University of Iowa, Iowa City.
Fairfax Family Practice Residency, Fairfax, Virginia.
JAMA. 2018 Jul 10;320(2):177-183. doi: 10.1001/jama.2018.8357.
Peripheral artery disease (PAD) is a manifestation of atherosclerosis in the lower limbs. It can impair walking and, in severe cases, can lead to tissue loss, infection, and amputation. In addition to morbidity directly caused by PAD, patients with PAD are at increased risk for cardiovascular disease (CVD) events, because atherosclerosis is a systemic disease that also causes coronary and cerebrovascular events.
To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on screening for PAD and CVD risk with the ankle-brachial index (ABI).
The USPSTF reviewed the evidence on whether screening for PAD with the ABI in generally asymptomatic adults reduces morbidity or mortality from PAD or CVD. The current review expanded on the previous review to include individuals with diabetes and interventions that include supervised exercise and physical therapy intended to improve outcomes in the lower limbs.
The USPSTF found few data on the accuracy of the ABI for identifying asymptomatic persons who can benefit from treatment of PAD or CVD. There are few studies addressing the benefits of treating screen-detected patients with PAD; 2 good-quality studies showed no benefit of using the ABI to manage daily aspirin therapy in unselected populations, and 2 studies showed no benefit from exercise therapy. No studies addressed the harms of screening, although the potential exists for overdiagnosis, labeling, and opportunity costs. Studies that addressed the harms of treatment showed nonsignificant results. Therefore, the USPSTF concludes that the current evidence is insufficient and that the balance of benefits and harms of screening for PAD with the ABI in asymptomatic adults cannot be determined.
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for PAD and CVD risk with the ABI in asymptomatic adults. (I statement).
外周动脉疾病（PAD）是下肢动脉粥样硬化的表现。它会影响行走能力，在严重情况下，会导致组织损失、感染和截肢。除了 PAD 直接引起的发病率外，患有 PAD 的患者发生心血管疾病（CVD）事件的风险也增加了，因为动脉粥样硬化是一种全身性疾病，也会导致冠状动脉和脑血管事件。
更新 2013 年美国预防服务工作组（USPSTF）关于使用踝肱指数（ABI）筛查 PAD 和 CVD 风险的建议。
USPSTF 审查了在一般无症状成年人中使用 ABI 筛查 PAD 是否会降低 PAD 或 CVD 的发病率或死亡率的证据。本次审查扩大了之前的审查范围，包括患有糖尿病的个体和包括监督运动和物理治疗在内的干预措施，旨在改善下肢的预后。
USPSTF 发现关于 ABI 识别无症状者的准确性的少量数据，这些无症状者可以从 PAD 或 CVD 的治疗中受益。关于治疗筛查出的 PAD 患者的益处的研究很少；2 项高质量的研究表明，在未选择的人群中，使用 ABI 管理日常阿司匹林治疗没有益处，2 项研究表明运动治疗没有益处。没有研究涉及筛查的危害，尽管存在过度诊断、标记和机会成本的可能性。研究表明，治疗的危害结果没有意义。因此，USPSTF 得出结论，目前的证据不足，无法确定在无症状成年人中使用 ABI 筛查 PAD 的益处和危害的平衡。
USPSTF 得出结论，目前的证据不足以评估在无症状成年人中使用 ABI 筛查 PAD 和 CVD 风险的益处和危害的平衡。（I 级声明）。
