Analysis of Ankle-Brachial Index, Waist-Hip Ratio, Ejection-Fraction, Obesity, Smoking, Alcohol Habits, Diabetes and Hypertension as Independent Predictors of Complexity and Severity of Coronary Artery Disease

Background: The present study was conducted to examine the association between various coronary risk factors and clinical parameters, with special emphasis on ankle-brachial index, in predicting the severity and complexity of coronary artery disease. Methods: Patients diagnosed with coronary artery disease at our hospital between September-2012 and December-2014 were examined in this study. Selected patients were screened for cardiovascular risk factors including diabetes, hypertension, smoking, and alcohol habits as well as for clinical parameters including body-mass index, waist-hip ratio, ankle-brachial index, and ejection fraction. All patients underwent coronary angiography and were evaluated for severity of coronary artery disease (based on number of vessels involved) and complexity of coronary angiographic lesions (measured by computer-assisted Syntax score calculator). The collected data were analyzed to determine the role of cardiovascular risk factors and clinical parameters as predictors of complexity and severity of coronary artery disease. Results: A total of 211 patients (mean age: 54.64 ± 9.9 years;81% males) with coronary artery disease were analyzed. Findings revealed that diabetes mellitus (p < 0.001), hypertension (p < 0.001), smoking habits (p = 0.036), and low ankle-brachial index (p < 0.001) were independent predictors of complex coronary artery disease as measured by Syntax score. Significant associations were also evident between severity of coronary artery disease and diabetes mellitus (p < 0.001), hypertension (p < 0.001), and ankle-brachial index (p < 0.001). Conversely, other cardiovascular risk factors including body-mass index, alcohol habits, wait-hip ratio, and ejection fraction did not exhibit significant associations with severity and complexity of coronary artery. Conclusions: The early diagnosis of coronary artery can be predicated by evaluating diabetes, hypertension, and smoking habits in patients presenting with acute coronary syndrome. In addition, ankle-brachial index can be used as an effective non-invasive bed-side tool, as an alternative to Syntax score, in predicting the severity and complexity of coronary artery disease.

New Approach to Measuring the Ankle and Toe Brachial Indices as New Markers for Early Detection of Lower Extremity Peripheral Artery Disease

Background: Lower extremity Peripheral artery disease (PAD) is caused by atherosclerosis, or Plaque buildup, that reduces the blood flow to the legs and feet. PAD affects approximately 230 million adults worldwide and is associated with an increased risk of coronary heart disease, stroke, and leg amputation. The first-line method for diagnosis of PAD is the Ankle Brachial Index (ABI), which is the ratio of ankle to brachial higher systolic pressure measured in ankles and arms. The Toe Brachial Index (TBI), which is the ratio of the toe systolic pressure to brachial higher systolic pressure measured in both arms, is considered to be an alternative to the ABI in screening for PAD. The ABI and TBI are measured on the right and left side, and the lower of these numbers is the patient’s overall ABI and TBI. Clinical studies and meta-analysis reviews have shown that the conventional ABI measurement, which uses a cuff, and handheld sphygmomanometer and continuous-wave Doppler tracings, provides an acceptable-to-high specificity level but low sensitivity when compared with vascular color Doppler ultrasound, and/or angiography methods. Another study has shown that the TBI measurement has greater sensitivity but lower specificity than the ABI when compared with vascular color Doppler ultrasound diagnostic based on waveforms. The aim of this clinical study was to evaluate the specificity and sensitivity of the VasoPad System comparing its results to the vascular color doppler ultrasound waveforms. Materials and Methods: The VasoPad System is an automated device using the pulse wave method to measure the arms and ankles dorsalis and tibial posterior artery blood pressures, the photoplethysmography second derivative (PTGSD) to estimate the toe systolic pressure, a patented photoplethysmography (PTG) index marker and volume plethysmography via cuffs during deflation. Vascular Color Doppler ultrasound can diagnose stenosis through the direct visualization of atherosclerosis or plaques and through waveform analysis. The vascular color Doppler ultrasound provides 3 waveform types. The type 1, triphasic waveform is normal blood flow and no atherosclerosis or plaque, the type 2, diphasic waveform is seen when there are atherosclerosis plaques, but normal blood flow, and the type 3, monophasic waveform reflects stenosis with diameter reduction > 50%. Results: The sum of the overall ABI and TBI VasoPad values, called Sum of Brachial Indices (SBI), gave a specificity of 88.89% and sensitivity of 100% for detecting vascular color Doppler ultrasound biphasic and monophasic waveforms versus triphasic waveforms with a cutoff ≤ 1.36 (P Conclusion: The VasoPad was useful for detecting PAD, which is fully defined as having vessel stenosis > 50% (Doppler monophasic waveforms) but also early stage of atherosclerosis plaque of the lower extremities (Doppler biphasic waveforms). The VasoPad method provided a remarkable sensitivity of 100% and a specificity level similar to those of the conventional ABI test method compared with the vascular color Doppler ultrasound. In addition to being useful to screen and detect PAD, the VasoPad offers early detection of lower extremity atherosclerosis, with normal blood flow (Doppler biphasic waveforms), which could provide greater treatment options and thus reduce the overall number of lower extremity complications.

