥患病率是10%-25%,但以間歇性跛行等臨床表現(xiàn)來診斷下肢動(dòng)脈硬化閉塞癥患病率僅為前者下肢動(dòng)脈硬化閉塞癥的10%-20%。MeijerW,etc.Theresultsshowankle-brachialpressureindexCriteriaforthediagnosisoflessthan0.9%.Peopleovertheageof
4、55lowerextremityarteriosclerosisobliteransprevalencerateis10%-25%,buttheclinicalmanifestationsofintermittentclaudicationtodiagnosethediseaseratelowerextremityarteriosclerosisobliteransarteriosclerosisobliteransoftheformer10%-?20%.。在中國(guó),年齡50歲以上的心血管高危人群中,四分之一存在下肢動(dòng)脈疾病。北
5、京60以上的老年人中,下肢動(dòng)脈疾病患者約為五分之一。一、概述InChina,theageof50yearsofageincardiovascularhigh-riskgroups,thereisaquarteroflowerextremityarterialdisease.?Beijing60orolder,thelowerextremityarterialdiseaseisaboutone-fifthofpatients。1.1年齡是下肢動(dòng)脈硬化閉塞癥的首要危險(xiǎn)致病因素,隨著年齡的增長(zhǎng)其發(fā)病率升高。1.2有糖尿病史患者具有下
6、肢動(dòng)脈硬化閉塞癥患病率較高、患病年齡小、病程進(jìn)展快等特點(diǎn)。1.3吸煙對(duì)外周血管的危害極大,是心、腦血管的兩倍。高血壓、高脂血癥、肥胖等也是下肢動(dòng)脈硬化閉塞癥下肢動(dòng)脈硬化閉塞癥的致病因素。二、致病因素:1.1Ageistheprimaryarteriosclerosisobliteransdiseaseriskfactors,withagetheincidencerateincreased1.2Historyofdiabetespatientswithlowerextremityarterialocclusivediseasep
7、revalenceofhighprevalenceofyoungage,rapidprogressionandsoon.1.3Theharmofsmokingonperipheralvasculargreatistheheart,cerebrovasculartwice.Hypertension,hyperlipidemia,andobesityislowerlimbarteriosclerosisobliteransarteriosclerosisobliteransfactor.。該病是多種因素長(zhǎng)期綜合性作用的過程。動(dòng)脈壁
8、內(nèi)皮細(xì)胞受損、功能改變、滲透性增高,血液中的單核細(xì)胞粘附、侵潤(rùn)、進(jìn)入內(nèi)皮下,吞噬脂質(zhì)成為泡沫細(xì)胞,形成脂肪斑,血小板聚集也在局部粘附、活化,吞噬細(xì)胞、內(nèi)皮細(xì)胞及粘附于內(nèi)皮細(xì)胞損傷處的血小板釋放生長(zhǎng)因子刺激平滑肌細(xì)胞進(jìn)入內(nèi)膜并增殖,脂肪斑變成纖維斑塊,最終導(dǎo)致動(dòng)脈粥樣硬化下肢動(dòng)