臂间收缩压差联合臂踝指数筛查锁骨下动脉狭窄的价值  

Adding brachial-ankle index to inter-arm systolic blood pressure difference for screening subclavian artery stenosis

作　　者：邓宇 马文韬[1] 邹玉宝[1] 董徽[1] 陈阳[1] 何际宁 华倚虹[1] 蒋雄京[1] DENG Yu;MA Wen-tao;ZOU Yu-bao;DONG Hui;CHEN Yang;HE Ji-ning;HUA Yi-hong;JIANG Xiong-jing(Department of Cardiology,Fuwai Hospital,Chinese Academy of Medical Science Peking Union Medical College,Beijing 100037,China)

机构地区：[1]北京协和医学院中国医学科学院阜外医院心内科,北京100037

出　　处：《中华高血压杂志》2022年第2期161-165,共5页Chinese Journal of Hypertension

摘　　要：目的评价臂间收缩压差(IASBPD)联合臂踝指数(BAI)筛查锁骨下动脉狭窄的价值。方法入选2017年10月至2018年10月在阜外医院行选择性弓上动脉造影,并于造影前5 d内完成同步四肢血压测量的所有患者,收集临床资料。由不知晓患者资料的研究者阅读锁骨下动脉造影结果,诊断金标准采用直径狭窄≥50%。应用受试者工作特征(ROC)曲线分析IASBPD和BAI的最佳诊断切点,评估二者联合诊断价值。结果共入选317例患者(634条锁骨下动脉),男性246例,占77.6%,年龄39~84(64.2±8.5)岁。患者133例锁骨下动脉直径狭窄≥50%,其中单侧狭窄100例,占75.2%,双侧狭窄33例,占24.8%。IASBPD和BAI的ROC曲线下面积分别为0.83(95%CI 0.79~0.88,P<0.001)和0.65(95%CI 0.60~0.71,P<0.001),最佳诊断切点分别为9 mm Hg和0.8。诊断锁骨下动脉狭窄,IASBPD≥9 mm Hg的敏感度为57.1%,特异度为94.0%,阳性预测值为87.4%,阴性预测值为75.2%;BAI≤0.8的敏感度为48.1%,特异度为86.4%,阳性预测值为71.9%,阴性预测值为69.7%。IASBPD联合BAI较二者单独诊断的敏感度增高至68.4%,特异度稍降低至82.6%。结论IASBPD联合BAI可提高筛查锁骨下动脉狭窄的敏感度。Objective To investigate the efficiency of inter-arm systolic blood pressure difference(IASBPD)combined with brachial-ankle index(BAI)for screening subclavian stenosis.Methods We retrospectively enrolled all hospitalized patients who underwent supra-arch artery angiography and had done simultaneous four-limb blood pressure measurements within 5 days before angiography from October 2017 to October 2018 at Fuwai hospital.The gold standard of subclavian stenosis was defined as 50%or more diameter stenosis identified on angiography by blind method.The receiver operating characteristic(ROC)curve was used to calculate the optimal cut-off values of IASBPD and BAI.The efficiency of IASBPD combined with BAI for screening stenosis was further investigated.Results Three hundred and seventeen patients(634 subclavian arteries)were consecutively enrolled.In them,246(77.6%)were male,with a mean age of(64.2±8.5)years.One hundred and thirty-three patients had stenosis≥50%,and 33(24.8%)were bilateral.The optimal cut-off points of IASBPD and BAI for diagnosing stenosis≥50%were 9 mm Hg and 0.8,with the area under the ROC curve of 0.83(95%CI 0.79-0.88,P<0.001)and 0.65(95%CI 0.60-0.71,P<0.001),respectively.The sensitivity,specificity,positive predictive value and negative predictive value of IASBPD were 57.1%,94.0%,87.4%and 75.2%,respectively;that of BAI were 48.1%,86.4%,71.9%and 69.7%,respectively.IASBPD combined with BAI significantly improved the sensitivity to 68.4%,while the specificity decreased to 82.6%compared with IASBPD or BAI alone.Conclusion IASBPD combined with BAI achieved greater sensitivity for screening subclavian stenosis.

关 键 词：锁骨下动脉狭窄 臂间收缩压差 臂踝指数 

分 类 号：R543.5[医药卫生—心血管疾病]