Natsuaki Chiharu, Inoguchi Toyoshi, Maeda Yasutaka, Yamada Tomomi, Sasaki Shuji, Sonoda Noriyuki, Shimabukuro Michio, Nawata Hajime, Takayanagi Ryoichi
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Innovation Center for Medical Redox Navigation, Kyushu University, Fukuoka, Japan.
Atherosclerosis. 2014 Jun;234(2):360-5. doi: 10.1016/j.atherosclerosis.2014.03.018. Epub 2014 Mar 27.
Peripheral artery disease (PAD) and diabetes mellitus are significant risk factors for all-cause death or cardiovascular death. PAD occurs more frequently in diabetic than in non-diabetic patients. However, the association of ankle-brachial index (ABI), especially borderline ABI, with clinical outcomes has not been fully elucidated in diabetic patients. This study aimed to investigate the association of ABI with mortality and the incidence of PAD in Japanese diabetic patients.
This observational study included 3981 diabetic patients (61.0 ± 11.8 years of age, 59.4% men), registered in the Kyushu Prevention Study for Atherosclerosis. Patients were divided into 3 groups according to the value of ABI at baseline: ABI ≤0.90 (abnormal ABI:354 patients), 0.91 ≤ ABI ≤ 0.99 (borderline ABI:333 patients), and 1.00 ≤ ABI ≤ 1.40 (normal ABI:3294 patients).
Cumulative incidence of all-cause death was significantly higher in patients with abnormal and borderline ABI than in those with normal ABI (34.4% vs. 13.5%, P < 0.0001 and 26.1% vs. 13.5%, P < 0.0001, respectively). In multivariate analysis, the risks for all-cause death in patients with abnormal ABI (HR:2.16; 95%CI:1.46-3.14; P = 0.0002) and borderline ABI (HR:1.78; 95%CI:1.14-2.70; P = 0.01) were significantly higher than in those with normal ABI. The incidence of PAD was remarkably higher in patients with borderline ABI than in those with normal ABI (32.2% vs.9.6%, P < 0.0001). After adjustment, the risk for PAD was significantly higher in patients with borderline ABI than in those with normal ABI (HR:3.10; 95%CI:1.90-4.95; P < 0.0001).
Borderline ABI in diabetic patients was associated with significantly higher risks for mortality and PAD compared with normal ABI.
外周动脉疾病（PAD）和糖尿病是全因死亡或心血管死亡的重要危险因素。PAD在糖尿病患者中比非糖尿病患者更常见。然而，在糖尿病患者中，踝臂指数（ABI），尤其是临界ABI与临床结局之间的关联尚未完全阐明。本研究旨在调查日本糖尿病患者中ABI与死亡率及PAD发病率之间的关联。
这项观察性研究纳入了3981例糖尿病患者（年龄61.0±11.8岁，男性占59.4%），这些患者均登记于九州动脉粥样硬化预防研究中。根据基线时的ABI值将患者分为3组：ABI≤0.90（异常ABI：354例患者）、0.91≤ABI≤0.99（临界ABI：333例患者）和1.00≤ABI≤1.40（正常ABI：3294例患者）。
异常ABI和临界ABI患者的全因死亡累积发生率显著高于正常ABI患者（分别为34.4%对13.5%，P<0.0001；26.1%对13.5%，P<0.0001）。在多变量分析中，异常ABI患者（HR：2.16；95%CI：1.46 - 3.14；P = 0.0002）和临界ABI患者（HR：1.78；95%CI：1.14 - 2.70；P = 0.01）的全因死亡风险显著高于正常ABI患者。临界ABI患者的PAD发病率显著高于正常ABI患者（32.2%对9.6%，P<0.0001）。经过调整后，临界ABI患者的PAD风险显著高于正常ABI患者（HR：3.10；95%CI：1.90 - 4.95；P<0.0001）。
与正常ABI相比，糖尿病患者的临界ABI与显著更高的死亡风险和PAD风险相关。
