多中心研究高血压患者心血管病危险度与踝臂指数异常的关联性  

Relevance of cardiovascular disease risk and abnormal ankle brachial index in hypertensive patients ： a multicentre study

作　　者：毛勇[1] 余金明[1] 胡大一[2] 姜庆五[1] 张芬[1] 战义强[1] 董英[3] 孔群钰[1] 

机构地区：[1]复旦大学公共卫生学院临床流行病研究中心公共卫生安全教育部重点实验室,上海200032 [2]北京大学人民医院心脏中心 [3]上海中医药大学预防医学教研室

出　　处：《中华医学杂志》2011年第42期2985-2989,共5页National Medical Journal of China

摘　　要：目的分析高血压患者高危和很高危心血管病（CVD）危险度与踝臂指数（ABI）异常的关联性，探讨根据CVD危险度防治下肢动脉疾病的措施。方法2008年12月至2009年5月，现况调查我国18个研究中心人选的2674例40岁以上无冠心病、卒中／短暂性脑缺血发作或动脉硬化临床症状的原发性高血压患者的ABI异常（ABI〈0．90）情况，并收集病史、体格检查和实验室检查资料。结果分析有效例数为2615例。高危与很高危组高血压患者的ABI异常率均有随年龄增长而增高的趋势（P〈0．001）。与高危组相比，很高危组的60～岁（1．3％比5．1％）和70～岁年龄组（4．1％比10．5％）的ABI异常率较高（P〈0．05）。校正一定因素（研究中心、靶器官损害、CVD危险因素和人口学因素），拟合CVD危险度与ABI异常关系的非条件Logistic回归模型表明，二者间有正相关关系（OR=1．874，95％CI1．153—3．045，P=0．0112），很高危高血压患者发生ABI异常的可能性是高危者的1．874倍。结论高危高血压患者的CVD危险度越高，发生ABI异常的可能性越大。该正相关效应在60-岁和70-岁年龄段的高危高血压患者中尤为明显。Objective To evaluate the relevance of cardiovascular disease （CVD） risk and abnormal ankle brachial index （ABI） in high-risk and very high-risk hypertensive patients and explore the strategies of prevention and treatment for peripheral arterial disease according to the CVD risk. Methods Between December 2008 and May 2009, the cross-sectional study investigated the prevalence of abnormal ABI （ ABI 〈 0. 90 ） in 2674 community-dwelling, hypertensive patients, aged ≥40 years old, without coronary heart disease, stroke/transient ischemic attack or known arteriosclerosis, from 18 centers in China. The relevant data were acquired through history, physical examination, laboratory examinations and other diagnostic tests. Results The number of subjects available for the full-analysis set was 2615. There was a rising prevalence of abnormal ABI with the advancing age in high-risk hypertensive patients and very highrisk ones （P 〈0. 001 ）. Compared with the high-risk group, the 60 years （ 1.3% vs 5.1% ） and 70 years （4.1% vs 10.5% ） age sub-groups of the very high-risk group had a significantly higher prevalence of abnormal ABI （P 〈 0. 05 ）. After adjusting for such factors as investigational center, target organ damage, CVD risk and demographics, an unconditional Logistic regression model revealed that CVD risk was positively correlated with abnormal ABI （ odds ratio 1. 874, 95% confidence interval 1. 153 - 3. 045, P = 0. 0112）. A very high-risk hypertensive patient was 1. 874 times more likely than a high-risk one to have an abnormal ABI. Conclusion A high-risk hypertensive patient with a higher CVD risk is more prone to have an abnormal ABI. Among the high-risk hypertensive patients in the 60 years and 70 years age sub-groups, such a positive correlation is especially pronounced.

关 键 词：高血压 危险因素 外周动脉疾病 踝臂指数 

分 类 号：R544.1[医药卫生—心血管疾病]