双侧踝臂血压指数和臂踝动脉脉搏波传导速度对称下降是诊断主动脉狭窄的有用指标

Symmetrical decrease of bilateral ankle brachial index and brachial-ankle pulse wave velocity is useful indicators for the diagnosis of aortic stenosis

目的评估双侧踝臂血压指数（ABI）和臂踝动脉脉搏波传导速度（baPWV）测量诊断胸、腹主动脉狭窄（AS）的价值。方法连续入选2010年4月至2013年4月北京阜外心血管病医院收治的双侧ABI均〈0.9的患者,其中AS患者56例（AS组）;双下肢动脉狭窄（BLEAS）患者160例（BLEAS组）。采集患者的一般资料,所有患者均测量双侧ABI和baPWV,并在1周内完成外周动脉造影或计算机断层扫描血管造影（CTA）。AS和BLEAS的诊断依据为CTA或外周动脉造影定量测量胸、腹主动脉或双侧下肢动脉一处或多处直径狭窄≥50%。采用受试者工作特征（ROC）曲线评估双侧ABI和baPWV对称下降诊断AS的准确性。两侧ABI（或baPWV）的差值为左侧ABI（或baPWV）减去右侧值后取绝对值。结果 AS组和BLEAS组间两侧ABI的差值（0.03±0.03比0.27±0.22）及两侧baPWV的差值（中位数0.55比3.92m/s）的差异有统计学意义（均P〈0.01）。两侧ABI差值的ROC曲线下面积为0.926（95%CI0.892-0.959）,ABI差值≤0.1诊断AS的敏感度为94.6%,特异度为79.4%,阳性预测值为61.6%,阴性预测值为97.7%;两侧baPWV差值的ROC曲线下面积为0.836（95%CI 0.781-0.891）,baPWV差值≤1.6 m/s诊断AS的敏感度为80.4%,特异度为74.4%,阳性预测值为52.3%,阴性预测值为91.5%。联合双侧ABI差值≤0.1和baPWV差值≤1.6m/s诊断AS的敏感度为75.0%,特异度为95.0%,阳性预测值为72.4%,阴性预测值为91.1%。结论双侧ABI差值≤0.1联合baPWV差值≤1.6 m/s可用于诊断AS,有助于AS与BLEAS的鉴别诊断。

Objective To evaluate the value of the bilateral ankle brachial index （ABI） and brachial-ankle pulse wave velocity （baPWV） for the diagnosis of thoracic and abdominal aortic stenosis （AS）. Methods Patients with bilateral ABI less than 0.9 were consecutively enrolled [AS, n= 56; bilateral lower extremity artery stenosis {BLEAS）, n=160] between April 2010 and April 2013 at Fuwai Hospital. Patients＂ general data was collected. Bilateral ABI and baPWV were measured in all the patients, and peripheral arterial angiography or computed tomography angiography （CTA} was performed within a week. AS or BLEAS was diagnosed when quantitative measurement of CTA or peripheral arterial angiography suggested that the diameter stenosis of aortic or bilateral lower extremity artery was more than 50%. The accuracy of diagnosis of AS based on symmetrical decrease of bilateral ABI and baPWV was evaluated by receiver operator characteristic （ROC） curve. The differences of the bilateral ABI or baPWV= ｜ ABI or baPWV（left）- ABI or baPWV（right）｜. Results The differences of the bilateral ABI （0.03 ± 0.03 vs 0.27±0.22） and difference of bilateral baPWV （median value 0.55 vs 3.92 m/s） differed significantly between the two groups （both P〈0.01}. When the differences of the bilateral ABI≤0.1, its sensitivity, specificity, positive predictive value and negative predictive value for AS diagnosis were 94.6%, 79.4%, 61.6% and 97.7% respectively with the area under the ROC curve of 0. 926 （95 % CI 0. 892-0. 959）. When the differences of the bilateral baPWV≤1. 6 m/s, its sensitivity, specificity, positive predictive value and negative predictive value for AS diagnosis were 80.4%, 74.4%, 52.3% and 91.5% respectively with the area under the ROC curve of 0. 836 （95% CI 0. 781- 0. 891）. When the difference of bilateral ABI≤0. 1 and the differences of the bilateral baPWV≤1. 6 m/s, their sensitivity, specificity, positive predictive value and negative predictive value of the diagnosis for AS were 75.0%, 95.0 %, 72.4 % and 91.1%. Conclusions The present study shows that the differences of bilateral ABI 40. 1 and bilateral baPWV≤1. 6 m/s have a high accuracy for the diagnosis of thoracic and ahdominal AS. Combination of the differences of the bilateral ABI and bilateral baPWV is useful in differential diagnosis of AS and BLEAS.