踝肱指数对血管源性及神经源性间歇性跛行的诊断价值

Diagnostic value of ankle-brachial index in vascular and neurogenic intermittent claudication

目的探讨踝肱指数(ABI)对血管源性及神经源性间歇性跛行的诊断价值。方法收集2021年10月至2022年3月于首都医科大学附属北京朝阳医院就诊的160例间歇性跛行患者的临床资料,根据病理类型的不同将其分为血管源性组(n=104)和神经源性组(n=56),收集两组患者的性别、年龄、体重指数(BMI)、病程、间歇性跛行严重程度、吸烟史、饮酒史、基础疾病情况、血肌酐(Scr)、尿素氮(BUN)、C反应蛋白(CRP)、血小板计数(PLT)、脂蛋白A(LpA)、同型半胱氨酸(Hcy)、趾肱指数(TBI)、ABI,分析发生血管源性间歇性跛行的影响因素。结果血管源性组患者CRP、LpA、Hcy水平均高于神经源性组患者,TBI、ABI均低于神经源性组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,CRP、LpA、Hcy、TBI、ABI均是发生血管源性间歇性跛行的影响因素(P﹤0.05)。不同严重程度间歇性跛行患者TBI、ABI比较,差异均有统计学意义(P﹤0.05);重度间歇性跛行患者TBI、ABI均低于轻度、中度患者,中度间歇性跛行患者TBI、ABI均低于轻度患者,差异均有统计学意义(P﹤0.05)。受试者工作特征(ROC)曲线结果显示,CRP、LpA、Hcy、TBI、ABI诊断血管源性间歇性跛行的曲线下面积(AUC)分别为0.692、0.697、0.700、0.783、0.801。结论ABI对神经源性间歇性跛行和血管源性间歇性跛行的诊断效能良好,可用于临床辅助诊断。

Objective To investigate the diagnostic value of ankle brachial index(ABI)in vascular and neurogenic intermittent claudication.Method Clinical data of 160 patients with intermittent claudication who were treated in the Beijing Chaoyang Hospital,Capital Medical University from October 2021 to March 2022 were collected.All patients were divided into vascular group(n=104)and neurogenic group(n=56).Gender,age,body mass index(BMI),course of disease,severity of intermittent claudication,smoking history,drinking history,underlying disease status,blood creatinine(Scr),urea nitrogen(BUN),C-reactive protein(CRP),platelet count(PLT),lipoprotein A(LpA),homocysteine(Hcy),toe brachial index(TBI)and ABI of the two groups were collected,and the factors affecting the occurrence of vascular intermittent claudication were analyzed.Result The levels of CRP,LpA,and Hcy in the vascular group were higher than those in the neurogenic group,but TBI and ABI were lower than those in the neurogenic group,the differences were statistically significant(P<0.05).Multivariate analysis showed that CRP,LpA,Hcy,TBI and ABI were related factors influencing the occurrence of vascular intermittent claudication(P<0.05).There were significant differences for TBI and ABI in patients with different severity of intermittent claudication,the differences were statistically significant(P<0.05).The TBI and ABI in patients with severe intermittent claudication were lower than those with mild and moderate conditions,and TBI and ABI in patients with moderate intermittent claudication were lower than those with mild conditions,the differences were statistically significant(P<0.05).The receiver operating characteristic(ROC)analysis showed that the area under the curve(AUC)of CRP,LpA,Hcy,TBI and ABI for the diagnosis of vascular intermittent claudication were 0.692,0.697,0.700,0.783,0.801,respectively.Conclusion ABI has good diagnostic efficacy for neurogenic intermittent claudication and vascular intermittent claudication,and can be used for clinical auxiliary diagnosis.