低踝臂指数与动脉硬化高危男性病死率关系的队列研究  

Relationship between low ankle.brachial index and mortality of men with several atherosclerotic risk factors:a cohort study of 1941 cases

作　　者：李宪凯[1] 李觉[1] 邢燕[1] 布艾加尔.哈斯木 余金明[1] 罗盈怡[1] 郑黎强[1] 胡大一[1] 

机构地区：[1]同济大学医学院心肺血管中心,上海200092

出　　处：《中华医学杂志》2007年第14期960-963,共4页National Medical Journal of China

摘　　要：目的研究具有多重动脉硬化危险的男性的踝臂指数(ABI)与全因和心血管疾病(CVD)病死率的关系。方法多中心连续人选内科住院病人中具有多个动脉硬化危险因素的男性病人1941例,年龄36～96岁,进行基线特征调查并平均随访13个月,观察其终点事件的发生率。结果外周动脉疾病(PAD)组的全因病死率(15.4%vs 7.7%)和 CVD 病死率(5.1%vs 1.8%)均高于正常组,且差异有统计学意义。在重度 PAD 组、轻度至中度 PAD 组、临界组和正常对照组中的全因病死率(分别为17.6%,15.2%,10.1%和7.3%)和 CVD 病死率(分别为14.7%,4.4%,2.9%和1.6%)差异有显著统计学意义(P<0.001)。经 Cox 回归分析后,轻至中度 PAD 组(0.4<ABI≤0.9)全因死亡的 RR 为1.585(95%CI:1.126～2.230)。重度 PAD 组(ABI≤0.4)CVD 死亡的 RR 为4.443(95%CI:1.811～10.902),轻至中度 PAD 组 CVD 死亡的 RR 为1.859(95%CI:1.091～3.166)。PAD组的全因死亡和 CVD 死亡生存明显低于正常组。结论 ABI 是全因死亡和 CVD 死亡的独立危险因素,ABI 越低 CVD 病死率可能越高。Objective To study the relationship between ankle-brachial index （ABI） and all cause mortality and cardiovascular disease mortality in men with several atherosclerotic risk factors. Methods 1941 male patients with no less than two atherosclerotic risk factors,aged 67 （36 -96）, from 20 hospitals in Shanghai and Beijing, underwent examination of ABI and were followed up for 13.6 - 1.3 months to record the all cause mortality and cardiovascular disease （CVD） mortality. Results The baseline examination showed that 467 patients were with the ABI≤0.9 and diagnosed as with peripheral arterial disease （PAD） and 1474 patients were found as with the normal ABI （ between 0.91 and 1.40 ）. The age of the PAD patients was 72 - 10 years, significantly older than that of those patients with normal ABI （66 - 12 years, P 〈0.001）. The rates of hypertension, diabetes mellitus, and smoking of the PAD patients were 77.0%, 46. 3%, and 71.0% respectively, all significantly higher than those of the patients with normal ABI （68.5%, 32.5%, and 63.4% respectively, P 〈 0.01, P 〈 0.01. and P 〈 0.03）. The all cause mortality and CVD mortality of the PAD patients were 15.4% and 5.1% respectively, beth significantly higher than those of the patients with the ABI 〉 0.9 （7.7% and 1.8%, beth P 〈 0.01 ）. After adjusting other risk factors, the patients with 0.41 〈 ABI ≤0.9 were more than 1. 585 times likely to die than those with 1.0 〈 ABI≤1.4 （95% CI： 1. 126 -2.230）. The patients with the ABI≤0.4 were more than 4.443 times likely to die of CVD than those with 1.0 〈 A BI ≤ 1.4 （95% CI： 1. 811 -10. 902）. The RR for C VD death in the patients with 0.41 〈 ABI≤0.9 was 1. 859（95% CI： 1. 091 -3. 166 ）. The all cause survival rate and CVD survival rate of the PAD group were beth significantly lower than those of the normal-ABI group （ beth P 〈 0. 001 ）. Conclusion Low ABI is an independent risk factor to all cause mortality and CVD mortality, especially to CVD mortality

关 键 词：动脉硬化 踝臂指数 病死率 危险因素 

分 类 号：R543[医药卫生—心血管疾病]