Feinglass J, McCarthy W J, Slavensky R, Manheim L M, Martin G J
Division of General Internal Medicine, Northwestern University Medical School, Chicago, IL 60611, USA.
J Vasc Surg. 1996 Oct;24(4):503-11; discussion 511-2. doi: 10.1016/s0741-5214(96)70066-6.
Claudication patients' perceptions of walking impairment often influence recommendations for peripheral bypass and angioplasty. The actual relationship between lower extremity blood flow and physical functioning, however, has rarely been explicitly studied.
Patients were enrolled at a visit to one of 16 vascular surgery offices and clinics that participated in a prospective outcomes study. A total of 555 patients (445 men and 110 women) with an abnormal ankle-brachial index (ABI), none of whom had had previous leg revascularization or symptoms of rest pain, skin ulcers, or gangrene, completed the SF36 Health Survey and the Peripheral Arterial Disease Walking Impairment Questionnaire (WIQ). Stepwise multiple regression analysis was used to test the statistical significance and strength of association between patients' ABI level and SF36 physical functioning (PF) and WIQ community walking distance scores, controlled for sociodemographic characteristics and the presence and severity of comorbid conditions.
Univariate correlations with ABI were modest but significant (PF score, r = 0.12, p = 0.004; WIQ distance score, r = 0.18, p < 0.001). ABI was a very significant predictor of both PF (b = 18.8; p = 0.001) and WIQ scores (b = 0.33; p < 0.0001) in the multiple regression analysis. Other positive predictors of PF scores were high-school graduation and male sex. Negative predictors of PF scores were heart, lung, and cerebrovascular disease; knee arthritis and chronic back pain; and enrollment at a Veterans Administration clinic rather than a private community or academic office.
Cross-sectional findings indicate that a 0.3 improvement in ABI is associated with an average improvement of 5.6% in PF or 10.3% in WIQ distance score. However, proper selection of individual candidates for interventional therapy, that is, those patients who have lower ABIs, lower initial functioning, and fewer disabling comorbidities would be predicted to produce a much greater functional benefit. Surgeons should make a rigorous functional evaluation when recommending interventional management of claudication.
间歇性跛行患者对行走障碍的认知往往会影响外周血管搭桥术和血管成形术的推荐。然而，下肢血流与身体功能之间的实际关系鲜有明确研究。
患者在参与一项前瞻性结局研究的16个血管外科办公室和诊所中的一处就诊时被纳入研究。共有555例踝臂指数（ABI）异常的患者（445例男性和110例女性）完成了SF36健康调查和外周动脉疾病行走障碍问卷（WIQ），这些患者均未曾接受过腿部血管重建术，也没有静息痛、皮肤溃疡或坏疽症状。采用逐步多元回归分析来检验患者ABI水平与SF36身体功能（PF）以及WIQ社区行走距离得分之间关联的统计学显著性和强度，并对社会人口学特征以及合并症的存在和严重程度进行了控制。
与ABI的单变量相关性适中但具有显著性（PF得分，r = 0.12，p = 0.004；WIQ距离得分，r = 0.18，p < 0.001）。在多元回归分析中，ABI是PF（b = 18.8；p = 0.001）和WIQ得分（b = 0.33；p < 0.0001）的非常显著的预测因素。PF得分的其他正向预测因素是高中毕业和男性。PF得分的负向预测因素是心脏、肺部和脑血管疾病；膝关节炎和慢性背痛；以及在退伍军人管理局诊所而非私人社区或学术机构就诊。
横断面研究结果表明，ABI提高0.3与PF平均提高5.6%或WIQ距离得分提高10.3%相关。然而，对于介入治疗个体候选人的恰当选择，即那些ABI较低、初始功能较差且致残合并症较少的患者，预计会产生更大的功能获益。外科医生在推荐间歇性跛行的介入治疗时应进行严格的功能评估。