Ankle-brachial index and brachial-ankle pulse wave velocity are risk factors for ischemic stroke in patients with type 2 diabetes

The incidence of ischemic stroke in patients with diabetes is increasing. While brachial-ankle pulse wave velocity （BaPWV） and ankle-bra- chial index （ABI） are known to be associated with ischemic cardiovascular and cerebrovascular diseases, whether these measures predict the risk of ischemic cerebrovascular disease in diabetic patients remains unclear. 117 patients with type 2 diabetes were enrolled in this study. According to the results of head magnetic resonance imaging, the patients were divided into a diabetes-only group （n = 55） and a diabetes and ischemic stroke group （n = 62）. We then performed ABI and BaPWV examinations for all patients. Compared with the diabe- tes-only group, we found decreased ABI and increased BaPWV in the diabetes and ischemic stroke group. Multivariate logistic regression analyses revealed that BaPWV and ABI were risk factors for ischemic stroke in patients with type 2 diabetes. Our findings indicate that decreased ABI and increased BaPWV are objective indicators of increased risk of ischemic stroke in patients with type 2 diabetes.

Screening of Peripheral Artery Disease by Systematic Measurement of Ankle-Brachial Index among Diabetic Patients in Dakar

Introduction: The peripheral artery disease (PAD) is one of the chronic and frightening vascular complications of the diabetes whose tracking can be done by the Ankle-Brachial Index (ABI) measurement. We conducted in this context a study which consisted in measuring the ABI among hospitalized diabetic patients at Teaching Hospital of Pikine in Dakar, over 18 months’ duration. The aim was to determine the prevalence and evaluate factors correlated to the presence of the PAD. Patients and Method: This cross-sectional descriptive study interested the whole of diabetic patients hospitalized in Internal Medicine/Endocrinology Department, from January 2013 to June 2014. We carried out a complete clinical examination associated with ABI measurement by a Doppler probe for each included patient after having collected the clinical and paraclinical data. Results: Our population of study comprised 209 diabetic patients with a female predominance (126, 60.3%). The sex-ratio man/woman was 0.6. The median age of the population of study was 54 ± 2 years. In our series, 157 (75.1%) patients discovered their diabetes with the waning of an affection while the 52 (24.9%) other patients discovered their diabetes at the time of a systematic assessment. The PAD appeared by an intermittent claudication among 38 patients (18.2%). The ABI was normal for 126 patients (60.3%). The ABI was low for 51 patients (24.4%), unilateral in 3.8% of cases and bilateral in 20.6% of cases. The ABI was high among 32 patients (15.3%), unilateral in 7.2% of cases and bilateral in 8.1% of cases. The ABI extremes values were 0.11 and 2. In the population of study, 46 patients (22%) had a well-compensated PAD. The PAD was low compensated for 3 patients (1.4%) and severe for 2 patients (1%). The ABI was more frequent and significantly among women than men, with 32 cases (25.4%) against 19 (22.9%) cases (p = 0.021). The proportion of low ABI was more important among patients whose diabetes had evolved for more than 5 years (42.3% of cases) with a peak of frequency in the duration of 6 - 10 years (47.7% of cases). Conclusion: The PAD global prevalence among hospitalized diabetic patients appeared high with 24.4% patients presenting low ABI. Its early diagnosis among subjects at risk as for our study population allowed identifying asymptomatic subjects having another cardiovascular damage. Thus, the screening of obstructive arteriopathy of lower limb PAD by the measurement of ABI should be applied to all diabetic patients for a better assessment of atherosclerotic complication.

