踝臂指数对颅内动脉狭窄严重程度的预测价值  

Evaluation of ankle brachial index to predict the extent of intracal artery stenosis

作　　者：李瑶宣[1] 钟维章[1] 陈友华[2] 宁加玲[3] 董艳玲[1] 薛富英[1] 李吕力[1] 

机构地区：[1]广西壮族自治区人民医院神经科,广西南宁530021 [2]广西壮族自治区人民医院骨密度室,广西南宁530021 [3]广西壮族自治区人民医院病案管理科统计室,广西南宁530021

出　　处：《中风与神经疾病杂志》2010年第1期38-41,共4页Journal of Apoplexy and Nervous Diseases

基　　金：广西壮族自治区卫生厅研究项目(Z2008053)

摘　　要：目的观察缺血性脑血管病患者踝臂指数(ABI)与颅内动脉狭窄程度的相关性,评价ABI对颅内动脉狭窄程度的预测价值。方法对100例行选择性全脑血管造影(DSA)的缺血性脑血管病患者进行研究,所有患者在造影前均进行ABI测量和常规生化检查。结果根据DSA结果分为正常组(21例)、轻度颅内动脉狭窄组(25例)、中度颅内动脉狭窄组(21例)、重度颅内动脉狭窄组(33例),各组ABI结果分别为:1.04±0.13、1.05±0.09、0.94±0.15、0.91±0.17,中、重度狭窄组患者ABI明显降低(P<0.01),而正常、轻度狭窄组患者的ABI无统计学差异。评价ABI对重度颅内动脉狭窄ROC曲线下面积为0.754±0.073(95%可信区间为:0.610～0.898,P=0.002),中度颅内动脉狭窄ROC曲线下面积为0.727±0.082(95%可信区间为:0.566～0.887,P=0.012)。ABI≤0.9作为截断值预测中、重度颅内动脉狭窄的特异度为81.0%,灵敏度分别为47.6%、66.7%,阳性似然比分别为2.51、3.51。Logisticd回归分析显示,在调整了收缩压、舒张压的影响后,ABI≤0.9仍是中、重度颅内动脉狭窄的显著预测因子,OR值分别为4.5、9.089;ABI0.91～0.99也是中、重度颅内动脉狭窄的独立预测因子,OR值分别为6.25、7.189。结论ABI≤0.9和ABI0.91～0.99都是中、重度颅内动脉狭窄的独立预测因子,ABI≤0.9是预测中、重度颅内动脉狭窄的最佳截断值,对中、重度颅内动脉狭窄具有中等程度的预测价值,对重度颅内动脉狭窄的预测价值高于中度颅内动脉狭窄。Objective To observe the relationship between ankle brachial index（ABI） and the extent of intracal artery stenosis and evaluate the value of ABI to predict the extent of stenosis in ischemic cerebrovascular disease patients. Methods We studied 100 ischemic cerebrovascular disease patients who were referred for digital subtraction angiography （DSA）. All patients underwent ABI and regular biochemical parameters evaluation before DSA. Results According to DSA, the patients were divided into the normal group（21 cases）, slight （25 cases） , midrange （21 cases） and severe （33 cases） intracal artery stenosis group. Each group ABI were 1.04 ± 0.13,1.05 ± 0.09,0.94 ± 0.15 and 0. 91±0.17. ABI reduced significantly（P 〈0.01 ） in the patients with midrange and severe intracal artery stenosis. There was no significant difference in ABI among the patients with no stenosis or slight intracal arterystenosis. The corresponding area under the ROC curve of severe stenosis were （0. 754 ± 0. 073 ）, with 95% confidence interval （CI） 0. 610 to 0. 898 （ P = 0. 002）. The corresponding area under the ROC curve of midrange stenosis were（0. 727 ±0. 082） ,with 95% CI 0. 566 to 0.887 （P = 0. 012）. ABI ≤0.9 was associated with a specificity of 81.0% and a sensitivity of 47.6% and a positive likelihood ratio of 2.51 for predicting the presence of midrange stenosis. As for severe stenosis, it was associated with a specificity of 81. 0% and a sensitivity of 66.7% and a positive likelihood ratio of 3.51. Logistic regression analysis revealed that after adjusting systolic pressure and diastolic pressure, ABI ≤ 0.9 was a significant predictor for midrange and severe intraeal artery stenosis with a odds ratio（OR） of 4.5 and 9. 089 respectively. ABI （0.91 - 0.99） also was significant predictor for midrange and severe intracal artery stenosis with a OR of 6.25 and 7.189 respectively. Conclusions In isehemic eerebrovascular disease patients, ABI ≤ 0.9 and ABI （0.91 -0.99 ） are sig

关 键 词：踝臂指数 颅内动脉狭窄 缺血性脑血管病 全脑血管造影 

分 类 号：R743[医药卫生—神经病学与精神病学]