Dépistage de l’Artériopathie Oblitérante des Membres Inférieurs du Diabétique à l’Aide de l’Index de Pression Systolique en Pratique Quotidienne à Bamako

Résumé

RESUMEIntroduction. L’Arteriopathie Obliterante des Membres Inferieurs (AOMI) est une complication grave du diabete. Elle est sous-evaluee chez nos diabetiques noirs africains. Le but de l’etude etait de depister l’AOMI chez les diabetiques type 2 par la mesure de l’IPS. Patients et Methode. Etude prospective, descriptive et analytique de 7 mois. IPS etait evalue par le calcul de la sensibilite, de la specificite et des VPP et VPN. Resultats. 170 diabetiques type 2 colliges. 32,93% avaient un IPS pathologique et ont constitue notre echantillon. 22,35% avaient IPS 1,30 (mediacalcose). La prevalence de l’AOMI etait 22,35% (38/170). Sur 56 diabetiques ayant une anomalie de l’IPS, l’echo-doppler arterielle des membres inferieurs a retrouve 67,85% de cas d’AOMI (IPS 1,30). L’âge moyen etait 45,50±11,7 ans, le sex ratio etait 0,40. Duree d’evolution moyenne du diabete etait 8,75±2,36 ans. L’HbA1c moyenne etait 10,38±2,36%. Les facteurs de risque majeur d’atherosclerose associes au diabete etaient la dyslipidemie (87,50%), l’HTA (76,78%), l’obesite (60,70%) et le tabagisme (26,78%). 75% avaient des troubles trophiques.  La survenue de l’AOMI etait significativement liee a l’âge du patient (p=0,035) et au risque cardiovasculaire associe (p=0,002). Une relation significative etait retrouvee entre l’IPS et l’echo-doppler arterielle des membres inferieurs (p=0,003). Pour la validite de l’IPS, la sensibilite=0,92, la specificite=0,83, la VPP=1, une VPN=0,83. Conclusion. L’AOMI est une pathologie frequente chez les noirs subsahariens diabetiques type2. L’IPS est un bon outil de depistage de l’AOMI chez le diabetique.ABSTRACTIntroduction. Peripheral arterial disease (PAD) is a serious complication of diabetes that is largely underdiagnosed in black African diabetics. The aim of our study was to screen this disease in black sub-Saharan type 2 diabetics by measuring ankle-brachial index (ABI). Patients and methods. This was a cross sectional descriptive and prospective study that lasted seven months from January 2018 to July 2018. It concerned 170 type 2 diabetic patients from the department of internal medicine and endocrinology of the Hopital du Mali (Bamako). The accuracy of ABI was assessed by comparison with  echodoppler. Results. Among 170 dibatetic patients, 56 (32.93%) had abnormal ABI. Their mean age was 45.50 ± 11.7 years and the sex ratio was 0.40 (female 71.43%). The mean duration of diabetes was 8.75 ± 2.36 years. The mean HbA1c value was 10.38 ± 2.36%. Forty patients (71%) were taking insulin. Thirty-eight patients (22.35%) had an ABI 1.30, suggestive of mediacalcosis. In the subgroup of 56 patients with abnormal ABI, there were 38 cases (67.85%) with PAD (ABI 1.30). furthermore, three cases (16.66%) of PAD were discovered by echodoppler in subjects with mediacalcosis. The main risk factors for diabetes associated atherosclerosis in patients with PAD were dyslipidemia (87.50%), high blood pressure (76.78%), obesity (60.70%) and tobacco smoking (26.78%). Forty-two patients (75%) had trophic disturbances. The occurrence of PAD was significantly related to the patient's age (p = 0.035) and to associated cardiovascular risk factors (p = 0.002). There was a statistically significant relationship between the ABI and the echoDoppler findigs (p = 0.003). Concerning accuracy values of ABI,  the sensitivity was 0.92, the specificity 0.83, a PPV 1, and NPV 0.83. Conclusion. PAD is  common in black sub-Saharan type 2 diabetic patinets. ABI can be used for the screening of this condition.

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