心血管病高危人群下肢动脉疾病和肾功能不全的相关性研究  

Study on the relation between peripheral arterial disease and renal insufficiency in high risk cardiovascular patients

作　　者：白红颖[1] 杨进刚 胡大一[3] 

机构地区：[1]首都医科大学附属北京同仁医院急诊科,北京100730 [2]中国医学科学院北京阜外心血管病医院冠心病中心 [3]北京大学人民医院心脏中心

出　　处：《中华流行病学杂志》2011年第6期622-624,共3页Chinese Journal of Epidemiology

摘　　要：目的评价心血管事件高危人群通过测量踝臂指数（ABI）诊断的下肢动脉疾病（PAD）和肾功能的相关性。方法人选5270例年龄≥50岁的心脑血管疾病或存在多重动脉粥样硬化危险因素患者，测定ABI值，采用Cockcroft—Gault公式计算肌酐清除率（CRCL），观察该人群中ABI异常（ABI~〈0．9）和肾功能不全（CRCL〈60ml·min-1·1．73m-1）的发生情况及其二者关联。结果5270例患者中有2648例（50．2％）存在肾功能不全，746例（14．2％）经ABI证实为PAD。ABI与CRCL呈正相关（r=0．217，P〈0．001）。肾功能不全患者中PAD的患病率显著高于肾功能正常者（19．9％ vs. 8．3％，P〈0．001）。经对危险因素和伴随疾病校正后，CRCL与PAD独立相关（OR=0．98，95％CI：0．98～0．99，P〈0．001）。结论心血管病高危人群中，存在肾功能不全的患者PAD发生率高。Objective This study was to examine the relation of peripheral arterial disease （PAD） and renal insufficiency in cardiovascular patients with high risk. Methods PAD, defined as an ankle brachial index （ABI） ≤0.9 in either leg and renal insufficiency, defined as an estimated creatinine clearance （CRCL） 〈60 ml ·min-1 · 1.73 m -1 were evaluated in 5270 Chinese patients at high risk of CV. Results 2648 （50.2%） patients had an estimated CRCL〈 60 ml ·min-1· 1.73 m-1, while 746 （14.2%） patients having PAD defined ABI≤0.9. ABI and CRCL were positively correlated （r=0.217, P〈0.001）. The prevalence of PAD in patients with renal dysfunction was significantly higher than those with normal renal function （19.9% vs. 8.3%, P〈0.001 ）. The association of ABI ≤ 0.9 with CRCL was independent from potential confounders such as age, diabetes, hypertension, hypercholesterolemia, smoking, coronary artery disease and stroke history （OR= 0.98,95% CI： 0.98- 0.99, P〈0.001）. Conclusion Results from the present study demonstrated a remarkably high prevalence of PAD （defined as an ABI≤0.9） among patients with renal dysfunction and at high risk. Even after adjustment for important confounders such as age, diabetes, and coronary artery and cerebro-vascular diseases etc., persons with lower CRCL were still more likely to have an ABI≤0.9.

关 键 词：下肢动脉疾病 肾功能不全 踝臂指数 

分 类 号：R54[医药卫生—心血管疾病] R692.5[医药卫生—内科学]