The Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Ul. Śniadeckich 10, 31-531, Kraków, Poland.
Department of Internal Medicine and Oncological Chemotherapy, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland.
Aging Clin Exp Res. 2019 Oct;31(10):1443-1449. doi: 10.1007/s40520-018-1095-6. Epub 2018 Dec 17.
Prevalence of peripheral arterial disease increases with age and is related to increased morbidity and mortality. The clinical diagnosis includes the measurement of ankle-brachial index (ABI).
To check the prevalence of abnormal ABI, and the value of physical examination of arterial system in detection of ABI < 0.9.
We performed subgroup analysis of patients included in the PolSenior survey. We measured ABI, performed physical examination of arterial system, assessed laboratory and questionnaire factors related to atherosclerosis. Participants were divided according to ABI strata of < 0.9, 0.9-1.4 and > 1.4. Clinical score of abnormalities on physical examination was proposed. Using logistic regression, we obtained areas under the curve (AUC).
The mean age of 844 participants (53.3% men) was 74.7 (10.6) years. ABI < 0.9 was found in 20.3% participants and it was linked to history of myocardial infarction, hypertension and renal failure. In the entire group, 72.4% of subjects declared, that they were able to walk a distance of 200 m without interruption. Higher clinical score was associated with lower ABI. Full physical examination (AUC = 0.67) followed by examination of lower extremities (AUC = 0.65) showed strongest diagnostic value for PAD based on ABI. Neither ABI nor clinical examination was a good predictor of the inability to walk 200 meters without difficulties.
DISCUSSION/CONCLUSIONS: Full clinical examination, only moderately, adds to detection of PAD. The ability to walk 200 m is not a good measure of PAD in older subjects.
周围动脉疾病的患病率随着年龄的增长而增加，与发病率和死亡率的增加有关。临床诊断包括踝肱指数（ABI）的测量。
检查异常 ABI 的患病率，以及动脉系统体格检查在检测 ABI<0.9 中的价值。
我们对 PolSenior 调查中纳入的患者进行了亚组分析。我们测量了 ABI，进行了动脉系统体格检查，评估了与动脉粥样硬化相关的实验室和问卷调查因素。参与者根据 ABI 分层分为<0.9、0.9-1.4 和>1.4。提出了体格检查异常的临床评分。使用逻辑回归，我们获得了曲线下面积（AUC）。
844 名参与者（53.3%为男性）的平均年龄为 74.7（10.6）岁。20.3%的参与者存在 ABI<0.9，且与心肌梗死、高血压和肾衰竭的病史有关。在整个组中，72.4%的受试者表示他们能够不间断地行走 200 米。较高的临床评分与较低的 ABI 相关。全面的体格检查（AUC=0.67），其次是下肢检查（AUC=0.65），在基于 ABI 的 PAD 诊断方面显示出最强的诊断价值。ABI 和临床检查都不是预测无法行走 200 米而无困难的良好指标。
讨论/结论：全面的临床检查仅适度增加了 PAD 的检出率。在老年患者中，行走 200 米的能力不是 PAD 的良好指标。
