[外周动脉疾病：预测因素与治疗强度。基于人群的INVADE项目的两年数据]

[Peripheral arterial disease: predictors and treatment intensity. Two-years of data from the population-based INVADE project].

作者信息

Sander K, Bickel H, Schulze Horn C, Huntgeburth U, Poppert H, Sander D

机构信息

Neurologische Klinik des Klinikums rechts der Isar der Technischen, Universität München, München, Germany.

出版信息

Dtsch Med Wochenschr. 2008 Mar;133(10):455-9. doi: 10.1055/s-2008-1046731.

DOI:10.1055/s-2008-1046731

PMID:18302095

Abstract

BACKGROUND AND PURPOSE

Asymptomatic peripheral arterial disease (PAD) is very common in the elderly and can be detected in 15-20% of patients above 55 years. The aim of this study was to determine PAD prevalence and risk factors within the population of the overall INVADE project (INtervention project of cerebroVAscular diseases and Dementia in the District of Ebersberg [Bavaria]), a prospective non-randomized analysis.

PATIENTS AND METHODS

A total of 3,909 participants were included in the INVADE project. An ankle-brachial index (ABI) measurement was available in 3 891 subjects. An additional 40 patients were excluded because their ABI was >1,5. The analysis was thus based on 3,851 participants. The mean age was 70.1 years (95% confidence interval: 69,8 - 70,3). There were 2 285 (59.3%) women. The changes of the different classical vascular and risk factors as well as various laboratory parameters, including high sensitivity C-reactive protein (hs-CRP) were recorded and analysed by the paired t-test or the Fisher's exact test. Independent predictors were calculated by multiple logistic regression analysis.

RESULTS

The prevalence of PDA was 18.6%. In 75% of the PAD patients the diagnosis had been unknown before study onset. Those with PAD were significant younger (69.6 vs. 72.2 years; p<0.0001), had significant lower hsCRP values (3,8 mg/l vs. 4.9 mg/l; p=0.002) and a lower vascular risk profile. After two years of intervention an improvement of vascular risk factors and reduction in necessary treatment, such as antihypertensives and platelet inhibitors, was documented. Independent risk factors for PAD development, in addition to the baseline ABI, were age, years of smoking (packs per day) and hsCRP.

CONCLUSION

The INVADE project confirms the high prevalence of PAD in an elderly population. These data underline the importance of measuring hsCRP for diagnosing and following PAD development.

摘要

背景与目的

无症状外周动脉疾病（PAD）在老年人中非常常见，在55岁以上的患者中，其检出率可达15% - 20%。本研究旨在确定整个INVADE项目（埃伯斯贝格区[巴伐利亚州]脑血管疾病与痴呆干预项目）人群中的PAD患病率及危险因素，这是一项前瞻性非随机分析。

患者与方法

共有3909名参与者纳入INVADE项目。3891名受试者进行了踝臂指数（ABI）测量。另外40名患者因ABI＞1.5被排除。因此，分析基于3851名参与者。平均年龄为70.1岁（95%置信区间：69.8 - 70.3）。女性有2285名（59.3%）。通过配对t检验或Fisher精确检验记录并分析不同经典血管及危险因素以及各种实验室参数（包括高敏C反应蛋白[hs-CRP]）的变化。通过多元逻辑回归分析计算独立预测因素。

结果

PAD患病率为18.6%。75%的PAD患者在研究开始前诊断未知。PAD患者显著更年轻（69.6岁对72.2岁；p＜0.0001），hsCRP值显著更低（3.8mg/L对4.9mg/L；p = 0.002），血管风险状况更低。经过两年干预，记录到血管危险因素有所改善，降压药和血小板抑制剂等必要治疗减少。除基线ABI外，PAD发生的独立危险因素为年龄、吸烟年数（每天包数）和hsCRP。