McDermott Mary M, Sufit Robert, Nishida Takashi, Guralnik Jack M, Ferrucci Luigi, Tian Lu, Liu Kiang, Tan Jin, Pearce William H, Schneider Joseph R, Sharma Leena, Criqui Michael H
Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 200, Chicago, IL 60611, USA.
Arch Intern Med. 2006 Oct 9;166(18):1986-92. doi: 10.1001/archinte.166.18.1986.
We determined whether lower extremity ischemia, as measured by the ankle brachial index (ABI), is associated with impaired lower extremity nerve function.
Participants included 478 persons with peripheral arterial disease (PAD) identified from noninvasive vascular laboratories and 292 persons without PAD identified from a general medicine practice and noninvasive vascular laboratories. Peripheral arterial disease was defined as an ABI lower than 0.90 (mild PAD: ABI, 0.70 to <0.90; moderate PAD: ABI, 0.50 to <0.70; and severe PAD: ABI, <0.50). The ABI and electrophysiologic measures of the peroneal, sural, and ulnar nerves were obtained.
Among 546 participants without diabetes, PAD participants had significantly impaired peripheral nerve function in the upper and lower extremities compared with non-PAD participants. After adjusting for age, sex, race, smoking, height, body mass index, recruitment source, alcohol use, disk disease, spinal stenosis, cardiac disease, and cerebrovascular disease, these associations were not statistically significant. After adjusting for confounders among nondiabetic participants, those with severe PAD (ABI, <0.50) had poorer peroneal nerve conduction velocity (NCV) compared with participants without PAD (42.6 vs 44.8 m/s; P = .003) and poorer peroneal NCV compared with participants with mild PAD (42.6 vs 45.0 m/s; P = .001) or moderate PAD (42.6 vs 44.1 m/s; P = .03). Among 224 participants with diabetes, after adjusting for confounders, PAD was associated with poorer peroneal NCV (40.8 vs 43.5 m/s; P = .01), sural nerve amplitude (3.1 vs 4.8 muV; P = .045), and ulnar NCV (47.6 vs 50.2 m/s; P = .03) compared with those without PAD.
Our findings suggest that leg ischemia impairs peroneal nerve function. This association is less strong in patients with diabetes, perhaps because of the overriding influence of diabetes on peripheral nerve function. Clinicians should consider screening for PAD in patients with idiopathic peroneal nerve dysfunction. Peripheral arterial disease-associated nerve dysfunction may contribute to PAD-associated functional impairment.
我们确定了通过踝臂指数（ABI）测量的下肢缺血是否与下肢神经功能受损有关。
参与者包括从无创血管实验室识别出的478例外周动脉疾病（PAD）患者以及从普通内科诊所和无创血管实验室识别出的292例无PAD患者。外周动脉疾病定义为ABI低于0.90（轻度PAD：ABI，0.70至<0.90；中度PAD：ABI，0.50至<0.70；重度PAD：ABI，<0.50）。获取了ABI以及腓总神经、腓肠神经和尺神经的电生理指标。
在546例无糖尿病的参与者中，与无PAD的参与者相比，PAD参与者的上下肢外周神经功能明显受损。在调整年龄、性别、种族、吸烟、身高、体重指数、招募来源、饮酒、椎间盘疾病、椎管狭窄、心脏病和脑血管疾病后，这些关联无统计学意义。在调整非糖尿病参与者的混杂因素后，与无PAD的参与者相比，重度PAD（ABI，<0.50）患者的腓总神经传导速度（NCV）较差（42.6对44.8米/秒；P = 0.003），与轻度PAD患者相比腓总神经NCV较差（42.6对45.0米/秒；P = 0.001），与中度PAD患者相比也较差（42.6对44.1米/秒；P = 0.03）。在224例糖尿病参与者中，调整混杂因素后，与无PAD的参与者相比，PAD与较差的腓总神经NCV（40.8对43.5米/秒；P = 0.01）、腓肠神经波幅（3.1对4.8微伏；P = 0.045）和尺神经NCV（47.6对50.2米/秒；P = 0.03）相关。
我们的研究结果表明腿部缺血会损害腓总神经功能。这种关联在糖尿病患者中不太明显，可能是因为糖尿病对周围神经功能的影响更为突出。临床医生应考虑对特发性腓总神经功能障碍患者进行PAD筛查。外周动脉疾病相关的神经功能障碍可能导致PAD相关的功能损害。
