踝臂指数对老年高血压合并下肢动脉病变患者发生心脑血管病风险的预测价值  

Assessment of peripheral arterial disease in elderly hypertensive patients and risk prediction of cardio-cerebral vascular disease by ankle-brachial index

作　　者：沈丹[1] 曹萍[1] 王桦[1] 刘珍丽[1] 

机构地区：[1]武汉大学中南医院综合医疗科,430071

出　　处：《疑难病杂志》2012年第5期343-345,共3页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨踝臂指数(ABI)对老年高血压合并下肢动脉病变(PAD)患者发生心脑血管病变风险的预测价值。方法回顾性分析老年高血压病患者285例,按照ABI值分为高血压合并PAD组(PAD组,55例)和高血压朱合并PAD组(非PAD组,230例),比较2组间臂踝脉搏波传导速度(baPWV)及各种心脑血管病危险因素的差异。结果与非PAD组比较,PAD组收缩压(SBP)、脉压(PP)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白(a)[Lp(a)]、血尿酸(UA)、C反应蛋白(CRP)、糖化血红蛋白(HbA_(1c))以及baPWV值均明显增加(P<0.05,或P<0.01);且发生冠心病、脑梗死的风险分别增高3.17倍(95%CI 1.29～7.76)和5.57倍(95%CI 2.15～14.44);相关分析显示,ABI与年龄(r=-0.273,P=0.025)、PP(r=-0.230,P=0.034)、Lp(a)(r=-0.361,P=0.002)、UA(r=-0.210,P=0.046)、CRP(r=-0.311,P=0.030)、HbA_(1c)(r=-0.272,P=0.017)、baPWV(r=-0.291,P=0.018)均呈负相关。Logistic回归分析提示,年龄、SBP、PP及Lp(a)是PAD的独立危险因素。结论 ABI可评估老年高血压患者下肢动脉病变的严重程度,并预测其心脑血管疾病的发生风险。Objective To investigate whether the ankle-brachial index （ABI） can assess peripheral arterial disease （PAD） in elderly hypertensive patients and predict the risk of eardio-eerebral vascular diseases. Methods The data of 285 elderly hypertensive patients was retrospectively reviewed and analyzed. They were diagnosed as hypertension with PAD （ n = 55 ） or without PAD （none-PAD, n = 230） according to ABI criteria. Brachial-ankle pulse wave velocity （baPWV） and various cardiovascular risk factors were compared between the two groups. Results The prevalence of PAD in elderly hypertensive pa- tients was 19.3%. Compared with patients without PAD, the levels of systolic blood pressure （SBP） , pulse pressure （PP） , low density lipoprotein-cholesterol （ LDL-C ）, lipoprotein （ a ） [ Lp （ a ） ], uric acid （ UA ）, C-reactive protein （ CRP ）, HbAlc and baPWV increased significantly （ P 〈0.05, or P 〈0.01 ） in the PAD group. The risk of suffering from coronary heart disease and cerebral infarction ,were increased of 3.17 （95 % CI 1.29 ± 7.76） and 5.57 （95 % CI 2.15 - 14.44） times in the PAD group respectively. There was a negative correlation between ABI and age（ r = -0. 273, P = 0. 025）, PP（ r = -0.230, P =0.034）, Lp （a） （r = -0.361,P =0.002）, UA（r = -0.210, P =0.046）, CRP（r = -0.311,P = 0. 030） , HbAlo （ r = - 0. 272, P = 0. 017） and baPWV （ r = - 0. 291, P = 0. 018）. Multivariate Logistic regression analy- sis indicated that age, SBP, PP and Lp （a） were independent risk factors for ABI. Conclusion ABI can assess the severity of peripheral arterial disease in elderly hypertensive patients and effectively predict the risk of cardio-eerebral vascular diseases.

关 键 词：踝臂指数 下肢外周动脉病变 高血压病 心脑血管病变 

分 类 号：R544.1[医药卫生—心血管疾病]