踝臂指数、趾臂指数与糖尿病患者和非糖尿病患者的心血管死亡率。
Ankle-brachial index, toe-brachial index, and cardiovascular mortality in persons with and without diabetes mellitus.
机构信息
Department of Medicine, Loma Linda University Medical Center, Loma Linda, Calif.
Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, San Diego, Calif.
出版信息
J Vasc Surg. 2014 Aug;60(2):390-5. doi: 10.1016/j.jvs.2014.02.008. Epub 2014 Mar 21.
BACKGROUND
The prognostic utility of the ankle-brachial index (ABI) may be hampered in persons with diabetes due to peripheral arterial stiffening in the ankles. Stiffening of toe arteries occurs infrequently in diabetes. We aimed to determine the nature of the relationship of the toe-brachial index (TBI) and ABI with cardiovascular disease (CVD) mortality and to determine whether the associations are modified in individuals with diabetes.
METHODS
Individuals with clinically suspected atherosclerotic peripheral arterial disease who underwent ABI and TBI measurements in a vascular laboratory were monitored longitudinally for CVD mortality.
RESULTS
Among 469 participants (89% men), the mean age was 68 ± 9 years, and 36% had diabetes. The mean ABI was 0.83 ± 0.28 and the mean TBI was 0.60 ± 0.24. During median 7.0 years of follow-up, there were 158 CVD deaths. The association of the ABI categories with CVD deaths differed in diabetic vs nondiabetic participants (P = .002 for interaction). In contrast, the association of the TBI categories with CVD deaths was similar, irrespective of diabetes status (P = .17 for interaction). Among diabetic patients, a U-shaped relationship was observed between ABI categories and CVD death: those with low (<0.90) and high (>1.30) ABIs were both at higher risk than those with normal ABIs (range, 0.90-1.30). In nondiabetic patients, association of ABI categories with CVD death was linear, such that those with an ABI >1.30 were at the lowest risk, whereas those with an ABI <0.90 were at higher risk. In contrast, the association of TBI categories with CVD death was linear irrespective of diabetes status. High TBI categories consistently predicted low risk, whereas risk was higher with progressively lower TBI categories.
CONCLUSIONS
Among diabetic individuals with clinically suspected peripheral arterial disease, those with low and high ABIs are both at higher risk of CVD death. In contrast, a linear relationship was observed between TBI categories and CVD death irrespective of diabetes status. These findings suggest that stiffened ankle arteries may limit the predictive value of the ABI in individuals with diabetes, a limitation that may be overcome by measurement of the TBI.
背景
由于踝部的外周动脉僵硬，糖尿病患者的踝臂指数（ABI）的预后实用性可能会受到影响。脚趾动脉的僵硬在糖尿病中很少发生。我们旨在确定脚趾-臂指数（TBI）与 ABI 与心血管疾病（CVD）死亡率的关系的性质，并确定这些关联是否在患有糖尿病的个体中发生改变。
方法
在血管实验室接受 ABI 和 TBI 测量的疑似有临床症状的动脉粥样硬化性外周动脉疾病患者进行了纵向监测，以评估 CVD 死亡率。
结果
在 469 名参与者（89%为男性）中，平均年龄为 68 ± 9 岁，36%患有糖尿病。平均 ABI 为 0.83 ± 0.28，平均 TBI 为 0.60 ± 0.24。在中位 7.0 年的随访期间，有 158 例 CVD 死亡。ABI 分类与 CVD 死亡的关联在糖尿病与非糖尿病患者中存在差异（交互作用 P =.002）。相比之下，TBI 分类与 CVD 死亡的关联相似，无论糖尿病状态如何（交互作用 P =.17）。在糖尿病患者中，ABI 分类与 CVD 死亡之间存在 U 型关系：ABI 较低（<0.90）和较高（>1.30）的患者的风险均高于 ABI 正常的患者（范围为 0.90-1.30）。在非糖尿病患者中，ABI 分类与 CVD 死亡的关联呈线性关系，即 ABI >1.30 的患者的风险最低，而 ABI <0.90 的患者的风险较高。相比之下，TBI 分类与 CVD 死亡的关联呈线性关系，无论糖尿病状态如何。高 TBI 分类始终预示着低风险，而随着 TBI 分类的逐渐降低，风险则会升高。
结论
在患有临床疑似外周动脉疾病的糖尿病个体中，ABI 较低和较高的患者的 CVD 死亡风险均较高。相比之下，TBI 分类与 CVD 死亡之间的关系呈线性关系，无论糖尿病状态如何。这些发现表明，踝部僵硬的动脉可能会限制糖尿病患者 ABI 的预测价值，而通过 TBI 的测量可能会克服这种限制。
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