Association of Race and Change in Ankle-Brachial Index: The Atherosclerosis Risk in Communities (ARIC) Cohort

Objective: This study evaluates the association of self-reported race with change in ankle-brachial index (ABI) over time and modification of this association by paraoxonase gene (PON1, PON2 and PON3) single nucleotide polymorphisms (SNPs). Methods: This longitudinal study included 11,992 (N = 2952 Black, N = 9040 White) participants from the Atherosclerosis Risk in Communities (ARIC) cohort with PON genotyping. Mixed-effects models examined whether race was associated with change in ABI over time after adjustment for known peripheral artery disease (PAD) risk factors. Results: Change in ABI over time differed between Whites and Blacks (race-time interaction, p < 0.0001). Stratified analyses showed that ABI values were better in both Blacks and Whites who completed high school or more education compared to those who completed less education. None of the PON SNPs met the significance level (p < 0.001) after Bonferroni correction for multiple comparisons. Conclusions: ABI differences by race were small and although statistically significant, may not be clinically significant. Change in ABI over time varies by race and may be modified by education. Results suggest that higher education may influence the lifestyle and behavioral choices contributing to better ABI in both Blacks and Whites. Further studies are needed to confirm this observation.

Risk factors and ankle brachial indexes in cerebral infarction combined with peripheral arterial disease

BACKGROUND: Ankle brachial index (ABI) is widely involved in researches and clinical application of peripheral vascular injury of patients with diabetes mellitus (DM); however, the application in cerebral infarction (CI) is rare. OBJECTIVE: To investigate the possible risk factor of cerebral infarction plus peripheral arterial disease (PAD), compare metabolic characteristics of patients who having CI plus PAD or only having CI, and understand the significance of ABI on screening and diagnosing CI plus PAD of lower limb. DESIGN: Contrast observation based on CI patients. SETTING: Department of Neurology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region. PARTICIPANTS: A total of 124 CI patients were selected from Department of Neurology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region from July 2005 to April 2006, including 72 males and 52 females aged from 45 to 88 years. All patients met the diagnostic criteria of cerebrovascular disease established by National Academic Conference of Cerebrovascular Diseases in 1995 and determined as cerebral infarction with MRI or CT examination. All patients provided informed consent. There were 46 cases (37.2%) with CI plus PAD and 78 cases (62.8%) only with CI. METHODS: Blood pressure of bilateral ankles and upper extremities was measured at plain clinostatism with DINAMAP blood pressure monitor (GE Company). The ratio between average systolic pressure of lateral ankle and average systolic pressure of both upper extremities was regarded as ABI. The normal ABI was equal to or more than 0.9. If ABI < 0.9 occurred at one side, patients were diagnosed as PAD. On the second morning after hospitalization, blood was collected to measure fasting blood glucose (FBG), 2-hour postprandial blood glucose (PBG2h), glycosylated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Among them, blood glucose, lipid and other biochemical markers were measured with enzyme chemistry assay and HbA1c was measured with HbA1c meter based on high liquid phase. Measurement data and enumeration data were compared with t test and Chi-square test, and multiple factors were dealt with Logistic regression analysis and multivariate linear regression analysis. MAIN OUTCOME MEASURES: Results of correlation between ABI and metabolic markers with multivariate linear regression analysis; risk factors of CI plus PAD with Logistic regression analysis; comparisons of metabolic markers between PAD and non-PAD patients. RESULTS: All 124 patients with acute CI were involved in the final analysis. ① Comparisons of metabolic markers: Levels of serum LDL-C and uric acid (UA) were higher of PAD patients than those of non-PAD patients (t =2.051 9, 3.339 1, P < 0.05); however, there were no significant differences among other metabolic markers (P > 0.05). ② Results of multivariate linear regression analysis: PBG2h, LDL-C and UA were obvious correlation with ABI of posterior tibial artery of lower limb and dorsal pedis artery (partial regression coefficient = -0.231 to -1.010, P < 0.05). ③ Risk factors of CI plus PAD with Logistic regression analysis: Age, smoking history, sum of CI focus (≥3) and LDL-C were independent risk factor of CI plus PAD (OR =1.524-5.422, P < 0.05-0.01). CONCLUSION: ① Levels of serum LDL-C and UA of patients with CI plus PAD are high. ② ABI of lower limbs is correlation with PBG2h, LDL-C and UA. In addition, measuring ABI is beneficial for early diagnosing PAD of lower limbs of patients who have poorly controlled blood glucose, abnormal lipid and poor renal function. ③ Age, LDL-C and sum of CI focus (≥3) are independent risk factors of CI plus PAD. It is of significance for screening non-PAD patients to evaluate risk degrees and prognosis and select therapeutic methods based on ABI measurement.

