踝肱指数在下肢动脉硬化闭塞症诊断中的价值及其危险因素分析
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摘要
目的:探讨踝肱指数(ABI)在下肢动脉硬化闭塞症的诊断与预防中的作用。方法:回顾性分析2013年6月至2016年6月入住我院血管外科并行下肢动脉造影的113例下肢动脉闭塞症患者,共148条病变血管作为研究对象;依据狭窄和ABI数值分别将病变血管分为正常组、狭窄组及闭塞组。将ABI与造影结果进行对比研究,并分析ABI与吸烟史、糖尿病史、高血压病史、C反应蛋白(C-RP)、血同型半胱氨酸(HCY)的相关性。结果:ABI对血管病变的诊断特异性及敏感性均较高,与血管造影并无明显差异(P> 0. 05);吸烟史、糖尿病史、高血压病史均是其降低的重要因素(P <0. 05),C反应蛋白、血同型半胱氨酸均与ABI呈负相关(P <0. 05)。结论:ABI对下肢动脉硬化闭塞性疾病的诊断与预防有重要的价值,可作为无创性诊断的首选方案,同时吸烟史、糖尿病史、高血压病史、C反应蛋白、血同型半胱氨酸均能影响ABI水平。
Objective: To investigate the ankle brachial index in the diagnosis and prevention of lower extremity atherosclerotic occlusive disease. Methods: 148 lesion arteries of 113 patients who were admitted to our department from June2013 to June 2016,were retrospectively analysed in this research. According to the angiography and ABI values,the lesion vasculars were divided into normal group,the stenosis and occlusion group. Compare ABI values and angiography results,and analysis of the relation of ABI between smoking history,diabetes history,hypertension,C-reactive protein( CRP),and blood homocysteine( HCY). Results: The ABI,with a well specificity and sensitivity for detecting the vascular disease,would be reduced by smoking,diabetes,hypertension( P < 0. 05). There was no difference between the ABI and angiography( P > 0. 05). Negative relation were between the C-RP,blood HCY and ABI( P < 0. 05). Conclusion:ABI plays an important role for the diagnosis and prevention of lower extremity arteriosclerosis occlusive disease. It can be used as a noninvasive diagnosis of the preferred scheme,at the same time,smoking,diabetes,hypertension,C-RP and blood homocysteine can affect the level of ABI.
Objective: To investigate the ankle brachial index in the diagnosis and prevention of lower extremity atherosclerotic occlusive disease. Methods: 148 lesion arteries of 113 patients who were admitted to our department from June2013 to June 2016,were retrospectively analysed in this research. According to the angiography and ABI values,the lesion vasculars were divided into normal group,the stenosis and occlusion group. Compare ABI values and angiography results,and analysis of the relation of ABI between smoking history,diabetes history,hypertension,C-reactive protein( CRP),and blood homocysteine( HCY). Results: The ABI,with a well specificity and sensitivity for detecting the vascular disease,would be reduced by smoking,diabetes,hypertension( P < 0. 05). There was no difference between the ABI and angiography( P > 0. 05). Negative relation were between the C-RP,blood HCY and ABI( P < 0. 05). Conclusion:ABI plays an important role for the diagnosis and prevention of lower extremity arteriosclerosis occlusive disease. It can be used as a noninvasive diagnosis of the preferred scheme,at the same time,smoking,diabetes,hypertension,C-RP and blood homocysteine can affect the level of ABI.
引文
[1] Liang Y,Nie H,Ren H,et al. Change of Serum Angiopoietin-like Protein 2 and Its Significance in Patients with Arteriosclerotic Occlusion[J]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao Acta Academiae Medicinae Sinicae,2017,39(2):188.
[2] Selvin E,Erlinger T P. Prevalence of and risk factors for peripheral arterial disease in the United States:results from the National Health and Nutrition Examination Survey,1999~2000[J]. Acc Current Journal Review,2004,13(11):37-38.
[3] Clement D L. Ankle-Brachial Index(ABI)[J]. Int Angiol,2015:12:75-79.
[4]齐文哲.踝臂指数与动脉硬化性疾病的相关性研究进展[J].实用医药杂志,2017,34(10):946-948.
[5]刘建平,刘凤恩,段青,等.复合手术治疗复杂下肢动脉硬化闭塞症[J].赣南医学院学报,2015,35(3):376-378.
[6]中华医学会外科学分会血管外科学组.下肢动脉硬化闭塞症诊治指南(上)[J].中华医学杂志,2015,95(24):145-151.
