Espinoza-Enciso Luis Fernando, Hernández-Gozar Iván Gonzalo, Zuñiga-Baldarrago Kevin Clared, Lozano-Purizaca Robert, Briceño-Alvarado Manolo, Yovera-Aldana Marlon
School of Medicine, Universidad Científica del Sur, Lima, Perú.
School of Medicine, Universidad Nacional de Piura, Piura, Perú.
PLoS One. 2025 Sep 18;20(9):e0316981. doi: 10.1371/journal.pone.0316981. eCollection 2025.
Peripheral arterial disease (PAD) and arterial calcification (AC) are frequent yet underdiagnosed vascular complications in individuals with type 2 diabetes mellitus (T2DM). The ankle-brachial index (ABI) is a widely used, non-invasive too for detecting these conditions. However, differences in ABI calculation methos can impact diagnostic accuracy and prevalence estimates.
To determine the prevalence of PAD and AC based on three ABI calculation methods in patients with T2DM attending a public hospital in Peru.
We conducted a cross-sectional study using data from the At-Risk Foot Program of the Endocrinology Department at Hospital María Auxiliadora (2015-2020). ABI was calculated for each lower limb using the highest, average or lowest systolic ankle pressure (SAP) from either the dorsalis pedis or posterior tibial artery as the numerator, divided by the highest brachial systolic pressure as the denominator. We applied a hierarchical classification: PAD was identified first (ABI < 0.9 in either limb), and among those without PAD, AC was identified (ABI > 1.3 in either limb); the rest were classified as normal. Prevalences estimates were calculated with 95% confidence intervals, and associations with clinical characteristics were explored using Poisson regression with robust variance.
We included 643 subjects with a mean age of 61.4 years, 69.8% female. The prevalence of PAD was 7.8% (95% CI: 5.8-10.1), 15.4% (95% CI:12.7-18.4), and 28.2% (95% CI 24.7-31.7) using the highest, average, or lowest SAP as the numerator in the ABI, respectively. Conversely, the prevalence of AC was 18.2% (95% CI: 15.3-21.4), 11.0% (95% CI: 8.7-13.7), and 16.2% (95% CI:13.4-19.3). In all three methods, PAD was associated with older age (p < 0.05) and AC was associated with longer duration of diabetes (p < 0.01).
Among patients with T2DM, PAD prevalence varied substantially (7.8% - 28.2%) depending on the ABI calculation method, while AC was present in up to 18.2%. The lowest ankle pressure method increased sensitivity and may be preferred in high-risk populations where avoiding missed diagnoses is critical. The highest ankle pressure method, which maximizes specificity, may be more suitable for general screening and comparability with existing literature, whereas the average pressure approach could be useful in research or prognostic modeling. The hierarchical classification strategy allowed PAD and AC to coexist in the same individual, although this was rare. Given the variability in prevalence across methods, local validation studies are needed to determine which approach optimally balances sensitivity, specificity, and clinical applicability in Peruvian diabetic populations.
外周动脉疾病（PAD）和动脉钙化（AC）是2型糖尿病（T2DM）患者常见但诊断不足的血管并发症。踝臂指数（ABI）是一种广泛用于检测这些病症的非侵入性工具。然而，ABI计算方法的差异会影响诊断准确性和患病率估计。
基于三种ABI计算方法，确定在秘鲁一家公立医院就诊的T2DM患者中PAD和AC的患病率。
我们使用玛丽亚·奥克西利亚多拉医院内分泌科高危足部项目（2015 - 2020年）的数据进行了一项横断面研究。使用足背动脉或胫后动脉的最高、平均或最低收缩期踝部压力（SAP）作为分子，除以最高肱动脉收缩压作为分母，计算每个下肢的ABI。我们应用了分层分类：首先确定PAD（任一肢体ABI < 0.9），在无PAD的患者中确定AC（任一肢体ABI > 1.3）；其余患者分类为正常。计算患病率估计值及其95%置信区间，并使用稳健方差的泊松回归探索与临床特征的关联。
我们纳入了643名受试者，平均年龄61.4岁，女性占69.8%。在ABI计算中，分别使用最高、平均或最低SAP作为分子时，PAD的患病率分别为7.8%（95% CI：5.8 - 10.1）、15.4%（95% CI：12.7 - 18.4）和28.2%（95% CI：24.7 - 31.7）。相反，AC的患病率分别为18.2%（95% CI：15.3 - 21.4）、11.0%（95% CI：8.7 - 13.7）和16.2%（95% CI：13.4 - 19.3）。在所有三种方法中，PAD与年龄较大相关（p < 0.05），AC与糖尿病病程较长相关（p < 0.01）。
在T2DM患者中，根据ABI计算方法的不同，PAD患病率差异很大（7.8% - 28.2%），而AC患病率高达18.2%。最低踝部压力法提高了敏感性，在避免漏诊至关重要的高危人群中可能更受青睐。最高踝部压力法可使特异性最大化，可能更适合一般筛查以及与现有文献进行比较，而平均压力法在研究或预后建模中可能有用。分层分类策略允许PAD和AC在同一患者中共存，尽管这种情况很少见。鉴于不同方法患病率的差异，需要进行本地验证研究，以确定哪种方法在秘鲁糖尿病患者人群中能最佳地平衡敏感性、特异性和临床适用性。
