Chang Li-Hsin, Hwu Chii-Min, Chu Chia-Huei, Won Justin G S, Kwok Ching-Fai, Lin Hong-Da, Chen Harn-Shen, Lin Yi-Chun, Lin Liang-Yu
Division of Endocrinology and Metabolism, Department of Medicine, Taouyan Branch of Taipei Veterans General Hospital, Taoyuan, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Division of Endocrinology and Metabolism, Department of Medicine, Taouyan Branch of Taipei Veterans General Hospital, Taoyuan, Taiwan; Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Am J Med Sci. 2016 May;351(5):492-8. doi: 10.1016/j.amjms.2016.02.035. Epub 2016 Mar 2.
The association between ankle brachial index (ABI) and outcomes in diabetic subjects is controversial. The purpose of this study was to evaluate whether the ABI is more strongly associated with cardiovascular outcomes comparing with non-high-density lipoprotein cholesterol (non-HDL-c).
A total of 452 type 2 diabetic subjects followed up for a mean of 5.8 years were grouped by ABI (<0.9 versus ≥0.9) and non-HDL-c (<100mg/dL versus ≥100mg/dL). Primary outcomes were composite events including all-cause mortality, hospitalization for coronary artery disease, stroke, revascularization, amputation and diabetic foot, and the secondary end point was all-cause mortality.
Intergroup differences in percentage of men, duration of diabetes, hemoglobin A1c, total cholesterol, low-density lipoprotein cholesterol, triglycerides and estimated glomerular filtration rate were significant. A total of 64 composite events and 17 deaths were recorded. A higher number of composite events occurred in the group with abnormal ABI but optimal non-HDL-c than in those with suboptimal non-HDL-c but normal ABI (29% versus 11%, P < 0.05). A similar trend was observed in all-cause mortality (11% versus 1%, P < 0.05). The ABI was the dominant risk factor for both end points after adjusting other factors (for composite events, hazard ratio = 0.02, 95% CI: 0.00-0.10, P < 0.001 and for all-cause mortality, hazard ratio = 0.01, 95% CI: 0.00-0.28, P = 0.006).
The ABI was more strongly associated with outcomes in diabetes than non-HDL-c. The ABI should be routinely screened in diabetes even without symptom.
踝臂指数（ABI）与糖尿病患者预后之间的关联存在争议。本研究的目的是评估与非高密度脂蛋白胆固醇（非HDL-c）相比，ABI是否与心血管预后的关联更强。
对452例2型糖尿病患者进行了平均5.8年的随访，根据ABI（<0.9与≥0.9）和非HDL-c（<100mg/dL与≥100mg/dL）进行分组。主要结局是复合事件，包括全因死亡率、冠状动脉疾病住院、中风、血运重建、截肢和糖尿病足，次要终点是全因死亡率。
男性百分比、糖尿病病程、糖化血红蛋白、总胆固醇、低密度脂蛋白胆固醇、甘油三酯和估算肾小球滤过率的组间差异显著。共记录了64例复合事件和17例死亡。ABI异常但非HDL-c正常的组中发生的复合事件数量高于非HDL-c异常但ABI正常的组（29%对11%，P<0.05）。全因死亡率也观察到类似趋势（11%对1%，P<0.05）。在调整其他因素后，ABI是两个终点的主要危险因素（对于复合事件，风险比=0.02，95%CI：0.00-0.10，P<0.001；对于全因死亡率，风险比=0.01，95%CI：0.00-0.28，P=0.006）。
与非HDL-c相比，ABI与糖尿病患者的预后关联更强。即使无症状，糖尿病患者也应常规筛查ABI。
