心血管疾病高危人群下肢动脉病与肾功能不全相关性研究

High prevalence of peripheral artery disease and renal insufficiency in persons with high risk of cardiovascular disease

目的:评价已发生心血管事件或有多重动脉粥样硬化(AS)危险因素的人群中踝臂指数(ABI)与肾功能不全的相关性。方法:连续入选2010-07-01-2011-02-28期间武汉市16家二级和三级医院的肾内科、心内科、内分泌科和神经内科收治的2 143例已发生心血管事件或有多重AS危险因素的患者,测定ABI值,并以Cockcroft-Gault公式计算肌酐清除率,肾功能不全定义为校正的肌酐清除率<60ml.min-1.1.73m-2;下肢动脉疾病(PAD)定义为ABI≤0.9。结果:821例(38.3%)有肾功能不全,630例(29.4%)有PAD。肌酐清除率与ABI呈正相关(r=0.29,P<0.01)。肾功能受损的独立危险因素包括:ABI异常(OR=1.22,95%CI,1.09～1.37,P<0.001)、年龄(OR=1.11,95%CI,1.10～1.14,P<0.001)、BMI(OR=0.83,95%CI,0.79～0.85,P<0.001)和高血压病史(OR=1.90,95%CI,1.40～2.60,P<0.001)。按AS累及血管床范围进行分组,肾功能不全发生率随着受AS累及的血管床范围的增加而增加(P<0.001)。经校正年龄、性别、高血压病史、糖尿病史、肥胖等因素后,受AS累及的血管床每增加一处,发生肾功能不全的可能增加1.54倍(OR=1.54,95%CI,1.22～1.94,P<0.001)。结论:心血管疾病高危人群中PAD和肾功能不全发病率高。肌酐清除率与ABI呈正相关。ABI异常是发生肾功能不全独立的危险因素。肾功能不全发生率随着AS累及血管床范围的增加而升高。

Objective：To evaluate the cross-sectional association of the renal insufficiency with lower-extremity peripheral arterial disease.Method：From July 2010 to Febrary 2011,consecutive patients diagnosed with atherosclerosis disease admitted in 16 cardiology centers and departments of endocrinology and neurology in Wuhan.Their baseline levels of ankle-brachial index（ABI）,serum creatinine and estimated creatinine clearance（CRCL） were determined.And detailed in-person interviews,physical examinations,and serum samples were obtained.PAD was defined as an ABI≤0.9,and renal insufficiency was defined as CRCL 60 ml·min-1·1.73 m-2.Data analysis was employed SPSS11.5.All P values were two-tailed and P0.05 was deemed statistically significant.Result：There were 2,143 patients enrolled and completed the whole study,of whom 821 cases（38.3%） had renal insufficiency（350 cases with ABI0.9） and 650 cases（29.4%） had PAD.CRCL was correlated with ABI（r=0.29,P0.01）.We categorized the patients into normal（ABI0.9） and low ABI（ABI≤0.4,0.4ABI≤0.9）,and found ABI≤0.4 group had a higher prevalence of renal insufficiency（P0.001）.Logistic regression analysis was performed with the CRCL as the dependent variable and ABI and known clinical risk factors as the independent variables.ABI≤0.9（OR=1.22,95%CI,1.09-1.37,P0.001） and age（OR=1.11,95%CI,1.10-1.14,P0.001）,body-mass index（BMI）（OR=0.83,95%CI,0.79-0.85,P0.001）,history of hypertension（OR=1.90,95%CI,1.40-2.60,P0.001） were all independent risk factor for renal insufficiency.Then we categorized the patients by how many vascular bed affected by atherosclerosis and found that patients with three sites of atherosclerosis disease had a much higher rates for renal insufficiency than those without AS（OR=1.54,95%CI,1.22-1.94,P0.001）.Conclusion：The prevalence of PAD and renal insufficiency among patients with cardiovascular high risk is increased remarkably.Patients with renal insufficiency are likely to have concomitant PAD.A lower ABI is associated with renal insufficiency.ABI is a useful and simple method for identifying patients with PAD.The rates of renal insufficiency dependent of the sites of criminal artery in atherosclerosis disease.