Modan M, Peles E, Halkin H, Nitzan H, Azaria M, Gitel S, Dolfin D, Modan B
Department of Clinical Epidemiology, Sheba Medical Center, Tel Hashomer, Israel.
Am J Cardiol. 1998 Nov 15;82(10):1242-7. doi: 10.1016/s0002-9149(98)00601-8.
We evaluated the 24-year mortality rates of male traumatic lower limb amputees (n = 201) of the Israeli army, wounded between 1948 and 1974 compared with a cohort sample representing the general population (n = 1,832). Mortality rates were significantly higher (21.9% vs 12.1%, p <0.001) in amputees than in controls. Cardiovascular disease (CVD) mortality was the main cause for this difference. The prevalence of selected risk factors for CVD was determined in 101 surviving amputees (aged 50 to 65 years) and a sample of the controls (n = 96) matched by age and ethnic origin. Amputees had higher plasma insulin levels (during fasting and in response to oral glucose loading) and increased blood coagulation activity. No differences were found in rates of current symptoms of ischemic heart disease or of cerebrovascular disease, obesity, hypertension, altered plasma lipoprotein profile, impaired physical activity, smoking, or nutritional habits. Traumatic lower limb amputees had increased mortality rates due to CVD. Surviving amputees had hyperinsulinemia, increased coagulability, and increased sympathetic and parasympathetic responses (described previously). These established CVD risk factors may explain the excess mortality due to CVD in traumatic amputees.
我们评估了1948年至1974年间受伤的以色列军队男性创伤性下肢截肢者（n = 201）的24年死亡率，并与代表普通人群的队列样本（n = 1,832）进行了比较。截肢者的死亡率显著高于对照组（21.9%对12.1%，p<0.001）。心血管疾病（CVD）死亡率是造成这种差异的主要原因。在101名存活的截肢者（年龄在50至65岁之间）和一组按年龄和种族匹配的对照组样本（n = 96）中，确定了选定的CVD风险因素的患病率。截肢者的血浆胰岛素水平较高（空腹时以及口服葡萄糖负荷后的反应），并且凝血活性增加。在缺血性心脏病或脑血管疾病的当前症状发生率、肥胖、高血压、血浆脂蛋白谱改变、身体活动受损、吸烟或营养习惯方面未发现差异。创伤性下肢截肢者因CVD导致的死亡率增加。存活的截肢者有高胰岛素血症、凝血性增加以及交感神经和副交感神经反应增强（先前已描述）。这些已确定的CVD风险因素可能解释了创伤性截肢者因CVD导致的额外死亡率。