Importance of Ankle/Brachial Pressure Index in Saudi Patients with Coronary Artery Disease

Background: The ankle/brachial pressure index (ABPI) has been shown to be a good marker of systemic atherosclerosis and a powerful predictor of cardiovascular morbidity and mortality. The objective of this study was to determine the importance of measuring ABPI in Saudi patients with coronary artery disease (CAD). METHODS: This is a hospital based cross-sectional study which was conducted on all Saudi patients who underwent coronary angiography without symptoms of peripheral arterial disease at King Fahd Hospital of the University, Al-Khobar Saudi Arabia. All patients underwent measurement of their ABPI. The study was carried out between December 2010 and November 2011. RESULTS: During the study period, two hundred and five patients were included. Fifty-nine (28.8%) patients were Group II (ABPI ≤ 0.90) and the rest was Group I (ABPI > 0.90). Significant correlation was also found between low ABPI and the extent of CAD (mean number of arteries involved in Group I was 1.78 ± 0.83 compared to 2.10 ± 0.736 in Group II p = 0.011). Nevertheless, the correlation between low ABPI, and the severity of presentation of CAD were also significant (Incidence of myocardial infarction with congestive heart failure was 0.5% in Group I compared to 12% in Group II p CONCLUSION: The ABPI is an important prognostic indicator for Saudi patients with CAD.

Pulse palpation and limited joint mobility examination are better indicators than oscillometric measurement for diagnosing abnormal ankle-brachial index

Background: Peripheral artery disease (PAD) is the least recognized form of atherosclerosis and may even result in amputation if the diagnosis is delayed. Manual pulse palpation is the traditional way to diagnose PAD. Doppler ultrasonographic measurement of ankle-brachial index (ABI) is the gold standard diagnosing method but requires training and is not necessarily available as an outpatient procedure. Using automated oscillometric blood pressure devices has been suggested as an easier method for measuring the ABI. Methods: A single observer palpated the arterial dorsalis pedis, examined hand joints and measured the ABI of one hundred diabetic patients using both Doppler and oscillometric methods. The purpose of this study was to compare the oscillometric method and the manual diagnosing methods to the gold standard method of using a hand held Doppler device for measuring the ABI and detecting PAD. Results: ABI was abnormal in 24 patients (24%) (22 males, 2 females) when measured with the Doppler method. Of these 24 patients, the oscillometric method would have missed 12 giving 12 false negatives. We found that the sensitivity of the oscillometric method was 50.0% and specificity 90.8%. Clinical examination with palpation of ADP combined with limited joint mobility (LJM) scoring would have missed only four cases. Conclusions: Although the oscillometric method is easy and accessible, it is not sensitive enough to be used as the only method in measuring ABI. The simple and inexpensive ADP pulse palpation combined with testing for LMJ was able to find 20 of the 24 (83%) patients with an abnormal ABI measured by Doppler stethoscope.

Association between Systolic Blood Pressure Difference ≥10 mm Hg and Ankle-Brachial Index

Background: In new outpatients, blood pressure should be measured in both arms. A previous study reported that an inter-arm systolic blood pressure difference (ΔSBP) of ≥10 mm Hg is associated with an increased risk of mortality. Aim: The aim was to identify the associations with absolute values of ΔSBP (|ΔSBP|) ≥10 mm Hg. Subjects and Methods: This study included 2481 patients. Patients with a body mass index ≥25 kg/m2 were defined as obese. The group of A was defined as following: ankle-brachial index (ABI) was <0.9 or ≥1.3. ΔSBP was expressed as right arm BP minus left arm BP. |ΔSBP| ≥10 mm Hg were analyzed using multivariate logistic analysis. Results: |ΔSBP| ≥10 mm Hg was found in 6.0% of patients and |ΔSBP| < 5 mm Hg in 80.4%. In multivariate analysis, the odds ratios (ORs) of the associations with |ΔSBP| ≥10 mm Hg were significantly associated with abnormal ABI and obesity regardless of sex and age. Moreover, the OR of the combined effects of abnormal ABI and obesity was higher than that of abnormal ABI and obesity alone. Conclusion: |ΔSBP| ≥10 mm Hg was associated with abnormal ABI and obesity. In a primary care setting, blood pressure should be actively measured in both arms. This study suggests that the associations with |ΔSBP| ≥10 mm Hg may be a useful part of screening for abnormal ABI.

