Gardner Andrew W, Parker Donald E, Montgomery Polly S, Blevins Steve M, Nael Raha, Afaq Azhar
CMRI Diabetes and Metabolic Research Program, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA.
J Vasc Surg. 2009 Jul;50(1):77-82. doi: 10.1016/j.jvs.2008.12.065. Epub 2009 Feb 15.
We tested the hypotheses that women have greater impairment in calf muscle hemoglobin oxygen saturation (StO(2)) in response to exercise than men, and that the sex-related difference in calf muscle StO(2) would partially explain the shorter claudication distances of women.
The study comprised 27 men and 24 women with peripheral arterial disease limited by intermittent claudication. Patients were characterized on calf muscle StO(2) before, during, and after a graded treadmill test, as well as on demographic and cardiovascular risk factors, ankle-brachial index (ABI), ischemic window, initial claudication distance (ICD), and absolute claudication distance (ACD).
Women had a 45% lower ACD than men (296 +/- 268 m vs 539 +/- 288 m; P = .001) during the treadmill test. Calf muscle StO(2) declined more rapidly during exercise in women than in men; the time to reach minimum StO(2) occurred 54% sooner in women (226 +/- 241 vs 491 +/- 426 seconds; P = .010). The recovery time for calf muscle StO(2) to reach the resting value after treadmill exercise was prolonged in women (383 +/- 365 vs 201 +/- 206 seconds; P = .036). Predictors of ACD included the time from start of exercise to minimum calf muscle StO(2), the average rate of decline in StO(2) from rest to minimum StO(2) value, the recovery half-time of StO(2), and ABI (R(2) = 0.70; P < .001). The ACD of women remained lower after adjusting for ABI (mean difference, 209 m; P = .003), but was no longer significantly lower (mean difference, 72 m; P = .132) after further adjustment for the StO(2) variables for the three calf muscles.
In patients limited by intermittent claudication, women have lower ACD and greater impairment in calf muscle StO(2) during and after exercise than men, the exercise-mediated changes in calf muscle StO(2) are predictive of ACD, and women have similar ACD as men after adjusting for calf StO(2) and ABI measures.
我们检验了以下假设，即运动时女性小腿肌肉血红蛋白氧饱和度（StO₂）的受损程度比男性更大，且小腿肌肉StO₂的性别差异能部分解释女性跛行距离较短的原因。
该研究纳入了27名男性和24名患有间歇性跛行所致外周动脉疾病的女性。对患者在分级平板运动试验前、运动期间和运动后的小腿肌肉StO₂进行了评估，同时还评估了人口统计学和心血管危险因素、踝臂指数（ABI）、缺血窗口、初始跛行距离（ICD）和绝对跛行距离（ACD）。
在平板运动试验期间，女性的ACD比男性低45%（296±268米对539±288米；P = 0.001）。女性运动期间小腿肌肉StO₂下降速度比男性更快；女性达到最低StO₂的时间比男性早54%（226±241秒对491±426秒；P = 0.010）。平板运动后女性小腿肌肉StO₂恢复到静息值的时间延长（383±365秒对201±206秒；P = 0.036）。ACD的预测因素包括从运动开始到小腿肌肉最低StO₂的时间、StO₂从静息到最低StO₂值的平均下降速率、StO₂的恢复半衰期以及ABI（R² = 0.70；P < 0.001）。调整ABI后女性的ACD仍然较低（平均差异为209米；P = 0.003），但在进一步调整三块小腿肌肉的StO₂变量后，不再显著较低（平均差异为72米；P = 0.132）。
在受间歇性跛行限制的患者中，女性的ACD低于男性，且运动期间及运动后小腿肌肉StO₂的受损程度比男性更大，运动介导的小腿肌肉StO₂变化可预测ACD，调整小腿StO₂和ABI测量值后，女性的ACD与男性相似。
