踝臂指数在糖尿病人群中对冠心病的预测价值

Ankle-brachial index as a predictor of coronary artery disease in patients with diabetes mellitus

目的研究糖尿患者群中踝臂指数(ABI)与冠状动脉(简称冠脉)病变的关系。方法对纳入研究的168例患者按照ABI≥0.9者为A组(73例),ABI<0.9者为B组(95例),收集其基本临床资料、测量ABI、行冠脉造影记录病变部位、数量。结果糖尿患者中合并ABI<0.9的人群平均冠脉病变支数显著多于ABI≥0.9的受试人群(P<0.001),达(2.2±1.0)支/例。两组对比,冠脉病变部位差异无统计学意义。ABI<0.9的人群中复杂类型(B2型、C型)比例(60.3%)远高于ABI≥0.9人群(33.9%)。ABI在糖尿病受试人群中预测冠状动脉病变的敏感性为52.5%,特异性为87.2%;预测复杂病变(B2+C)敏感性为49.2%,特异性为90.6%。ABI是复杂病变(B2+C)的独立预测因子(OR:3.42)。结论ABI对于糖尿病患者中冠心病的筛查是一项简单、价廉、无创、较可靠的方法,对于冠状动脉的复杂病变也有很好的预测价值。

Objective To examine the relation of ankle-brachial index（ABI） and the severity of coronary artery disease（CAD） in the patients with diabetes mellitus（DM）. Methods A total 168 patients with diabetes mellitus were enrolled. The patients were divided into two groups according to the resuh of ABI measurement：group A had ABI value of at least 0.9; group B had ABI,of less 0.9. All patients underwent coronary angiography examination and ABI measurement. Results There were noticeable difference in mean lesion numbers（1.5±0.8,2.2±1.0,P〈0. 001） between the two groups. Moreover, group B contained a higher percentage of complex stenoses with B2 or C classification than in group A（60.3% versus 33.9% ,P〈0. 001）. The sensitivity and specificity for predicting CAD and complex stenosens given ABI of less than 0.9 in the patients with DM were 52.5 %, 87.2% and 49.2 %,90. 6% respeetively[OR 3.42]. Conclusion ABI is a simple, inexpensive, useful noninvasive tool for predicting CAD in the patients with diabetes mellitus;ABI can predict the presence of complex morphology of CAD.