甘油三酯-葡萄糖乘积指数与动脉硬化进展的回顾性队列研究

目的:胰岛素抵抗(insulin resistance,IR)与动脉硬化和不良心血管病事件均存在密切关联。甘油三酯-葡萄糖(triglyceride-glucose,TyG)指数可作为评估IR的有效指标。本研究旨在探讨Ty G指数与动脉硬化进展风险的关系。方法:本研究为回顾性队列研究。选取2012年1月至2022年12月在中南大学湘雅三医院健康管理医学中心参加健康体检次数≥2且完成动脉硬化检测的成年人作为研究对象,收集其临床资料。TyG指数采用公式ln(甘油三酯×空腹血糖/2)计算。基线TyG指数分别以连续变量和四分位数的分类变量为自变量评价。动脉硬化进展采用臂踝脉搏波传导速度(brachial-ankle pulse wave velocity,baPWV)的年变化速率和新发动脉僵硬度增加为因变量评价。通过线性回归模型和Cox比例风险回归模型,探索TyG指数是否为动脉硬化进展的独立风险因素。根据年龄、性别、体重指数,以及是否合并2型糖尿病、高血压和高脂血症进行亚组分析,以确定TyG指数和动脉硬化进展之间的关联特征。结果:共纳入4971名研究对象,随访时间为(3.01±1.98)年。随访期间,baPWV的年变化速率为(24.94±81.15)cm/s,共计278例为新发动脉僵硬度增加。在全面校正混杂因素后,自变量为连续变量时,基线Ty G指数与baPWV的年变化速率(β=17.5,95%CI 9.00~25.94,P<0.001)和新发动脉僵硬度增加[风险比(hazard ratio,HR)=1.43,95%CI 1.18~1.74,P<0.001]呈独立正相关。自变量为分类变量时,与第1四分位数组相比,第2、3、4四分位数组的baPWV年变化速率依次增加,新发动脉僵硬度增加的风险也依次增高(均P<0.05)。年龄≥45岁、男性、BMI<28 kg/m2、高血压病、无高血压病、无2型糖尿病和无高脂血症亚组中,基线TyG指数(连续和分类变量)与新发动脉僵硬度增加具有明显关联(均P<0.05),各亚组均不存在显著的交互作用(均P>0.05)。结论:TyG指数与动脉硬化进展风险增加独立相关,可用作体检人群动脉硬化进展风险的评估指标。

心脏彩色超声联合心踝血管指数和踝臂指数用于冠心病早期诊断的价值研究

目的:研究心脏彩色超声联合心踝血管指数(CAVI)和踝臂指数(ABI)用于冠心病早期诊断的价值。方法:选取2019年12月至2022年12月乐山市人民医院收治的146例冠心病患者,将其纳入观察组,另将同期在医院体检的70名正常体检者纳入健康对照组。两组受试者均行心脏彩色超声并检测CAVI、ABI,比较两组心肌做功指数(Tei指数)、舒张期E峰血流速度(E)与舒张晚期A峰血流速度(A)比值(E/A)、左心房内径(LAD)、左心室射血分数(LVEF)、CAVI以及ABI水平;绘制受试者工作特征(ROC)曲线,分析Tei指数、E/A、LAD、LVEF、CAVI及ABI单独诊断冠心病的价值;以冠状动脉造影结果为“金标准”,以一致性Kappa检验分析Tei指数、E/A、LAD、LVEF、CAVI及ABI联合诊断冠心病的效能。结果:观察组Tei指数、LVEF及CAVI水平明显高于健康对照组,差异有统计学意义(t=19.357、25.728、21.766,P<0.05),E/A、LAD及ABI水平明显低于健康对照组,差异有统计学意义(t=7.721、2.769、10.610,P<0.05)。经ROC分析证实Tei指数、E/A、LAD、LVEF、CAVI及ABI能够用于诊断冠心病,ROC曲线下面积分别为0.914、0.796、0.553、0.950、0.930和0.834。经一致性Kappa检验分析,Tei指数、E/A、LAD、LVEF、CAVI及ABI联合诊断冠心病的灵敏度为98.6%,特异度为92.9%,准确率为96.8%(Kappa=0.925,P<0.05)。结论:Tei指数、E/A、LAD、LVEF、CAVI及ABI可用于诊断冠心病,且联合诊断的效能更高。

