Chen Szu-Chia, Lee Mei-Yueh, Huang Jiun-Chi, Mai Hsiu-Chin, Kuo Po-Lin, Chang Jer-Ming, Chen Hung-Chun, Yang Yi-Hsin
Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
PLoS One. 2017 Apr 13;12(4):e0175363. doi: 10.1371/journal.pone.0175363. eCollection 2017.
Peripheral artery occlusive disease is common among diabetes mellitus (DM) and end-stage renal disease patients, and tends to progress faster and lead to worse outcomes. This study compared the association of DM with the decline in ankle-brachial index (ABI) among patients on hemodialysis (HD). This was a longitudinal analysis of ABI in HD patients from 2009 to 2015. Medical records and yearly ABI values were obtained. A longitudinal mixed-model analysis was used to evaluate ABI changing trends while accounting for within-patients correlation. There were 296 patients on HD in the period of 2009-2015. In a 6-year follow-up, those with DM had a more rapid ABI decline compared to non-DM patients (slopes: -0.014 vs. 0.010 per year, interaction p < 0.001). In DM patients, female sex, high pulse pressure, high triglyceride, low creatinine, and high uric acid were associated with a decrease in ABI. In non-DM patients, old age, high pulse pressure, high low-density lipoprotein cholesterol, and high uric acid were associated with a decreased in ABI. There were 49.6% of patients with a normal ABI experienced a decrease at least 0.1 of ABI from baseline, and 35.3% had a final ABI < 0.9 in patients with a baseline ABI ≥ 0.9 (n = 232). In this study, DM patients on HD tend to develop a more rapid decline in ABI than non-DM patients on HD. Age, sex, pulse pressure, lipid profile, creatinine, and uric acid are associated with a decreased in ABI.
外周动脉闭塞性疾病在糖尿病（DM）患者和终末期肾病患者中很常见，并且往往进展更快，导致更差的预后。本研究比较了血液透析（HD）患者中DM与踝臂指数（ABI）下降之间的关联。这是一项对2009年至2015年HD患者ABI的纵向分析。获取了病历和年度ABI值。采用纵向混合模型分析来评估ABI的变化趋势，同时考虑患者内部的相关性。2009 - 2015年期间有296例HD患者。在6年的随访中，与非DM患者相比，DM患者的ABI下降更快（斜率：每年-0.014对0.010，交互作用p<0.001）。在DM患者中，女性、高脉压、高甘油三酯、低肌酐和高尿酸与ABI下降有关。在非DM患者中，老年、高脉压、高低密度脂蛋白胆固醇和高尿酸与ABI下降有关。在基线ABI正常的患者中，有49.6%的患者ABI从基线至少下降了0.1，在基线ABI≥0.9的患者中（n = 232），有35.3%的患者最终ABI<0.9。在本研究中，HD的DM患者比HD的非DM患者ABI下降更快。年龄、性别、脉压、血脂谱、肌酐和尿酸与ABI下降有关。
