踝臂指数与外周动脉疾病死亡率之间的关系

Association between ankle brachial index and mortality in patients with peripheral arterial disease

关键词:  外周动脉疾病  踝臂指数  死亡率

Key words:  peripheral arterial disease  ankle brachial index  mortality

摘要:

目的研究无创检测方法踝臂指数(ankle brachial index, ABI)和外周动脉疾病(peripheral arterial disease, PAD)死亡率之间的关系。方法自2004年7月至2005年1月在上海和北京连续入选年龄≥35岁且具有≥2项以上动脉硬化危险因素的住院患者,危险因素包括高血压,糖尿病,吸烟和高脂血症,分别测定ABI并获取基线数据,所有研究对象随访至2008年2月或研究对象死亡,平均随访(38±2)个月。结果 共入选3732例患者,其中PAD患病率为26%,将ABI分为≤0.4,0.41~0.90,0.91~0.99和1.00~1.40共4组,Kaplan-Meier分析显示随着ABI的降低,生存率逐渐降低(P<0.001)；Cox回归分析ABI≤0.4组3年全因死亡风险和心血管疾病死亡风险分别是ABI=1.0~1.40组的3.11倍(95%CI:1.94~4.98)和4.79倍(95% CI:2.74~8.39,ABI=0.41~0.90组是ABI=1.0~1.40组的1.53倍(95% CI:1.20~1.96)和2.03倍(95% CI:1.48~2.79)。结论 随着ABI的降低,PAD患者的心血管和全因死亡率呈升高趋势,ABI能预测国人PAD患者的预后。

Abstract:

Objective To investigate the association between ankle brachial index (ABI) and mortality of patients with peripheral arterial disease (PAD). MethodsPatients aged over 35 years with at least two atherosclerotic risk factors (hypertension, hyperlipidemia, diabetes and smoking) were consecutively enrolled from the hospitals in Shanghai and Beijing between July 2004 and Jane 2005. ABI was measured and questionnaire survey was conducted for the baseline characteristics of patients. The participants were followed up till February 2008 or deceased. ResultsA total of 3732 inpatients were enrolled, including 969 cases of PAD with a prevalence rate of 26.0%. Total 3210 eligible patients were divided into 4 groups according to ABI value:≤0.4 group (n=69), 0.41-0.90 group (n=750), 0.91-0.99 group (n=455) and 1.00-1.40 group (n=1936). Kaplan-Meier analysis showed the survival was aggravated as ABI decreased; Cox regression analysis showed that using 1.0-1.40 group as reference, the risks of all-cause mortality and of cardiovascular mortality in ABI≤0.4 group were 3.11 times (95% CI:1.94-4.98) and 4.79 times (95% CI:2.74-8.39), respectively; those of 0.41-0.90 group were 1.53 times (95% CI:1.20-1.96) and 2.03 times (95% CI:1.48-2.79), respectively. ConclusionAnkle brachial index is an independent risk factor for all-cause mortality and cardiovascular mortality in patients with peripheral arterial disease.