Mostaza Jose M, Suarez Carmen, Manzano Luis, Cairols Marc, García-Iglesias Francisca, Sanchez-Alvarez Julio, Ampuero Javier, Godoy Diego, Rodriguez-Samaniego Andrés, Sanchez-Zamorano Miguel A
Arteriosclerosis Unit, Hospital Carlos III, Sinesio Delgado, 10, 28029 Madrid, Spain.
J Am Soc Nephrol. 2006 Dec;17(12 Suppl 3):S201-5. doi: 10.1681/ASN.2006080915.
Both decreased GFR and albuminuria are associated with an elevated prevalence of peripheral artery disease. However, the combined effects of these alterations previously were not evaluated. Patients with hypertension and with no known vascular disease (n = 955; mean age 66 yr; 56% male) were selected from internal medicine outpatient clinics throughout Spain. Cardiovascular risk factors, urinary albumin excretion, and the ankle-brachial index (ABI) were assessed in all participants. GFR was estimated according to the Cockroft-Gault equation. Of the study population, 62% had diabetes, 23.8% had a GFR <60 ml/min per 1.73 m2, and 43.8% had albuminuria. The prevalence of ABI <0.9 was greater in patients with a GFR <60 ml/min per 1.73 m2 (37.4 versus 24.3%; P < 0.0001) and in those who had albuminuria (32.2 versus 23.3%; P = 0.001). In patients with both alterations, the prevalence of ABI <0.9 was 45.7%. Multivariate analysis indicated that the factors that were associated independently with low ABI were age (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.03 to 1.08; P < 0.0001), triglyceride concentration (OR 1.003; 95% CI 1.001 to 1.005; P = 0.001), presence of albuminuria (OR 1.61; 95% CI 1.18 to 2.20; P = 0.003), smoking habit (OR 1.72; 95% CI 1.13 to 2.63; P = 0.012), and a GFR <60 ml/min per 1.73 m2 (OR 1.47; 95% CI 1.01 to 2.17; P = 0.049). In patients with hypertension and without known vascular disease, reduced GFR and albuminuria are associated independently with an ABI <0.9. Their combined presence characterizes a subgroup of the population who have an elevated prevalence of peripheral artery disease and could benefit from early diagnosis and treatment.
肾小球滤过率（GFR）降低和蛋白尿均与外周动脉疾病患病率升高相关。然而，此前未评估这些改变的联合效应。从西班牙各地的内科门诊中选取了无已知血管疾病的高血压患者（n = 955；平均年龄66岁；56%为男性）。对所有参与者评估心血管危险因素、尿白蛋白排泄和踝臂指数（ABI）。根据Cockcroft - Gault方程估算GFR。在研究人群中，62%患有糖尿病，23.8%的GFR<60 ml/（min·1.73 m²），43.8%有蛋白尿。GFR<60 ml/（min·1.73 m²）的患者中ABI<0.9的患病率更高（37.4%对24.3%；P<0.0001），有蛋白尿的患者中该患病率也更高（32.2%对23.3%；P = 0.001）。在同时有这两种改变的患者中，ABI<0.9的患病率为45.7%。多变量分析表明，与低ABI独立相关的因素有年龄（比值比[OR]1.06；95%置信区间[CI]1.03至1.08；P<0.0001）、甘油三酯浓度（OR 1.003；95%CI 1.001至1.005；P = 0.001）、蛋白尿的存在（OR 1.61；95%CI 至2.20；P = 0.003）、吸烟习惯（OR 1.72；95%CI 1.13至2.63；P = 0.012）以及GFR<60 ml/（min·1.73 m²）（OR 1.47；95%CI 1.01至2.17；P = 0.049）。在无已知血管疾病的高血压患者中，GFR降低和蛋白尿均与ABI<0.9独立相关。它们的共同存在特征性地表明了外周动脉疾病患病率升高的一个亚组人群，这些人可能从早期诊断和治疗中获益。
