多重动脉粥样硬化患者踝臂指数与全因、心因性死亡的相关性研究

Relationship of ankle-brachial index with all-cause mortality and cardiovascular mortality in Chinese patients with multiple risk factors of atherosclerosis: a 6-year prospective cohort study

目的探讨踝臂指数作为冠心病独立危险因素的地位和作用。通过随访,评估不同ABI水平对于具有多重动脉粥样硬化危险因素的住院患者长期预后的意义、目前所需采取的措施。方法多中心随机抽取符合条件的3 732例住院患者,分为≤0.4,0.4<ABI≤0.9,0.9<ABI≤1.3,三组。以全因死亡及心因性死亡为主要临床事件终点。以冠心病发病率及冠心病再入院率心血管事件为次要临床事件终点。采用多因素方差分析,卡方检验,趋势卡方检验,Cox回归,分析相关变量及不同ABI对于具有多重动脉粥样硬化危险因素患者的预后影响。结果ABI异常组与正常组相比,年龄明显增高,男性大于女性,高血压﹑脑卒中﹑糖尿病﹑高尿酸血症﹑肾功能不全﹑肥胖症的患病率及吸烟的发生率明显增高,间差异均有统计学意义(P<0.05)。同时发现在冠心病患者中,PCI﹑CABG﹑心绞痛﹑心肌梗死发生率明显增高并具有统计学意义(P<0.05)。随访结果显示:在ABI异常组中,全因死亡率及心因性死亡率显著增高。ABI正常组对比≤0.4组,其全因死亡率与心因性死亡率分别为(7.2%vs33.3%);(3.2%vs 18.5%),(P<0.01)。Cox回归显示异常ABI是冠心病患者全因死亡率和心因性死亡率及冠心病发病率的独立预测因子。对比ABI异常组与正常组,患者全因死亡率的相对危险度是1.82(95%CI:1.15-2.90),心因性死亡率的相对危险度是2.97(95%CI:1.56-5.98)。结论异常ABI是除年龄,高血压,糖尿病,吸烟,高脂血症,脑卒中,肾功能损害等传统因素外独立的冠心病危险因素,并能预测具有多重动脉粥样硬化危险因素患者的预后状况。对比ABI异常组与正常组,其全因死亡率的相对危险度是1.82(95%CI:1.15-2.90),心因性死亡率的相对危险度是2.97(95%CI:1.56-5.98)。建议对高危人群进行PAD筛查,尤其是在具有多重动脉粥样硬化危险因素的患者中首先开展,并将无症状的PAD个体尽早纳入一级预防队列。

Objective To elucidate the relationship of ankle-brachial index（ABI） with all-cause mortality and cardiovascular mortality in Chinese patients with multiple risk factors of atherosclerosis.Methods A total of 3732 consecutive patients with multiple risk factors of atherosclerosis underwent ABI measurement.The patients were classified as ABI≤0.4,0.4ABI≤0.9,and 0.9ABI≤1.3;0.9 was used as cut-off value of ABI for peripheral arterial disease（PAD）.The patients were followed up from November 2004 to January 2011 for average of 68.85±11.37 months.Factors related to coronary atherosclerotic heart disease（CVD）,all-cause mortality,in-hospital major adverse cardiac events（MACE） and follow-up MACE were evaluated by multivariate Cox regression analysis and log rank test.Potential confounding variables with P0.10 were adjusted for multivariate analysis.Results The base-line character and Cox regression analysis showed that abnormal ABI value was a predictor of CVD,independent to age,gender,hypertension,diabetes mellitus,ischemic stroke,body mass index（BMI） and smoking（P0.05）.In-hospital MACE and follow-up MACE in patients with abnormal ABI value were also significantly higher than those with normal ABI value.After adjusting for age and other covariates,multivariate Cox proportional-hazards regression model revealed that abnormal ABI value was correlated with all-cause mortality（RR： 1.82,95% CI： 1.15-2.90,P0.01） and cardiovascular disease mortality（RR： 2.97,95% CI： 1.56-5.98,P0.01）.Conclusion Abnormal ABI value is an independent risk factor for cardiovascular disease in patients with multiple risk factors of atherosclerosis and can be used as a predictor for increased follow-up MACE and decreased survival rate.