四逆散治疗糖尿病周围神经病变的效果及对震动感觉阈值的影响

目的 研究四逆散治疗糖尿病周围神经病变的效果及对震动感觉阈值(VPT)的影响。方法 纳入2018年3月至2023年3月我院收治的80例糖尿病周围神经病变患者,根据随机数字表法将其分为对照组、观察组,各40例。对照组采用常规治疗(甲钴胺联合依帕司他),观察组在此基础上加用四逆散治疗。比较两组的治疗效果。结果 观察组的治疗总有效率高于对照组(P<0.05)。治疗后,两组的空腹血糖(FPG)、餐后2 h血糖(2 h PG)水平及糖化血红蛋白(HbA1c)均显著降低,且观察组低于对照组(P<0.05)。治疗后,两组的中医证候积分、多伦多临床评分系统(TCSS)评分均显著降低,且观察组低于对照组(P<0.05)。治疗后,两组的VPT显著降低,臂踝指数(ABI)显著升高,且观察组优于对照组(P<0.05)。两组的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 四逆散治疗糖尿病周围神经病变的效果显著,可缓解患者的临床症状,调节血糖水平,修复受损神经功能,具有较高安全性。

16周有氧运动对中老年baPWV及ABI的影响

目的:探讨16周有氧运动锻炼对中老年动脉硬化的干预作用及相关机制。方法:以27名中老年人为研究对象,平均年龄(62.70±3.26)岁,采用每次60 min、每周6次,共16周的广场舞/太极拳进行锻炼,分别测试锻炼前和锻炼8周末、16周末受试者收缩压(SBP)、舒张压(DBP)、左肱踝动脉脉搏波传导速度(L-ba PWV)、右肱踝动脉脉搏波传导速度(R-ba PWV)、左踝臂血压指数(L-ABI)和右踝臂血压指数(R-ABI)的变化,并检测血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-c)、低密度脂蛋白胆固醇(LDL-c)、超氧化物歧化酶(SOD)、丙二醛(MDA)和谷胱甘肽过氧化物酶(GSH-Px)等相关指标的变化。结果:(1)与运动前相比,有氧运动锻炼8周末R-ba PWV、R-ABI下降,16周末则L-ba PWV、R-ba PWV、R-ABI、L-ABI均呈显著性下降(P<0.01);(2)与运动前比,8周末SBP和DBP显著下降(P<0.05),16周末SBP、DBP和脉压差则显著降低(P<0.01,P<0.05);(3)与运动前相比,在8周末、16周末受试者TC、LDL-c均显著降低(P<0.01),HDL-c、TG在8周末和16周末的变化则无统计学意义;(4)与试验前相比,8周末血清SOD、GSH-Px、MDA无明显变化,16周末血清SOD、GSH-Px活性呈显著性升高、而血清MDA含量则呈显著性下降(P<0.01)。结论:通过16周有氧运动,可明显降低中老年人ba PWV和ABI水平,调节血压、血脂及过氧化脂质水平,进而可能对动脉硬化程度起到一定的改善作用。

冠心病患者CAVI与ABI改变的临床研究

目的探讨冠状动脉粥样硬化性心脏病(CHD,冠心病)患者在动脉硬化及僵硬度指标心踝血管指数(cardio-ankle vascular index,CAVI)与踝臂指数(ankle-brachial index,ABI)改变的临床价值。方法随机选取在安徽医科大学第一附属医院心血管内科行选择性冠状动脉造影检查及治疗的患者269例,其中经冠脉造影证实的冠心病患者(狭窄≥50%)217例作为实验组(冠心病组),并根据冠状动脉血管病变支数分为相应的亚组,其余52例(狭窄<50%)作为对照组(非冠心病组),比较两组间在CAVI、ABI的差异。结果①随着冠状动脉狭窄程度的加重,CAVI进行性增高,组间的差异有统计学意义(P<0.01)。②非冠心病组与冠心病组的ABI均在正常范围,但冠心病组的ABI低于非冠心病组(P<0.01)。多支病变组ABI低于对照组、单支病变组(P<0.05)。③CAVI(+)预测冠心病的敏感性较高(66.4%),特异性欠佳(32.7%);ABI降低预测冠心病的敏感性低(18.0%),但特异性高(96.2%)。结论 CAVI(-)可能是非冠心病有意义的独立预测因子,CAVI(+)有利于早期发现动脉硬化,ABI降低是冠心病独立的危险因子,可作为冠心病诊断参考指标。

