Boyko E J, Ahroni J H, Davignon D, Stensel V, Prigeon R L, Smith D G
Medical Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington 98108, USA.
J Clin Epidemiol. 1997 Jun;50(6):659-68. doi: 10.1016/s0895-4356(97)00005-x.
We assessed the value of the medical history and physical examination in the diagnosis of peripheral vascular disease in diabetic subjects.
We performed a cross-sectional study in 631 diabetic veteran enrollees of a general internal medicine clinic that compared data obtained from a history and clinical evaluation with the presence of severe peripheral vascular disease defined as an ankle-arm index (AAI) < or = 0.5 derived from Doppler blood pressure measurement.
We identified 90 limbs with an AAI < or = 0.5. Results presented below apply to the right leg, but do not differ from the left. Diminished or absent foot peripheral pulses (sensitivity 65%, specificity 78%), venous filling time > 20 sec (sensitivity 22%, specificity 93.9%), age > 65 years (sensitivity 83%, specificity 54%), claudication symptoms in < 1 block (sensitivity 50%, specificity 87%), and patient reported history of physician diagnosed peripheral vascular disease (PVD) (sensitivity 80%, specificity 70%) had the largest positive (or smallest negative) likelihood ratios. Capillary refill time > 5 sec or foot characteristics (absent hair, blue/purple color, skin coolness, or atrophy) conveyed little diagnostic information. Individual factors did not change disease probability to a clinically important degree. A stepwise logistic regression model identified four factors significantly (p < 0.05) associated with low AAI: absent or diminished peripheral pulses, patient reported history of PVD, age, and venous filling time. Substitution of < 1 block claudication for PVD history in this model resulted in a small reduction in model accuracy.
Many purportedly useful historical and exam findings need not be elicited in diabetic patients suspected of having severe peripheral vascular disease, since most information related to probability of this disorder may be obtained from patient age, self-reported history of physician diagnosed PVD (or < 1 block claudication), peripheral pulse palpation, and venous filling time.
我们评估了病史和体格检查在诊断糖尿病患者外周血管疾病中的价值。
我们对一家普通内科门诊的631名糖尿病退伍军人入组者进行了一项横断面研究，将病史和临床评估获得的数据与通过多普勒血压测量得出的踝臂指数（AAI）≤0.5所定义的严重外周血管疾病的存在情况进行比较。
我们确定了90条AAI≤0.5的肢体。以下结果适用于右腿，但与左腿无差异。足部外周脉搏减弱或消失（敏感性65%，特异性78%）、静脉充盈时间>20秒（敏感性22%，特异性93.9%）、年龄>65岁（敏感性83%，特异性54%）、<1街区的间歇性跛行症状（敏感性50%，特异性87%）以及患者自述医生诊断的外周血管疾病（PVD）病史（敏感性80%，特异性70%）具有最大的阳性（或最小的阴性）似然比。毛细血管再充盈时间>5秒或足部特征（毛发缺失、蓝色/紫色、皮肤凉或萎缩）几乎没有诊断信息。个体因素并未将疾病概率改变到具有临床意义的程度。逐步逻辑回归模型确定了四个与低AAI显著相关（p<0.05）的因素：外周脉搏消失或减弱、患者自述的PVD病史、年龄和静脉充盈时间。在该模型中用<1街区的间歇性跛行替代PVD病史会导致模型准确性略有降低。
对于怀疑患有严重外周血管疾病的糖尿病患者，许多据称有用的病史和检查结果无需询问，因为与该疾病概率相关的大多数信息可从患者年龄、自述医生诊断的PVD病史（或<1街区的间歇性跛行）、外周脉搏触诊和静脉充盈时间中获得。
