Stoffers H E, Kester A D, Kaiser V, Rinkens P E, Kitslaar P J, Knottnerus J A
Department of General Practice, University of Limburg, Maastricht, The Netherlands.
J Clin Epidemiol. 1996 Dec;49(12):1401-5. doi: 10.1016/s0895-4356(96)00275-2.
We investigated the value of the ankle-brachial systolic pressure index (ABPI) as a test for the diagnosis of peripheral arterial occlusive disease (PAOD) in general practice. ABPI measurements on 231 legs of 117 subjects performed in three general practice centers (GPC) were compared with the diagnostic conclusions of a Vascular Laboratory. The optimum cutoff value for the ABPI, its accuracy and diagnostic value were estimated. In a subpopulation of 51 subjects for whom repeated measurements were available, we checked whether taking the mean of three consecutive ABPIs for test outcome would enhance diagnostic performance. Receiver Operating Characteristic analysis showed that overall performance of the GPC ABPI was good (area under the curve approximately 0.9). Performing repeated ABPI measurements was superior to performing a single measurement. The optimum cutoff value for the ABPI was 0.97, associated with a diagnostic odds ratio (OR) of 17 and an accuracy of 81%. In a somewhat more selected subpopulation, the optimum cutoff value was 0.92 (OR 70, accuracy 90%). On the basis of our results, we suggest the following rule of thumb: if the ABPI < 0.8 or if the mean of three ABPIs < 0.9, it is highly probable that PAOD is present (PV+ > or = 95%); if the ABPI > 1.1 or if the mean of three ABPIs > 1.0, PAOD can be ruled out (PV- > or = 99%). In conclusion, in primary health care, the ABPI measurement can be a useful supplementary test in ambiguous diagnostic situations with regard to PAOD.
我们研究了踝臂收缩压指数（ABPI）作为基层医疗中诊断外周动脉闭塞性疾病（PAOD）的一项检测指标的价值。在三个基层医疗中心（GPC）对117名受试者的231条腿进行了ABPI测量，并将其与血管实验室的诊断结论进行比较。估计了ABPI的最佳临界值、准确性和诊断价值。在一个有51名受试者可进行重复测量的亚组中，我们检查了采用连续三次ABPI测量的平均值作为检测结果是否会提高诊断性能。受试者工作特征分析表明，GPC的ABPI总体性能良好（曲线下面积约为0.9）。进行重复的ABPI测量优于单次测量。ABPI的最佳临界值为0.97，诊断比值比（OR）为17，准确性为81%。在一个选择标准稍高的亚组中，最佳临界值为0.92（OR 70，准确性90%）。根据我们的研究结果，我们建议如下经验法则：如果ABPI<0.8或三次ABPI测量的平均值<0.9，则极有可能存在PAOD（阳性预测值PV+≥95%）；如果ABPI>1.1或三次ABPI测量的平均值>1.0，则可排除PAOD（阴性预测值PV-≥99%）。总之，在初级卫生保健中，ABPI测量在PAOD诊断不明确的情况下可作为一项有用的补充检测。
