Abraham P, Bickert S, Vielle B, Chevalier J M, Saumet J L
Laboratoire de physiologie et d'explorations vasculaires, Centre Hospitalier Universitaire, Angers, France.
J Vasc Surg. 2001 Apr;33(4):721-7. doi: 10.1067/mva.2001.112802.
This study defined how ankle arterial blood pressure measurements should be analyzed for the detection of moderate arterial disease (asymptomatic while walking). We used external iliac artery endofibrosis as a unique model of an isolated moderate arterial lesion, the role of which in exercise-related pain can be surgically proven.
Patients who were ambulatory in our institutional referral center were studied. Brachial pressures, ankle pressures, and heart rate were measured simultaneously on all four limbs at rest and after maximal exercise in 108 healthy athletes and 78 patients (among 89 athletes referred for suspicion of endofibrosis) with confirmed or excluded external iliac endofibrosis. For these 78 patients, we calculated systolic ankle pressure change, ankle/brachial index, and deviation from the ankle/brachial index to heart rate regression line (DAHR) that was defined in the 108 healthy athletes.
In patients with endofibrosis, ankle/brachial index and ankle pressure were normal at rest. One minute after exercise, areas (mean +/- SE of area) under the receiver operating characteristics curve for the diagnosis of endofibrosis were 0.91 +/- 0.02, 0.91 +/- 0.03, 0.95 +/- 0.02, and 0.96 +/- 0.02 for ankle pressure, pressure change, ankle/brachial index, and DAHR, respectively. For all criteria, area decreased with time in the recovery period.
After heavy-load exercise, the ankle/brachial index at minute 1 should be used rather than the systolic ankle pressure value or ankle pressure change as a means of improving the efficacy of the detection of endofibrosis in athletes. A 0.66 value of the index at minute 1 after maximal exercise seems an optimal cutoff point for clinical use, providing a 90% sensitivity rate and 87% specificity rate in the diagnosis of moderate arterial lesions. At rest and after 1 minute of recovery, the ankle/brachial index to heart rate relationship should be considered to be an efficient tool for analyzing the results of pressures measurements and improving detection efficiency.
本研究确定了应如何分析踝部动脉血压测量值，以检测中度动脉疾病（行走时无症状）。我们使用髂外动脉内膜纤维化作为孤立性中度动脉病变的独特模型，其在运动相关疼痛中的作用可通过手术证实。
对在我们机构转诊中心能走动的患者进行研究。在108名健康运动员和78名（89名因怀疑内膜纤维化而转诊的运动员中）确诊或排除髂外内膜纤维化的患者休息时及最大运动后，同时测量四肢的肱动脉血压、踝部血压和心率。对于这78名患者，我们计算了收缩期踝部压力变化、踝/肱指数以及与108名健康运动员中定义的踝/肱指数至心率回归线的偏差（DAHR）。
在内膜纤维化患者中，休息时踝/肱指数和踝部压力正常。运动后1分钟，用于诊断内膜纤维化的受试者操作特征曲线下面积（面积的均值±标准误），踝部压力、压力变化、踝/肱指数和DAHR分别为0.91±0.02、0.91±0.03、0.95±0.02和0.96±0.02。对于所有标准，恢复期面积随时间减小。
在重载运动后，应使用运动后第1分钟的踝/肱指数，而非收缩期踝部压力值或踝部压力变化，作为提高运动员内膜纤维化检测效率的手段。最大运动后第1分钟指数值0.66似乎是临床应用的最佳切点，在中度动脉病变诊断中提供90%的灵敏度和87%的特异度。在休息时和恢复1分钟后，踝/肱指数与心率的关系应被视为分析压力测量结果和提高检测效率的有效工具。
