踝臂指数的流行病学研究与进展

Epidemiological research and progress of ankle brachial index

背景:踝臂指数的测量是诊断外周动脉疾病(踝臂指数<0.90)的简便有效无创的方法。患有外周动脉疾病的患者通常有局部血管的动脉粥样硬化症状,并且增加了心血管事件发生和死亡的风险。目的:总结近年来踝臂指数的流行病学研究进展,为进一步开展外周血管疾病的预防和控制提供循证医学的依据。方法:检索Pubmed数据库,纳入论点论据可靠并与踝臂指数方面的研究相关的文章,排除重复性研究或者与文章研究目的无关的文章。保留26篇文章做进一步分析。结果与结论:有研究表明外周动脉疾病能够预测心血管疾病发生率和死亡率。研究发现慢性肾病、胰岛素使用、蛋白尿、亚甲基四氢叶酸还原酶677T基因型、高龄、女性、超重肥胖、高血压、糖尿病史、吸烟史、升高的高敏感性C反应蛋白以及较低的高密度脂蛋白等是外周动脉疾病患者的危险因素,建议应该加强对糖尿患者、高血压患者以及高脂血症等"三高"人群的非传统危险因素的检测和干预。外周动脉疾病作为动脉粥样硬化的经典指标,不仅仅能够反映下肢动脉缺血性疾病,而且也能预测到心血管疾病的发生发展。利用踝臂指数能够很好的诊断外周动脉疾病(踝臂指数<0.9)。尽管外周动脉疾病能够很好的预测心血管事件的发生和死亡,但经常未被诊断和处理。目前,踝臂指数的临床筛查在国内尚未得到全面普及和推广。针对外周动脉疾病高危人群及有下肢动脉疾病风险的患者应建议进行常规踝臂指数检查。

BACKGROUDN：Ankle-brachial index was a simple and effective non-invasive method to diagnose peripheral arterial disease（ankle-brachial index 0.90）.Patients suffering from peripheral arterial disease usually indicated partial vascular symptoms of atherosclerosis and increased cardiovascular events and mortality risks.OBJECTIVE：To summarize the epidemiological progress of ankle-brachial index so as to further provide evidences for prevention and control of peripheral arterial disease.METHODS：Experimental data were retrieved from Pubmed database.Articles about ankle-brachial index were included,but articles about duplicated research and unrelated articles were excluded.A total of 26 articles were finally included.RESULTS AND CONCLUSION：Studies have shown that peripheral arterial disease could predict the incidence and mortality of cardiovascular disease.Studies found that the risk factors of peripheral arterial disease included chronic kidney disease,insulin use,proteinuria,MTHFR 677T genotype,age,female,overweight and obesity,hypertension,diabetes history,smoking history,elevated high-sensitivity C-reactive protein and low high-density lipoprotein.It was recommended that the risk factors should be strongly detected in patients with diabetes,hypertension,and hyperlipidemia.Peripheral arterial disease,as a atherosclerosis classic indicator,not only reflects the lower extremity arterial ischemic disease,but also predicts the occurrence and development of cardiovascular disease.The use of ankle-brachial index is a good diagnostic indicator of peripheral arterial disease（ankle-brachial index 〈0.9）.Although the peripheral arterial disease is a good prediction of cardiovascular events and death,it is not often diagnosed and treated.At present,clinical screening of ankle-brachial index in our country has not been universally popularized and promoted.High-risk population for peripheral arterial disease and lower extremity arterial disease should be recommended for routine checks of ankle-brachial index.