Gardner Andrew W, Montgomery Polly S
CMRI Metabolic Research Program, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA.
J Vasc Surg. 2008 Jun;47(6):1251-8. doi: 10.1016/j.jvs.2008.01.048. Epub 2008 Apr 14.
To determine the effect of metabolic syndrome components on intermittent claudication, physical function, health-related quality of life, and peripheral circulation in patients with peripheral arterial disease (PAD), and to identify the metabolic syndrome components most predictive of each outcome measure.
Patients limited by intermittent claudication with three (n = 48), four (n = 45), or five (n = 40) components of metabolic syndrome were studied. Patients were assessed on PAD-specific measures consisting of ankle-brachial index (ABI), initial claudication distance, absolute claudication distance, 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) progressively declined (P = .019) in those with three (203 +/- 167 m), four (124 +/- 77 m), and five (78 +/- 57 m) metabolic syndrome components, and absolute claudication distance progressively declined (P = .036) in these groups as well (414 +/- 224 m vs 323 +/- 153 m vs 249 +/- 152 m, respectively). Furthermore, compared with patients with only three components of metabolic syndrome, those with all five components had impaired values (P < .05) for peak oxygen uptake, ischemic window, 6-minute walk distance, self-perceived walking ability and health, daily physical activity, health-related quality of life on six of eight domains, calf hyperemia, and calf ischemia after vascular occlusion. Abdominal obesity was the predictor (P < .05) of exercise performance during the treadmill and 6-minute walk tests, as well as physical activity. Elevated fasting glucose was the predictor (P < .05) of peripheral vascular measures, self-perceived walking ability and health, and health-related quality of life.
PAD patients with more metabolic syndrome components have worsened intermittent claudication, physical function, health-related quality of life, and peripheral circulation. Abdominal obesity and elevated fasting glucose are the metabolic syndrome components that are most predictive of these outcome measures. Aggressively treating these metabolic syndrome components may be particularly important in managing symptoms and long-term prognosis of PAD patients.
确定代谢综合征各组分对周围动脉疾病（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，并确定最能预测各项结局指标的代谢综合征组分。
对受间歇性跛行限制且患有代谢综合征三个（n = 48）、四个（n = 45）或五个（n = 40）组分的患者进行研究。对患者进行PAD特异性指标评估，包括踝臂指数（ABI）、初始跛行距离、绝对跛行距离、身体功能指标、健康相关生活质量，以及血管闭塞3分钟后的小腿血流和经皮氧分压反应。
初始跛行距离（均值±标准差）在患有三个（203±167米）、四个（124±77米）和五个（78±57米）代谢综合征组分的患者中逐渐下降（P = 0.019），绝对跛行距离在这些组中也逐渐下降（P = 0.036）（分别为414±224米、323±153米和249±152米）。此外，与仅患有三个代谢综合征组分的患者相比，患有所有五个组分的患者在峰值摄氧量、缺血窗口、6分钟步行距离、自我感知的步行能力和健康状况、日常身体活动、八个领域中的六个领域的健康相关生活质量、小腿充血以及血管闭塞后的小腿缺血方面的值受损（P < 0.05）。腹部肥胖是跑步机和6分钟步行试验期间运动表现以及身体活动的预测指标（P < 0.05）。空腹血糖升高是外周血管指标、自我感知的步行能力和健康状况以及健康相关生活质量的预测指标（P < 0.05）。
患有更多代谢综合征组分的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更差。腹部肥胖和空腹血糖升高是最能预测这些结局指标的代谢综合征组分。积极治疗这些代谢综合征组分对于管理PAD患者的症状和长期预后可能尤为重要。
