Kitahara Tokuyuki, Ono Kumeo, Tsuchida Akiyasu, Kawai Hironobu, Shinohara Masahiko, Ishii Yoshitaka, Koyanagi Hikaru, Noguchi Toshiharu, Matsumoto Takayuki, Sekihara Tetsuo, Watanabe Yukiyasu, Kanai Hideo, Ishida Hideki, Nojima Yoshihisa
Department of Medicine and Clinical Science, Gunma Graduate School of Medicine, Maebashi, Japan.
Am J Kidney Dis. 2005 Oct;46(4):688-96. doi: 10.1053/j.ajkd.2005.06.016.
Pulse wave velocity (PWV) and ankle-brachial blood pressure index (ABPI) are markers for atherosclerosis, and each predicts mortality in patients undergoing hemodialysis. However, there have been no studies in the past that compared head-to-head the clinical validity of these 2 parameters. Compared with conventional aortic PWV, brachial-ankle PWV (baPWV) is considered simple and thereby easily applicable to clinical use.
To clarify the relationship between baPWV and ABPI and assess their prognostic values, we analyzed 785 hemodialysis patients with a mean age of 60.2 +/- 12.5 (SD) years for whom ABPI and baPWV at baseline had been measured simultaneously and who were followed up for 33.8 +/- 10.8 months.
Of 785 patients, 131 deaths were recorded. In Kaplan-Meier analysis, all-cause mortality was progressively and significantly greater from the lowest quartile of baPWV onward (log-rank test, 41.8; P < 0.001). However, in Cox proportional hazards analysis, the impact of baPWV was insignificant when ABPI was included as a covariate. ABPI maintained strong predictive power in this model. When patients who had advanced peripheral arterial occlusive disease (ABPI < 0.9) were excluded from analysis, patients with the highest quartile of baPWV had significantly increased hazard ratios of all-cause (hazard ratio, 4.08; 95% confidence interval, 1.46 to 11.43; P < 0.007) and cardiovascular (hazard ratio, 7.03; 95% confidence interval, 1.49 to 33.08; P < 0.014) mortality. The predictive power of baPWV in this population was independent from other covariates associated with atherosclerotic disorders.
In a head-to-head comparison, ABPI, but not baPWV, showed strong power in predicting the mortality of hemodialysis patients. However, baPWV was useful to pick a high-risk population in patients with ABPI greater than 0.9. Thus, screening hemodialysis patients by means of baPWV and ABPI provides complementary information in identifying a high-risk population.
脉搏波速度（PWV）和踝臂血压指数（ABPI）是动脉粥样硬化的标志物，且均可预测接受血液透析患者的死亡率。然而，过去尚无研究对这两个参数的临床有效性进行直接比较。与传统的主动脉PWV相比，臂踝PWV（baPWV）被认为操作简单，因此易于应用于临床。
为明确baPWV与ABPI之间的关系并评估其预后价值，我们分析了785例平均年龄为60.2±12.5（标准差）岁的血液透析患者，这些患者在基线时同时测量了ABPI和baPWV，并进行了33.8±10.8个月的随访。
785例患者中，记录到131例死亡。在Kaplan-Meier分析中，从baPWV最低四分位数开始，全因死亡率逐渐显著升高（对数秩检验，41.8；P<0.001）。然而，在Cox比例风险分析中，当将ABPI作为协变量纳入时，baPWV的影响不显著。ABPI在该模型中保持了强大的预测能力。当将患有晚期外周动脉闭塞性疾病（ABPI<0.9）的患者排除在分析之外时，baPWV最高四分位数的患者全因（风险比，4.08；95%置信区间，1.46至11.43；P<0.007）和心血管（风险比，7.03；95%置信区间，1.49至33.08；P<0.014）死亡率的风险比显著增加。baPWV在该人群中的预测能力独立于与动脉粥样硬化疾病相关的其他协变量。
在直接比较中，ABPI而非baPWV在预测血液透析患者死亡率方面显示出强大能力。然而，baPWV有助于筛选ABPI大于0.9的患者中的高危人群。因此，通过baPWV和ABPI对血液透析患者进行筛查可为识别高危人群提供补充信息。
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