药物涂层球囊联合血管减容对下肢动脉硬化闭塞病变病人血运重建率、血管内皮功能及踝肱指数的影响

目的观察药物涂层球囊(DCB)联合血管减容对下肢动脉硬化闭塞病变(LEAOD)病人血运重建率、血管内皮功能及踝肱指数(ABI)的影响。方法选择2018年6月至2021年6月黄河三门峡医院收治的LEAOD病人100例,按随机数字表法分两组,对照组(n=50)予DCB,研究组(n=50)予DCB联合血管减容。比较靶血管通畅率、靶血管血运重建(TLR)率、再狭窄率、Rutherford分级情况、血管内皮功能、ABI、下肢动脉最小管腔直径(MLD)、晚期管腔丢失(LLL)值。结果术后12个月,研究组靶血管通畅率(92.00%,46/50)均较对照组(74.00%,37/50)高(P<0.05)。术后12个月,研究组TLR率(2.00%,1/50)、再狭窄率(0,0/50)均较对照组(18.00%,9/50)、(12.00%,6/50)低(P<0.05)。术后,两组Rutherford分级情况均优于术前(P<0.05),且研究组Rutherford分级情况均优于对照组(Z=-2.21,P=0.027)。术后个12个月,两组血流介导的血管内皮舒张程度值(FMD)、硝酸甘油介导的血管内皮舒张程度值(NMD)、足背动脉ABI、胫后动脉ABI均高于术前(P<0.05),且研究组高于对照组(均P<0.05)。术后个12个月,两组的下肢动脉MLD、LLL值均低于术后次日(P<0.05),且研究组下肢动脉MLD高于对照组(P<0.05),LLL值低于对照组(P<0.05)。结论DCB联合血管减容能提高LEAOD病人靶血管通畅率,降低TLR率、再狭窄率,改善Rutherford分级情况、血管内皮功能、ABI,调节下肢动脉MLD、LLL值。

高血压病合并2型糖尿病患者动态血压与CAVI及ABI相关性研究

目的探讨高血压病(EH)及合并2型糖尿病(T2DM)患者24 h动态血压水平及与心踝血管指数(CAVI)、踝臂指数(ABI)的相关性。方法随机入选90例高血压病患者,分为单纯高血压病组(EH组,n=47),高血压病伴糖尿病组(EH+T2DM组,n=43)。所有入选者进行24 h动态血压监测,CAVI、ABI指标及颈动脉超声检查。对两组上述指标进行比较,并对动态血压与CAVI、ABI进行直线相关分析。结果与EH组患者比较,EH+T2DM组患者各时段的平均收缩压(SBP)、脉压(PP)、收缩压负荷(SBP-L)及CAVI呈增高趋势,而ABI和夜间血压下降率降低,两组比较均有统计学差异(P均<0.05)。EH组患者杓型血压占42.5%,EH+T2DM杓型血压占23.3%,两组比较有统计学差异(P<0.05)。CAVI与24 h平均收缩压(24 hSBP)、夜间平均收缩压(nSBP)、24 h平均脉压差(24 hPP)、日间平均脉压差(dPP)、夜间平均脉压差(nPP)、夜间收缩压负荷(nSBP-L)、夜间舒张压负荷(nDBP-L)呈正相关,ABI与24 hSBP、白天平均收缩压(dSBP)、dPP、白天收缩压负荷(dSBP-L)、nSBP-L等指标呈负相关。结论合并T2DM可增加EH患者收缩压、脉压及收缩压负荷水平,并加速动脉硬化的进展。

西洛他唑联合尼可地尔对LEAOD患者baPWV、ABI指数及CD36水平的影响

目的:探讨西洛他唑联合尼可地尔对下肢动脉硬化闭塞症(LEAOD)患者臂踝脉搏波传导速度(baPWV)、踝肱指数(ABI)及清道夫受体CD36水平的影响。方法:选取116例LEAOD患者作为研究对象,采用随机数字表法分为对照组和治疗组,每组58例。对照组患者采用西洛他唑治疗,治疗组在西洛他唑治疗的基础上联合尼可地尔治疗,比较两组临床治疗效果,治疗前后baPWV、ABI和CD36水平以及不良反应发生情况。结果:治疗结束后,有效率对照组仅为74.1%,而治疗组为91.4%,两组差异有统计学意义(P <0.05)。治疗前两组baPWV、ABI以及CD36水平均无显著性差异,治疗后两组均baPWV、CD36水平显著降低,ABI显著升高,但与对照组相比,治疗组baPWV和CD36水平降低更为明显,ABI升高更为显著(均P <0.05)。对照组和治疗组不良反应发生率分别为15.5%、13.8%,差异无统计学意义(P> 0.05)。结论:西洛他唑联合尼可地尔对LEAOD患者治疗效果显著,有效降低了baPWV值和CD36水平,提高了ABI,而且安全性较高,值得在临床广泛应用。

