踝臂指数对中国慢性肾脏病患者全因死亡率和心血管死亡率的预测价值。

Predictive value of ankle-brachial index to all-cause mortality and cardiovascular mortality in Chinese patients with chronic kidney disease.

作者信息

Wang Yong, Guo Xiaoyan, Li Jue, Hu Dayi, Zhao Dongdong, Ma Heng, Mou Qingjie, Liu Jing, Xu Yawei

机构信息

Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.

出版信息

Vasa. 2012 May;41(3):205-13. doi: 10.1024/0301-1526/a000187.

DOI:10.1024/0301-1526/a000187

PMID:22565622

Abstract

BACKGROUND

To investigate the predictive value of ankle-brachial index (ABI) for all-cause mortality and cardiovascular mortality in Chinese patients with chronic kidney disease (CKD).

PATIENTS AND METHODS

1563 CKD patients were enrolled in the cohort and were followed up for about 3 years in China. CKD was defined as an eGFR less than 60 ml/min/1.73m(2). 573 participants were diagnosed with PAD using ABI <= 0.90. Their average age was 73.4 ±8.2 years.

RESULTS

During a median follow-up of 38 months, there were 1353 CKD patients with complete data. A total of 313 patients (161 with and 152 without PAD) died during follow-up. 184 deaths (99 with and 85 without PAD) were caused by cardiovascular disease (CVD). All-cause and CVD mortality of CKD patients with PAD was increased 2.2-fold and 2.4-fold compared with CKD patients without PAD. The hazard ratio (HR) of PAD for all-cause and CVD mortality was 2.15 (95 % CI: 1.66 - 2.79) and 2.51 (95 % CI: 1.80 - 3.50) respectively. Mortality of CKD patients significantly increased with decreasing ABI. That of CKD patients with ABI <= 0.4 was the highest (42.9 % and 28.6 %, respectively) in different ABI categories. Relative risks of all-cause and CVD mortality of CKD patients with ABI <= 0.4 were increased 3.479-fold (95 % CI: 2.076 - 5.830) and 4.960-fold (95 % CI: 2.644 - 9.302) respectively compared with those of patients with ABI > 1.0 and <= 1.4. Special models to evaluate the predictive value of ABI to mortality of CKD patients suggested that addition of ABI significantly increased the predictive value of the model for 3-year mortality compared with a model including conventional risk factors alone.

CONCLUSIONS

Low ankle-brachial index can predict increased mortality of chronic kidney disease patients. Addition of ankle-brachial index can significantly improve the prediction of 3-year mortality compared with conventional risk factors alone.

摘要

背景

探讨踝臂指数（ABI）对中国慢性肾脏病（CKD）患者全因死亡率和心血管死亡率的预测价值。

患者与方法

1563例CKD患者纳入该队列研究，并在中国进行了约3年的随访。CKD定义为估算肾小球滤过率（eGFR）低于60 ml/min/1.73m²。573例参与者经ABI≤0.90诊断为外周动脉疾病（PAD）。他们的平均年龄为73.4±8.2岁。

结果

在38个月的中位随访期内，有1353例CKD患者获得完整数据。随访期间共有313例患者死亡（161例合并PAD，152例未合并PAD）。184例死亡（99例合并PAD，85例未合并PAD）由心血管疾病（CVD）导致。合并PAD的CKD患者全因死亡率和CVD死亡率较未合并PAD的CKD患者分别升高2.2倍和2.4倍。PAD对全因死亡率和CVD死亡率的风险比（HR）分别为2.15（95%CI：1.66 - 2.79）和2.51（95%CI：1.80 - 3.50）。CKD患者的死亡率随ABI降低而显著升高。在不同ABI类别中，ABI≤0.4的CKD患者死亡率最高（分别为42.9%和28.6%）。与ABI＞1.0且≤1.4的患者相比，ABI≤0.4的CKD患者全因死亡率和CVD死亡率的相对风险分别升高3.479倍（95%CI：2.076 - 5.830）和4.960倍（95%CI：2.644 - 9.302）。评估ABI对CKD患者死亡率预测价值的特殊模型表明，与仅包含传统危险因素的模型相比，加入ABI显著提高了模型对3年死亡率的预测价值。