Johns Kevin, Saeedi Ramesh, Mancini G B John, Bondy Greg
University of British Columbia, Vancouver, BC, Canada.
AIDS Res Hum Retroviruses. 2010 Sep;26(9):955-9. doi: 10.1089/aid.2009.0275.
Metabolic complications common to the HIV-positive population may increase the risk for cardiovascular disease. Asymptomatic peripheral arterial disease (PAD) is associated with increased cardiovascular risk. The ankle-brachial pressure index (ABI) is a screening tool commonly used for the detection of asymptomatic PAD. The prevalence of asymptomatic PAD based on ABI in HIV-positive patients is unknown. This study was cross-sectional in design and assessed PAD by measuring the systolic ABI as determined by a handheld 8-MHz Doppler probe with the patient at rest in a supine position. A brief medical history including pertinent risk factors was obtained. One hundred and sixty-seven HIV-positive patients were evaluated (97.6% male; mean age 52.0 years; 31.2% current smokers, 29.4% former smokers, 26.3% diabetes mellitus). Asymptomatic PAD (ABI < or = 0.9) was found in four patients (2.4%, 95% CI: 0.3-4.5%). Smoking was a significant predictor of PAD. Patients with a positive test for PAD had at least two major risk factors for the disease including smoking, a history of disease in another vascular bed, dyslipidemia, diabetes, and hypertension. All patients with a positive test for PAD had a high risk (>20%) for cardiovascular disease according to the Framingham risk score. Three of the four patients with positive tests had previously diagnosed vascular disease (CAD, stroke). Three patients presenting with PAD were evaluated and all had a positive ABI. The prevalence of PAD compared to previous studies on PAD in HIV was low and identified only those patients with high cardiovascular risk based on other features. ABI was not useful in detecting occult vascular disease in HIV-positive patients and offers no additional information to that derived from cardiovascular risk stratification.
HIV 阳性人群常见的代谢并发症可能会增加心血管疾病的风险。无症状外周动脉疾病（PAD）与心血管风险增加相关。踝臂指数（ABI）是一种常用于检测无症状 PAD 的筛查工具。基于 ABI 的 HIV 阳性患者中无症状 PAD 的患病率尚不清楚。本研究采用横断面设计，通过测量患者仰卧位休息时手持 8MHz 多普勒探头测定的收缩期 ABI 来评估 PAD。获取了包括相关危险因素在内的简要病史。对 167 名 HIV 阳性患者进行了评估（男性占 97.6%；平均年龄 52.0 岁；当前吸烟者占 31.2%，既往吸烟者占 29.4%，糖尿病患者占 26.3%）。4 名患者（2.4%，95%CI：0.3 - 4.5%）被发现患有无症状 PAD。吸烟是 PAD 的一个重要预测因素。PAD 检测呈阳性的患者至少有两种该疾病的主要危险因素，包括吸烟、另一血管床疾病史、血脂异常、糖尿病和高血压。根据弗雷明汉风险评分，所有 PAD 检测呈阳性的患者患心血管疾病的风险都很高（>20%）。4 名检测呈阳性的患者中有 3 名先前已被诊断患有血管疾病（冠心病、中风）。对 3 名出现 PAD 的患者进行了评估，他们的 ABI 均呈阳性。与之前关于 HIV 患者中 PAD 的研究相比（本研究中）PAD 的患病率较低，并且仅根据其他特征识别出那些心血管风险高的患者。ABI 在检测 HIV 阳性患者的隐匿性血管疾病方面并无用处，并且相较于心血管风险分层所获得的信息并无额外价值。