围绝经期女性baPWV、ABI及血清Hcy、Lp(a)与心血管事件的相关性分析

目的 分析围绝经期女性臂踝脉搏波传导速度(baPWV)、臂踝血压指数(ABI)及血清同型半胱氨酸(Hcy)、脂蛋白a[Lp(a)]与心血管事件的相关性。方法 选取2021年7月-2021年10月体检的1 000例围绝经期妇女,根据是否发生动脉粥样硬化性心血管疾病(ASCVD)分为ASCVD组和非ASCVD组,比较两组的临床资料和baPWV、ABI、Hcy、Lp(a)以及颈动脉内中膜厚度(cIMT)水平,采用Pearson法对ASCVD组baPWV、ABI、Hcy、Lp(a)水平和cIMT做相关性分析,采用Logistics回归分析围绝经期妇女发生ASCVD事件的独立危险因素,建立风险预测模型,采用Hosmer-Lemeshow拟合优度检验和受试者工作特征(ROC)曲线评估模型的拟合程度与预测效能。结果 ASCVD组的体质指数、baPWV、Hcy、Lp(a)、cIMT水平和合并糖尿病、高血压、高血脂、冠心病和烟酒史占比均高于非ASCVD组,ABI低于非ASCVD组(P<0.05),cIMT(OR=1.618)、Hcy(OR=1.454)、baPWV(OR=1.346)是影响围绝经期妇女发生ASCVD事件的独立危险因素(P<0.05),ASCVD组的baPWV、Hcy、Lp(a)水平与cIMT呈正相关,ABI水平与cIMT呈负相关(P<0.05),围绝经期妇女发生ASCVD事件风险预测模型为LogP=28.911+0.481×cIMT+0.374×Hcy+0.297×baPWV,经Hosmer-Lemeshow拟合优度检验P=0.511,预测模型的AUC为0.795(95%CI:0.696-0.874),灵敏度和特异度分别为64.10%和87.76%。结论 baPWV、ABI、Hcy、Lp(a)与cIMT具有较好的相关性,baPWV、Hcy和cIMT是围绝经期妇女发生ASCVD事件的独立危险因素,本研究建立的围绝经期妇女发生ASCVD的风险预测模型,具备一定的预测效能。

踝肱指数诊断慢性肢体威胁性缺血患者全球肢体解剖分期系统3期的可行性研究

目的探讨踝肱指数(ABI)诊断慢性肢体威胁性缺血(CLTI)患者全球肢体解剖分期系统(GLASS)3期的可行性。方法收集2020年1月至2022年10月于西安交通大学第一附属医院就诊的73例CLTI患者的临床资料,按照GLASS分期的不同将其分为GLASS 1~2期组(n=24)和GLASS 3期组(n=49)。比较两组患者的ABI,采用受试者工作特征(ROC)曲线进行诊断价值分析,计算ROC曲线下面积(AUC)、阈值、灵敏度、特异度。结果GLASS 1~2期组患者平均ABI为0.890(0.710,1.000),高于GLASS 3期组患者的0(0,0.595),差异有统计学意义(Z=-5.676,P﹤0.05)。ROC曲线显示,ABI诊断CLTI患者GLASS 3期的AUC为0.903,阈值为0.490,灵敏度为95%,特异度为70%。结论CLTI患者GLASS 1~2期与GLASS 3期的ABI差异显著,以0.490为ABI阈值可于术前预筛出GLASS 3期患者,从而更好地预判手术策略。

下肢动脉病变程度对富血小板凝胶治疗糖尿病足溃疡的影响

目的探讨下肢动脉病变程度对富血小板凝胶治疗糖尿病足溃疡的影响。方法选取糖尿病足溃疡患者129例为研究对象。根据踝肱指数和下肢动脉血管超声结果分为轻度组49例、中度组44例和重度组36例。3组患者均给予常规治疗联合富血小板凝胶治疗。比较3组患者治疗前后溃疡面积变化和肉芽面积变化。结果3组治疗前后的溃疡面积及其差值比较,差异有统计学意义(P<0.05);3组治疗前后的肉芽面积及其差值比较,差异有统计学意义(P<0.05)。溃疡面积差值与踝肱指数呈正相关(r=0.392,P<0.001),与糖尿病病程呈负相关(r=-0.420,P<0.001);肉芽面积差值与踝肱指数呈正相关(r=0.406,P<0.001),与糖尿病病程呈负相关(r=-0.375,P<0.001)。结论下肢动脉病变越严重,富血小板凝胶治疗糖尿病足溃疡的疗效越差。