Cai Huoying, Pan Baihong, Xu Jie, Liu Shuai, Wang Lei, Wu Kemin, Yang Pu, Huang Jianhua, Wang Wei
Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China.
Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, China.
Front Cardiovasc Med. 2022 Jun 3;9:890228. doi: 10.3389/fcvm.2022.890228. eCollection 2022.
Etiology and risk factors of peripheral artery disease (PAD) include age, smoking, and hypertension, etc. , which are shared by an abdominal aortic aneurysm (AAA). Concomitance with AAA in patients with PAD is not rare but is easily overlooked in the clinical situation, though management strategies are altered totally. This study aims to investigate diagnostic biomarkers for the prediction of AAA in patients with PAD.
A total of 684 patients diagnosed with AAA and/or PAD were enrolled and analyzed retrospectively. Each patient with PAD and AAA was gender and age-matched. Demographic data, medical history, and serum laboratory test profiles were obtained. Statistical analysis was performed to determine diagnostic biomarkers of AAA in patients with PAD.
Firstly, 320 patients with PAD-only and 320 patients with AAA-only were compared. Levels of bilirubin and D-Dimer were decreased, while the incidence of diabetes mellitus, levels of fibrinogen, and platelet count were increased significantly in patients with PAD-only compared with those in patients with AAA-only ( < 0.001). Next, 364 patients with PAD (44 patients with AAA) and 364 patients with AAA (44 patients with PAD) were compared. Multivariate logistic regression analysis confirmed the differential distribution of bilirubin, D-dimer, fibrinogen, and platelet count between patients with AAA and patients with PAD ( < 0.05). Receiver operator curves (ROC) showed that the area under the curve (AUC) of total bilirubin, direct bilirubin, D-dimer, fibrinogen, and platelet count was 0.6113, 0.5849, 0.7034, 0.6473, and 0.6785, respectively. Finally, to further validate the predictive efficacy of mentioned markers, a multivariable logistics regression analysis was performed between the PAD only group and the PAD with AAA group. The results suggested increased levels of D-dimer in the PAD with AAA group compared to the PAD only group (OR: 2.630, 95% CI:1.639-4.221; < 0.001). In particular, the Youden index suggested that the cut-off value of D-dimer for predicting AAA in patients with PAD was 0.675 mg/L with a sensitivity of 76.9% and a specificity of 84.9% (AUC = 0.8673; 95% CI, 0.8106-0.9240, < 0.001). In all 364 patients with PAD, 41.46% patients were diagnosed AAA when D-dimer is >0.675 mg/L, while only 3.55% patients were diagnosed AAA when D-dimer ≤ 0.675 mg/L.
PAD and AAA exert different clinical and serum profiles; D-dimer (>0.675 mg/L) is a reliable biomarker for the prediction of AAA in patients with PAD.
外周动脉疾病（PAD）的病因和危险因素包括年龄、吸烟和高血压等，腹主动脉瘤（AAA）也存在这些因素。PAD患者合并AAA并不罕见，但在临床中易被忽视，尽管治疗策略会完全改变。本研究旨在探究预测PAD患者发生AAA的诊断生物标志物。
共纳入684例诊断为AAA和/或PAD的患者并进行回顾性分析。每个PAD和AAA患者在性别和年龄上进行匹配。获取人口统计学数据、病史和血清实验室检查结果。进行统计分析以确定PAD患者中AAA的诊断生物标志物。
首先，比较了320例单纯PAD患者和320例单纯AAA患者。与单纯AAA患者相比，单纯PAD患者的胆红素和D-二聚体水平降低，而糖尿病发病率、纤维蛋白原水平和血小板计数显著升高（<0.001）。接下来，比较了364例PAD患者（44例合并AAA）和364例AAA患者（44例合并PAD）。多因素逻辑回归分析证实了AAA患者和PAD患者之间胆红素、D-二聚体、纤维蛋白原和血小板计数的差异分布（<0.05）。受试者工作特征曲线（ROC）显示，总胆红素、直接胆红素、D-二聚体、纤维蛋白原和血小板计数的曲线下面积（AUC）分别为0.6113、0.5849、0.7034、0.6473和0.6785。最后，为进一步验证上述标志物的预测效能，在单纯PAD组和合并AAA的PAD组之间进行了多变量逻辑回归分析。结果表明，合并AAA的PAD组中D-二聚体水平高于单纯PAD组（OR：2.630，95%CI：1.639 - 4.221；<0.001）。特别是，约登指数表明，预测PAD患者发生AAA的D-二聚体临界值为0.675mg/L，敏感性为76.9%，特异性为84.9%（AUC = 0.8673；95%CI，0.8106 - 0.9240，<0.001）。在所有364例PAD患者中，当D-二聚体>0.675mg/L时，41.46%的患者被诊断为AAA，而当D-二聚体≤0.675mg/L时，只有3.55%的患者被诊断为AAA。
PAD和AAA具有不同的临床和血清特征；D-二聚体（>0.675mg/L）是预测PAD患者发生AAA的可靠生物标志物。
