Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Section 4, Taichung, 40705, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan.
Cardiovasc Diabetol. 2020 Oct 9;19(1):173. doi: 10.1186/s12933-020-01149-7.
Peripheral artery disease (PAD) in the lower extremities is a common complication of type 2 diabetes and has been shown to be associated with mortality. The ankle-brachial index (ABI) is a simple noninvasive method to screen PAD, but this method has limited sensitivity. We hypothesized that using the percentage of mean arterial pressure (%MAP) in combination with the ABI would improve the prediction of mortality.
We retrospectively collected data from patients with type 2 diabetes who had undergone ABI and %MAP measurements at our hospital. We separated the cohort into four groups according to their ABI and %MAP values, and we examined whether these indices were associated with mortality.
A total of 5569 patients (mean age, 65 ± 11 years) were enrolled. During the follow-up period (median, 22.9 months), 266 (4.8%) of the enrolled patients died. The combination of ABI and %MAP was significantly more effective than ABI alone for predicting mortality (C index of 0.62, 95% confidence interval [CI] of 0.57 to 0.65 vs. C index of 0.57, 95% CI of 0.53 to 0.62; P = 0.038). In multivariate analysis (with a reference group defined by ABI > 0.90 and %MAP ≤ 45%), the highest risk of mortality was seen in patients with ABI ≤ 0.90 and %MAP > 45% (hazard ratio = 2.045 [95% CI 1.420, 2.945], P < 0.001).
The use of %MAP alongside ABI appears to significantly improve the prediction of all-cause mortality in patients with type 2 diabetes.
下肢外周动脉疾病（PAD）是 2 型糖尿病的常见并发症，并且与死亡率相关。踝肱指数（ABI）是一种筛查 PAD 的简单无创方法，但该方法的敏感性有限。我们假设使用平均动脉压（MAP）的百分比（%MAP）与 ABI 相结合将提高对死亡率的预测能力。
我们回顾性地收集了在我院接受 ABI 和 %MAP 测量的 2 型糖尿病患者的数据。我们根据他们的 ABI 和 %MAP 值将队列分为四组，并检查这些指数是否与死亡率相关。
共纳入 5569 例患者（平均年龄 65±11 岁）。在随访期间（中位数 22.9 个月），266 例（4.8%）患者死亡。ABI 和 %MAP 的组合在预测死亡率方面明显优于单独的 ABI（C 指数为 0.62，95%置信区间 [CI]为 0.57 至 0.65 比 C 指数为 0.57，95%CI 为 0.53 至 0.62；P=0.038）。在多变量分析中（以 ABI>0.90 和 %MAP≤45%定义的参考组为基准），ABI≤0.90 和 %MAP>45%的患者死亡率最高（危险比=2.045[95%CI 1.420，2.945]，P<0.001）。
ABI 结合 %MAP 的使用似乎显著提高了 2 型糖尿病患者全因死亡率的预测能力。
