Vriens B, D'Abate F, Ozdemir B A, Fenner C, Maynard W, Budge J, Carradice D, Hinchliffe R J
Vascular Department, Colchester General Hospital, Colchester Hospital University NHS Foundation Trust, Colchester.
St. George's Vascular Institute, St. George's Hospital, St. George's University NHS Foundation Trust, London.
Diabet Med. 2018 Jul;35(7):895-902. doi: 10.1111/dme.13634. Epub 2018 May 2.
Peripheral artery disease is common in people with diabetes-related foot ulceration and is a risk factor for amputation. The best method for the detection or exclusion of peripheral artery disease is unknown. This study investigated the utility of clinical examination and non-invasive bedside tests in screening for peripheral artery disease in diabetes-related foot ulceration.
Some 60 people presenting with new-onset ulceration participated. Accuracy of pulses, ankle pressure, toe pressure, toe-brachial index (TBI), ankle-brachial pressure index (ABPI), pole test at ankle, transcutaneous oxygen pressure and distal tibial waveform on ultrasound were examined. The gold standard diagnostic test used was > 50% stenosis in any artery or monophasic flow distal to calcification in any ipsilateral vessel on duplex ultrasound.
The negative and positive likelihood ratios of pedal pulse assessment (0.75, 1.38) and the other clinical assessment tools were poor. The negative and positive likelihood ratios of ABPI (0.53, 1.69), transcutaneous oxygen pressure (1.10, 0.81) and ankle pressure (0.67, 2.25) were unsatisfactory. The lowest negative likelihood ratios were for tibial waveform assessment (0.15) and TBI (0.24). The highest positive likelihood ratios were for toe pressure (17.55) and pole test at the ankle (10.29) but the negative likelihood ratios were poor at 0.56 and 0.74.
Pulse assessment and ABPI have limited utility in the detection of peripheral artery disease in people with diabetes foot ulceration. TBI and distal tibial waveforms are useful for selecting those needing diagnostic testing.
外周动脉疾病在糖尿病相关足部溃疡患者中很常见，且是截肢的危险因素。目前尚不清楚检测或排除外周动脉疾病的最佳方法。本研究调查了临床检查和无创床边检查在筛查糖尿病相关足部溃疡外周动脉疾病中的效用。
约60例新发溃疡患者参与研究。检查了脉搏、踝压、趾压、趾臂指数（TBI）、踝臂压力指数（ABPI）、踝部杆式试验、经皮氧分压以及超声检查胫后动脉波形的准确性。所采用的金标准诊断测试为双功超声显示任何动脉狭窄>50%或同侧任何血管钙化远端出现单相血流。
足部脉搏评估（阴性和阳性似然比分别为0.75、1.38）及其他临床评估工具的效用较差。ABPI（阴性和阳性似然比分别为0.53、1.69）、经皮氧分压（阴性和阳性似然比分别为1.ll、0.81）和踝压（阴性和阳性似然比分别为0.67、2.25）的效用也不令人满意。胫后动脉波形评估（阴性似然比为0.15）和TBI（阴性似然比为0.24）的阴性似然比最低。趾压（阳性似然比为17.55）和踝部杆式试验（阳性似然比为10.29）的阳性似然比最高，但阴性似然比分别为0.56和0.74，较差。
脉搏评估和ABPI在检测糖尿病足溃疡患者外周动脉疾病方面效用有限。TBI和胫后动脉波形有助于筛选出需要进行诊断性检查的患者。