[7] Rada C,Oummou S,Merzouk F,et al. Ankle-brachial index screening for peripheral artery disease in high cardiovascular risk patients. Prospective observational study of370 asymptomatic patients at high cardiovascular risk[J].Journal Des Maladies Vasculaires,2016,41(6):353.
[8] Rd S R,Reis S P,Macfarlane J J,et al. Noninvasive Physiologic Vascular Studies:A Guide to Diagnosing Peripheral Arterial Disease[J]. Radiographics A Review Publication of the Radiological Society of North America Inc,2017,37(1):346.
[9]孙树申,王茂军.踝臂指数对2型糖尿病下肢动脉病变的预测价值[J].河北联合大学学报(医学版),2016,18(3):202-204.
[10] Lee S H,Choi S H,Kim E K,et al. Borderline anklebrachial index is associated with poor short-term clinical outcome after coronary artery intervention[J]. Atherosclerosis,2016,249:186-190.
[11]王琦,周艳辉,王康鸣.同型半胱氨酸、胱抑素C、C反应蛋白与冠心病的相关性研究[J].重庆医学,2016,45(18):2556-2558.
[12] Kaptoge S,Di A E,Lowe G,et al. C-reactive protein concentration and risk of coronary heart disease,stroke,and mortality:an individual participant meta-analysis[J]. Lancet,2010,375(9709):132.
[13] Criqui MH,Fronek A,Barrett Connor E,et al. The prevalence of peripheral arterial disease in a defined popularion[J]. Ciculation,1985,71:510-515.
[14]王昆,胡大一,杨进刚,等. 1008例有心血管危险因素患者踝臂指数异常的发生率及其相关因素[J].首都医科大学学报,2006,27(4):499-511.
[15] Hirsch AT,Criqui MH,Treat Jacobson D,et al. Peripheral arterial disease detection,awareness,And treatment in primary care[J]. JAMA,2001,286:1317-1324.
[2] Selvin E,Erlinger T P. Prevalence of and risk factors for peripheral arterial disease in the United States:results from the National Health and Nutrition Examination Survey,1999~2000[J]. Acc Current Journal Review,2004,13(11):37-38.
[3] Clement D L. Ankle-Brachial Index(ABI)[J]. Int Angiol,2015:12:75-79.
[4]齐文哲.踝臂指数与动脉硬化性疾病的相关性研究进展[J].实用医药杂志,2017,34(10):946-948.
[5]刘建平,刘凤恩,段青,等.复合手术治疗复杂下肢动脉硬化闭塞症[J].赣南医学院学报,2015,35(3):376-378.
[6]中华医学会外科学分会血管外科学组.下肢动脉硬化闭塞症诊治指南(上)[J].中华医学杂志,2015,95(24):145-151.
[7] Rada C,Oummou S,Merzouk F,et al. Ankle-brachial index screening for peripheral artery disease in high cardiovascular risk patients. Prospective observational study of370 asymptomatic patients at high cardiovascular risk[J].Journal Des Maladies Vasculaires,2016,41(6):353.
[8] Rd S R,Reis S P,Macfarlane J J,et al. Noninvasive Physiologic Vascular Studies:A Guide to Diagnosing Peripheral Arterial Disease[J]. Radiographics A Review Publication of the Radiological Society of North America Inc,2017,37(1):346.
[9]孙树申,王茂军.踝臂指数对2型糖尿病下肢动脉病变的预测价值[J].河北联合大学学报(医学版),2016,18(3):202-204.
[10] Lee S H,Choi S H,Kim E K,et al. Borderline anklebrachial index is associated with poor short-term clinical outcome after coronary artery intervention[J]. Atherosclerosis,2016,249:186-190.
[11]王琦,周艳辉,王康鸣.同型半胱氨酸、胱抑素C、C反应蛋白与冠心病的相关性研究[J].重庆医学,2016,45(18):2556-2558.
[12] Kaptoge S,Di A E,Lowe G,et al. C-reactive protein concentration and risk of coronary heart disease,stroke,and mortality:an individual participant meta-analysis[J]. Lancet,2010,375(9709):132.
[13] Criqui MH,Fronek A,Barrett Connor E,et al. The prevalence of peripheral arterial disease in a defined popularion[J]. Ciculation,1985,71:510-515.
[14]王昆,胡大一,杨进刚,等. 1008例有心血管危险因素患者踝臂指数异常的发生率及其相关因素[J].首都医科大学学报,2006,27(4):499-511.
[15] Hirsch AT,Criqui MH,Treat Jacobson D,et al. Peripheral arterial disease detection,awareness,And treatment in primary care[J]. JAMA,2001,286:1317-1324.