Garimella Pranav S, Ix Joachim H, Katz Ronit, Shlipak Michael G, Criqui Michael H, Siscovick David S, Kramer Holly, Sibley Christopher T, Sarnak Mark J
Tufts Medical Center, Boston, MA.
University of California, San Diego, CA.
Am J Kidney Dis. 2015 Jan;65(1):33-40. doi: 10.1053/j.ajkd.2014.05.014. Epub 2014 Jul 3.
Low ankle-brachial index (ABI) is a reflection of atherosclerotic disease, and high ABI is an indicator of calcified vessels. The associations of albuminuria and cystatin C level with incidence of either low or high ABI are unknown.
Prospective longitudinal cohort study.
SETTING & PARTICIPANTS: MESA (Multi-Ethnic Study of Atherosclerosis) enrolled community-dwelling adults (N=6,814) aged 45-84 years who were free of clinical cardiovascular disease at baseline.
Baseline albumin-creatinine ratio (ACR) and serum cystatin C level.
Development of low (<0.90), and high (>1.40) ABI using multinomial regression among persons with ABI of 0.90-1.40 at baseline.
During 9.8 years of follow-up, 221 and 89 participants progressed to low and high ABIs, respectively. Baseline ACR and cystatin C level were higher among progressors compared with nonprogressors. In multivariable analyses, doubling of ACR was associated with increased risk of progression to low (OR, 1.08; 95% CI, 0.99-1.20) and high (OR, 1.16; 95% CI, 1.01-1.32) ABIs. Compared to the lowest quintile, the highest quintile of ACR had a significantly increased risk of progression to low (OR, 1.79; 95% CI, 1.03-3.12) and high (OR, 2.76; 95% CI, 1.32-5.77) ABIs. Higher cystatin C levels were associated with progression to low (OR per 1-SD greater, 1.12; 95% CI, 1.00-1.26) but not high (OR per 1-SD greater, 1.01; 95% CI, 0.81-1.25) ABI, but the highest quintile of cystatin C was not associated independently with either outcome.
Single measure of albuminuria and low number of progressors to high ABI.
In adults free of clinical cardiovascular disease, albuminuria was a strong independent risk factor for the development of both high and low ABIs, important and different measures of peripheral artery disease.
低踝臂指数（ABI）反映动脉粥样硬化疾病，高ABI是血管钙化的指标。蛋白尿和胱抑素C水平与低或高ABI发生率之间的关联尚不清楚。
前瞻性纵向队列研究。
动脉粥样硬化多族裔研究（MESA）纳入了年龄在45 - 84岁、基线时无临床心血管疾病的社区居住成年人（N = 6814）。
基线白蛋白肌酐比值（ACR）和血清胱抑素C水平。
在基线ABI为0.90 - 1.40的人群中，使用多项回归分析低（<0.90）和高（>1.40）ABI的发生情况。
在9.8年的随访期间，分别有221名和89名参与者进展为低ABI和高ABI。进展者的基线ACR和胱抑素C水平高于未进展者。在多变量分析中，ACR翻倍与进展为低ABI（比值比[OR]，1.08；95%置信区间[CI]，0.99 - 1.20）和高ABI（OR，1.16；95% CI，1.01 - 1.32）的风险增加相关。与最低五分位数相比，ACR最高五分位数进展为低ABI（OR，1.79；95% CI，1.03 - 3.12）和高ABI（OR，2.76；95% CI，1.32 - 5.77）的风险显著增加。较高的胱抑素C水平与进展为低ABI（每增加1个标准差的OR，1.12；95% CI，1.00 - 1.26）相关，但与高ABI无关（每增加1个标准差的OR，1.01；95% CI，0.81 - 1.25），但胱抑素C的最高五分位数与这两种结果均无独立关联。
蛋白尿的单次测量以及进展为高ABI的人数较少。
在无临床心血管疾病的成年人中，蛋白尿是高和低ABI发生的强独立危险因素，而高和低ABI是外周动脉疾病的重要且不同的指标。
