Alvarez-Sabín José, Gil-Núñez A, Quintana M, Barbera G
Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona.
Neurologia. 2009 Jul-Aug;24(6):366-72.
The prevalence of asymptomatic peripheral arterial disease (PAD) detected by the ankle-brachial index (ABI) measurement in stroke patients and its relation with the risk of vascular events recurrence is unknown. A main objective of the APICA study (prevalence of peripheral arterial disease and metabolic syndrome in acute cerebral ischemia) is to analyse the prevalence in our country and to identify clinical variables associated with higher risk of PAD.
Epidemiologic, observational, longitudinal, multicenter study including patients older than 50 with non-cardioembolic transient ischemic attack (TIA) or ischemic stroke, consecutively recruited. PAD was determined if ABI = 0.9. Statistical analysis was performed with SPSS 15.0. A logistic regression analysis was performed to find factors independently associated with asymptomatic PAD.
977 patients were included. 651 (66.7 %) were males and mean age was 69.1. 396 (40.5 %) cases had PAD, after excluding patients with previously known PAD, 321 (35.6%) were defined as asymptomatic PAD. The factors independently associated with asymptomatic PAD were: age (OR 1.020 [1.004-1.037], p = 0.017), previous stroke (1.52 [1.05-2.20], p = 0.027), coronary revascularization (1.97 [1.03-3.79], p = 0.041), established stroke (1.86 [1.20-2.88], p = 0.006), atherothrombotic etiology (1.54 [1.13-2.10], p = 0.006), systolic blood pressure (1.009 [1.001-1.017], p = 0.027) and waist perimeter (0.989 [0.978-1.000], p = 0.005).
More than a third of the patients with noncardioembolic ischemic stroke have asymptomatic PAD. Asymptomatic PAD is mainly observed in older patients, with hypertension, multiple vascular territories condition and with atherothrombotic etiology of stroke.
通过踝臂指数（ABI）测量在卒中患者中检测到的无症状外周动脉疾病（PAD）的患病率及其与血管事件复发风险的关系尚不清楚。APICA研究（急性脑缺血中外周动脉疾病和代谢综合征的患病率）的一个主要目标是分析我国的患病率，并确定与PAD高风险相关的临床变量。
进行一项流行病学、观察性、纵向、多中心研究，纳入年龄大于50岁的非心源性短暂性脑缺血发作（TIA）或缺血性卒中患者，连续招募。若ABI≤0.9，则判定为PAD。使用SPSS 15.0进行统计分析。进行逻辑回归分析以找出与无症状PAD独立相关的因素。
共纳入977例患者。其中男性651例（66.7%），平均年龄69.1岁。396例（40.5%）患者患有PAD，排除既往已知患有PAD的患者后，321例（35.6%）被定义为无症状PAD。与无症状PAD独立相关的因素有：年龄（比值比[OR]1.020[1.004 - 1.037]，p = 0.017）、既往卒中（1.52[1.05 - 2.20]，p = 0.027）、冠状动脉血运重建（1.97[1.03 - 3.79]，p = 0.041）、确诊卒中（1.86[1.20 - 2.88]，p = 0.006）、动脉粥样硬化血栓形成病因（1.54[1.13 - 2.10]，p = 0.006）、收缩压（1.009[1.001 - 1.017]，p = 0.027）和腰围（0.989[0.978 - 1.000]，p = 0.005）。
超过三分之一的非心源性缺血性卒中患者患有无症状PAD。无症状PAD主要见于老年患者，伴有高血压、多血管区域病变以及动脉粥样硬化血栓形成性卒中病因。
