Gardner Andrew W, Montgomery Polly S, Parker Donald E
CMRI Metabolic Research Center, University of Oklahoma Health Sciences Center, Department of Medicine, Division of Gerontology, University of Maryland, USA.
J Vasc Surg. 2006 Jun;43(6):1191-6; discussion 1197. doi: 10.1016/j.jvs.2006.02.042.
This study was conducted to (1) examine the effect of metabolic syndrome on intermittent claudication, physical function, health-related quality of life, and peripheral circulation in patients with peripheral arterial disease (PAD), and (2) determine whether peripheral vascular function was predictive of intermittent claudication and physical function in patients with metabolic syndrome.
Patients limited by intermittent claudication and who had metabolic syndrome (n = 133) were compared with those without metabolic syndrome (n = 201). Patients were assessed on metabolic syndrome characteristics, PAD-specific measures consisting of ankle/brachial index and claudication distances, physical function measures, health-related quality of life, and calf blood flow and transcutaneous oxygen tension responses after 3 minutes of vascular occlusion.
Initial claudication distance (mean +/- SD) was 29% shorter (P = .018) in patients with metabolic syndrome than in the controls (128 +/- 121 meters vs 180 +/- 166 meters), and absolute claudication distance was 22% shorter (P = .025) in those with metabolic syndrome (319 +/- 195 meters vs 409 +/- 255 meters). Furthermore, patients with metabolic syndrome had lower peak oxygen uptake (P = .037), a shorter 6-minute walk distance (P = .027), lower values on six domains of health-related quality of life (P < .05), reduced calf hyperemia (P = .028), and greater calf ischemia (P < .001) after vascular occlusion. In the group with metabolic syndrome, calf ischemia was correlated with initial claudication distance (r = 0.30, P = .004), absolute claudication distance (r = 0.40, P < .001), and peak oxygen uptake (r = 0.52, P < .001).
Metabolic syndrome worsens intermittent claudication, physical function, health-related quality of life, and peripheral circulation in patients with PAD. Calf ischemia in those with metabolic syndrome was predictive of intermittent claudication and physical function. The additive burden of metabolic syndrome thus places patients who are limited by intermittent claudication at an even greater risk for living a functionally dependent lifestyle. Aggressive risk-factor modification designed to treat components of metabolic syndrome should be evaluated for efficacy in modifying physical and vascular function in patients with intermittent claudication.
本研究旨在（1）探讨代谢综合征对周围动脉疾病（PAD）患者间歇性跛行、身体功能、健康相关生活质量及外周循环的影响，以及（2）确定外周血管功能是否可预测代谢综合征患者的间歇性跛行和身体功能。
将受间歇性跛行限制且患有代谢综合征的患者（n = 133）与无代谢综合征的患者（n = 201）进行比较。对患者进行代谢综合征特征评估、由踝臂指数和跛行距离组成的PAD特异性测量、身体功能测量、健康相关生活质量评估，以及血管闭塞3分钟后的小腿血流和经皮氧分压反应评估。
代谢综合征患者的初始跛行距离（均值±标准差）比对照组短29%（P = 0.018）（128±121米对180±166米），绝对跛行距离在代谢综合征患者中短22%（P = 0.025）（319±195米对409±255米）。此外，代谢综合征患者的峰值摄氧量较低（P = 0.037），6分钟步行距离较短（P = 0.027），健康相关生活质量的六个领域得分较低（P < 0.05），血管闭塞后小腿充血减少（P = 0.028），小腿缺血更严重（P < 0.001）。在代谢综合征组中，小腿缺血与初始跛行距离（r = 0.30，P = 0.004）、绝对跛行距离（r = 0.40，P < 0.001）和峰值摄氧量（r = 0.52，P < 0.001）相关。
代谢综合征会使PAD患者的间歇性跛行、身体功能、健康相关生活质量和外周循环恶化。代谢综合征患者的小腿缺血可预测间歇性跛行和身体功能。因此，代谢综合征的附加负担使受间歇性跛行限制的患者面临功能依赖性生活方式的更大风险。应评估旨在治疗代谢综合征各组成部分的积极危险因素干预措施对改善间歇性跛行患者身体和血管功能的疗效。
