臂踝指数与锁骨下动脉重度狭窄的相关性研究

Association between brachial-ankle index and severe subclavian artery stenosis

目的探讨臂踝指数(BAI)与锁骨下动脉重度狭窄的相关性。方法收集2012年3月~2014年6月在火箭军总医院神经内科门诊及住院的单侧锁骨下动脉重度狭窄(狭窄率≥70%)患者70例为狭窄组,另选无锁骨下动脉病变患者70例为对照组。采用无创伤全自动外周动脉检测仪测量BAI、脉搏波形上升时间(UT)和脉搏波形。计算BAI诊断锁骨下动脉重度狭窄的敏感性、特异性、准确性、阳性预测值和阴性预测值。结果狭窄组患侧肢体的BAI明显低于狭窄组健侧肢体和对照组,UT明显长于狭窄组健侧肢体和对照组,差异有统计学意义[0.6±0.1vs 0.9±0.1和0.9±0.1;(261.0±11.8)ms vs(188.0±12.1)ms和(186.0±12.6)ms,P<0.01]。狭窄组患侧肢体脉搏波形呈低钝波者58例(82.9%),呈低平波者11例(15.7%)。狭窄组中BAI诊断为重度狭窄31例,对照组中BAI诊断为无狭窄65例,BAI诊断锁骨下动脉重度狭窄的敏感性为44.3%,特异性为92.9%、准确性为68.6%,阳性预测值为86.1%,阴性预测值为62.5%。结论 BAI<0.70诊断锁骨下动脉重度狭窄的特异性和阳性预测值高,诊断的准确性较高。

Objective To study the association between brachial-ankle index（BAI）and severe subclavian artery stenosis.Methods Seventy severe subclavian artery stenosis patients with a stenosis rate≥70%admitted to our hospital served as a stenosis group and 70 subclavian artery stenosis-free patients served as a control group in this study.Their BAI,pulse wave upstroke time（UT）and pulse wave form were recorded with a noninvasive automatic peripheral arterial device.The sensitivity,specificity,accuracy,positive and negative prediction value of BAI in diagnosis of subclavian artery stenosis were calculated.Results The BAI of stenosis-involved extrmities was significantly lower while the pulse wave UT was significantly longer in stenosis group than in control group（0.6±0.1 vs 0.9±0.1 and 0.9±0.1,261.0±11.8 vs 188.0±12.1 ms and 186.0±12.6 ms,P〈0.01）.The low obtuse pulse wave form and low plain pulse wave form were detected respectively in stenosis-involved extrmities of 58 patients（82.9%）and 11 patients（15.7%）of stenosis group.The sensitivity,specifity,accuracy,positive and negative prediction value of BAI in diagnosis of severe subclavian artery stenosis were 44.3%,92.9%,68.6%,86.1%and 62.5%respectively.Conclusion The specifity,positive prediction value and accuracy of BAI0.70 are rather high in diagnosis of severe subclavian artery stenosis.