中文摘要：

目的比较颈动脉和下肢动脉超声对新诊断2型糖尿病患者动脉粥样硬化的检出率及与心脑血管事件的关系。方法选择上海交通大学附属第六人民医院内分泌科2007年8月-2008年7月148例新诊断2型糖尿病住院患者行颈动脉和下肢动脉多普勒超声检查。糖尿病动脉粥样硬化被定义为颈动脉或下肢动脉存在任何部位的动脉粥样硬化斑块。采用Kappa统计方法评价颈动脉和下肢动脉超声对糖尿病动脉粥样硬化检出率的差异。同时比较不同动脉粥样硬化分布类型间心脑血管事件发生率的差异。结果单纯以颈动脉或下肢动脉超声检测作为诊断依据，新诊断2型糖尿病动脉粥样硬化患病率分别为27．0％和62．2％，联合检测患病率为66．2％。颈动脉超声诊断的动脉粥样硬化与糖尿病动脉粥样硬化间的Kappa值为0．32（95％C10．22～0．42），下肢动脉超声诊断的动脉粥样硬化与糖尿病动脉粥样硬化间的Kappa值为0．91（95％C10．84～0．98）。颈动脉和下肢动脉同时发生粥样硬化患者心脑血管事件发生率（26．5％）明显高于单纯颈动脉或单纯下肢动脉粥样硬化患者（分别为0％及10．3％）。结论联合颈动脉和下肢动脉超声检查可以更加准确地反映2型糖尿病患者动脉粥样硬化病变。颈动脉和下肢动脉同时发生粥样硬化的2型糖尿病患者心脑血管事件发生率明显增高，应该更加积极干预以减少将来心脑血管事件的发生。

英文摘要：

Objective To compare the detection rates of atherosclerosis by carotid versus lower limb ultrasound in newly diagnosed type 2 diabetics and analyze the relationship between atheroselerosis and cardio-cerebrovascular events. Methods A total of 148 newly diagnosed type 2 diabetics were recruited. Both carotid and lower extremity atherosclerosis were assessed by Doppler ultrasound. Diabetic atherosclerosis was defined as the presence of either carotid or lower extremity plaques in any of the above- mentioned arterial segments. A kappa value was computed to document the agreement between isolated carotid （or lower limb） atherosclerosis and diabetic atheroselerosis. The prevalence of cardio-eerebrovascular events was compared among different distribution types of atherosclerosis. Results According to the diagnostic criteria, the prevalence of diabetic atherosclerosis was 66. 2% in the newly diagnosed type 2 diabetes. Based on carotid or lower extremity ultrasound, the prevalence of diabetic atherosclerosis was 27.0% and 62. 2% respectively in newly diagnosed type 2 diabetes. The kappa values for the agreement between carotid/lower limb atherosclerosis and diabetic atheroselerosis were 0. 32/0. 91 （95% confidence interval 0. 22 -0. 42 for carotid vs 0. 84 -0. 98 for lower extremity）. The combination of carotid and lower extremity arterial atherosclerosis was associated with a significantly increased detection rate of cardio- eerebrovascular events （26. 5% ） versus those with either carotid or lower extremity arterial atheroselerosis （0% and 10.3% respectively）. Conclusion The combination of carotid and lower extremity ultrasonography can more accurately reflect the atherosclerotic lesions in type 2 diabetes. Due to a higher prevalence of cardio-eerebrovascular events, type 2 diabetics with both carotid and lower extremity atherosclerosis should be managed more aggressively to reduce the risk of cardio-cerebrovascular events.