Musil Dalibor, Kaletova Marketa, Herman Jiri
Department of Internal Medicine I - Cardiology, Palacky University Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2011 Dec;155(4):367-71. doi: 10.5507/bp.2011.054.
The aim of this cross-sectional prospective study was investigate whether there is a correlation between age, BMI and severity of chronic venous disease (CVD), evaluated clinically (CEAP classification) and anatomically (extent of the epifascial venous reflux).
213 patients, 65 males (30.5%, mean age 45.1 ± 13.9 years) and 148 females (69.5%, mean age 47.5 ± 13.5 years) were divided into three age categories: 18-40 years (40.8%), 41-74 years (56.3%) and ≥75years (2.8%). BMI was classified as normal weight (18.5 - <25 kg/m(2)), overweight (25 - <30 kg/m(2)) and obesity (≥30 kg/m(2)). Clinical examination of the lower limbs assessed presence and severity of venous signs as included in the CEAP classification. BMI was calculated. Anatomical extent of CVD was described as the number of segments of the superficial and perforating veins with documented reflux by duplex imaging.
Median age increased the number of insufficient venous segments (1 insufficient venous segment - median age 41.0 years, 5 insufficient venous segments - median age 51.0 years). The frequency of reflux in the superficial and perforating veins significantly increased with age (p<0.05). A statistically significant correlation was also found between age and the CEAP classification (p<0.01). This was more significant than the correlation between age and number of insufficient venous segments. In the whole group and in women the Spearman's correlation analysis revealed only a weak positive correlation between BMI and reflux in the superficial veins (r=0.145 respectively r=0.264) (p<0.05). No correlation was found in men (r=0.091). Weak positive correlation between BMI and stage of venous insufficiency (CEAP classification) was demonstrated for the whole group of patients (r=0.229, p<0.01), for women (r=0.293, p<0.05) and for men (r=0.245, p<0.01). Multiple linear regression showed age (p<0.0001) and BMI (p=0.049) as significant predictors of clinical grade according to the CEAP classification and the CEAP clinical class (p<0.0001) as a significant predictor of extent of the epifascial venous reflux.
The study confirmed the relationship between age, clinical (CEAP clinical class) and pathophysiological (extent of the venous reflux) severity of CVD Older age means an increased number of insufficient venous segments and increased risk of the clinical progression of CVD from varicose veins to chronic venous insufficiency (C(3)-C(6), trophic skin changes and venous ulcers). Our results support the BMI, in term of frequency of venous reflux, as a risk factor in the whole group of patients but only in women but not in men. Multiple linear regression showed BMI together with age as significant predictors of clinical grade of CVD (p<0.05) according to the CEAP classification. As regards the influence of BMI on clinical severity/grade of CVD (CEAP), the results of our study support BMI as an important risk factor.
本横断面前瞻性研究旨在调查年龄、体重指数（BMI）与慢性静脉疾病（CVD）严重程度之间是否存在相关性，通过临床评估（CEAP分类）和解剖学评估（筋膜上静脉反流范围）进行。
213例患者，65例男性（30.5%，平均年龄45.1±13.9岁）和148例女性（69.5%，平均年龄47.5±13.5岁）被分为三个年龄组：18 - 40岁（40.8%）、41 - 74岁（56.3%）和≥75岁（2.8%）。BMI被分类为正常体重（18.5 - <25 kg/m²）、超重（25 - <30 kg/m²）和肥胖（≥30 kg/m²）。对下肢进行临床检查，评估CEAP分类中所包含的静脉体征的存在情况和严重程度。计算BMI。CVD的解剖学范围通过双功超声成像记录有反流的浅静脉和穿静脉节段数量来描述。
年龄中位数增加时，静脉功能不全节段数量增加（1个静脉功能不全节段 - 年龄中位数41.0岁，5个静脉功能不全节段 - 年龄中位数51.0岁）。浅静脉和穿静脉反流频率随年龄显著增加（p<0.05）。年龄与CEAP分类之间也发现有统计学显著相关性（p<0.01）。这比年龄与静脉功能不全节段数量之间的相关性更显著。在整个组和女性中，Spearman相关性分析仅显示BMI与浅静脉反流之间存在弱正相关（分别为r = 0.145和r = 0.264）（p<0.05）。在男性中未发现相关性（r = 0.091）。在整个患者组、女性和男性中均显示BMI与静脉功能不全阶段（CEAP分类）之间存在弱正相关（整个患者组r = 0.229，p<0.01；女性r = 0.293，p<0.05；男性r = 0.245，p<0.01）。多元线性回归显示，根据CEAP分类，年龄（p<0.0001）和BMI（p = 0.049）是临床分级的重要预测因素，CEAP临床分级（p<0.0001）是筋膜上静脉反流范围的重要预测因素。
该研究证实了年龄、CVD的临床（CEAP临床分级）和病理生理（静脉反流范围）严重程度之间的关系。年龄越大，静脉功能不全节段数量增加，CVD从静脉曲张进展为慢性静脉功能不全（C3 - C6，营养性皮肤改变和静脉溃疡）的临床风险增加。我们的结果支持BMI就静脉反流频率而言，在整个患者组中是一个危险因素，但仅在女性中是，在男性中不是。多元线性回归显示，根据CEAP分类，BMI与年龄一起是CVD临床分级的重要预测因素（p<0.05）。关于BMI对CVD（CEAP）临床严重程度/分级的影响，我们研究的结果支持BMI作为一个重要危险因素。
