Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kamigyo-ku, Kyoto, Japan.
Hypertens Res. 2012 Jul;35(7):745-9. doi: 10.1038/hr.2012.16. Epub 2012 Feb 16.
The aim of this study was to investigate whether toe-brachial index (TBI) is more strongly associated with albuminuria or estimated glomerular filtration rate (eGFR) than ankle-brachial index (ABI), and thus is a more suitable tool for evaluating the association between peripheral artery disease (PAD) and diabetic nephropathy than ABI in patients with type 2 diabetes. We evaluated the relationships between ABI or TBI and the degree of urinary albumin excretion or eGFR, as well as the major cardiovascular risk factors, in 390 patients with type 2 diabetes. Furthermore, we compared the area under the receiver-operator characteristic curve (AUC) of TBI or ABI for albuminuria or chronic kidney disease (CKD). Low-density lipoprotein cholesterol was negatively associated with ABI. Age and duration of diabetes were negatively associated with TBI, and diastolic blood pressure and high-density lipoprotein cholesterol were positively associated with TBI. Log (urinary albumin excretion) was associated more strongly with TBI (r=-0.265, P<0.0001) than with ABI (r=-0.132, P=0.0111), and eGFR was positively associated with TBI (r=0.195, P=0.0002) but not with ABI (r=0.023, P=0.6571). The AUCs of TBI for albuminuria (P=0.0002) and CKD (P=0.0322) were significantly greater than those of ABI. In conclusion, TBI is associated more strongly with albuminuria and eGFR than ABI in patients with type 2 diabetes. Our study suggests that TBI may be a more suitable tool for evaluating the association between PAD and diabetic nephropathy than ABI in patients with type 2 diabetes.
本研究旨在探讨足踝肱指数（TBI）与白蛋白尿或估算肾小球滤过率（eGFR）的相关性是否强于踝肱指数（ABI），以及在 2 型糖尿病患者中，TBI 是否比 ABI 更适合评估外周动脉疾病（PAD）与糖尿病肾病之间的关联。我们评估了 390 例 2 型糖尿病患者的 ABI 或 TBI 与尿白蛋白排泄量或 eGFR 程度之间的关系，以及主要心血管危险因素。此外，我们比较了 TBI 或 ABI 对白蛋白尿或慢性肾脏病（CKD）的受试者工作特征曲线（ROC）下面积（AUC）。低密度脂蛋白胆固醇与 ABI 呈负相关。年龄和糖尿病病程与 TBI 呈负相关，舒张压和高密度脂蛋白胆固醇与 TBI 呈正相关。Log（尿白蛋白排泄量）与 TBI 的相关性更强（r=-0.265，P<0.0001），而与 ABI 的相关性较弱（r=-0.132，P=0.0111），eGFR 与 TBI 呈正相关（r=0.195，P=0.0002），而与 ABI 无关（r=0.023，P=0.6571）。TBI 对白蛋白尿（P=0.0002）和 CKD（P=0.0322）的 AUC 明显大于 ABI。结论：TBI 与 2 型糖尿病患者的白蛋白尿和 eGFR 的相关性强于 ABI。本研究表明，TBI 可能比 ABI 更适合评估 2 型糖尿病患者的 PAD 与糖尿病肾病之间的关联。
