Jahn Jürgen, Zimmermann Werner, Moysidis Theodoros, Kröger Knut
Innere Medizin II des Evangelischen Krankenhauses Castrop-Rauxel, Germany.
Department of Vascular Medicine, HELIOS Klinikum Krefeld, Germany.
Vasa. 2014 May;43(3):202-8. doi: 10.1024/0301-1526/a000350.
The measurement of the ankle-brachial index (ABI) is a straightforward method for the detection of atherosclerosis in the lower limbs. Pneumoplethysmographic pulse-volume recordings (PVR) investigations are supposed to be less valid. Thus we compared the sensitivity of ABI and PVR in detection of PAD and its improvement by combining both methods.
122 consecutive patients admitted for PAD treatment were included. All patients (81 females; mean age 70 ± 15 years) had angiographic imaging of their peripheral arteries, a standardized personal interview and a determination of the ABI based on the highest (ABI high) and lowest (ABI low) ankle pressure. PVR parameters were oscillometric index (OI) and time to normalisation (TN) after exercise.
There was a small variation of ABI with different segmental manifestations of PAD. The OI did not vary with different segmental manifestations. TN was longest in iliac artery manifestation and got shorter with more distal manifestation. Correlation of TN and ABI high and ABI low was low. Sensitivity of ABI high in all legs was 78 %, but only 40 % in isolated crural manifestation. ABI low has higher sensitivities with 87 % in all legs, but a much lower specificity. Combining ABI and TN increases both sensitivity and specificity. The best sensitivity and specificity was seen using ABI low + TN in combination in all kinds of manifestations with 94 % and 96 %, respectively.
Combined assessment of ABI low and TN in post-exercise PVR seems to be a highly sensitive but also specific method to look for PAD compared to ABI high alone.
测量踝臂指数（ABI）是检测下肢动脉粥样硬化的一种直接方法。人们认为呼吸体积描记法脉搏容积记录（PVR）检查的有效性较低。因此，我们比较了ABI和PVR在检测外周动脉疾病（PAD）方面的敏感性，以及两种方法联合使用时其敏感性的提高情况。
纳入122例连续因PAD治疗入院的患者。所有患者（81名女性；平均年龄70±15岁）均接受了外周动脉血管造影成像、标准化的个人访谈，并根据最高（ABI高）和最低（ABI低）踝部压力测定了ABI。PVR参数为运动后的示波指数（OI）和恢复正常的时间（TN）。
ABI在PAD不同节段表现中的变化较小。OI在不同节段表现中无变化。TN在髂动脉表现中最长，随着病变部位更靠近远端而缩短。TN与ABI高和ABI低的相关性较低。ABI高在所有下肢的敏感性为78%，但在孤立的小腿病变中仅为40%。ABI低的敏感性较高，在所有下肢中为87%，但特异性低得多。联合使用ABI和TN可提高敏感性和特异性。在各种表现中，联合使用ABI低+TN时的敏感性和特异性最佳，分别为94%和96%。
与单独使用ABI高相比，运动后PVR中联合评估ABI低和TN似乎是一种检测PAD的高度敏感且特异的方法。
