目的 探讨踝臂指数(ABI)对老年高血压合并下肢动脉病变(PAD)患者发生心脑血管病变风险的预测价值.方法 回顾性分析老年高血压病患者285例,按照ABI值分为高血压合并PAD组(PAD组,55例)和高血压未合并PAD组(非PAD组,230例),比较2组间臂踝脉搏波传导速度(baPWV)及各种心脑血管病危险因素的差异.结果 与非PAD组比较,PAD组收缩压(SBP)、脉压(PP)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白(a)[Lp(a)]、血尿酸(UA)、C反应蛋白(CRP)、糖化血红蛋白(HbA1c)以及baPWV值均明显增加(P<0.05,或P<0.01);且发生冠心病、脑梗死的风险分别增高3.17倍(95%CI 1.29～7.76)和5.57倍(95%CI 2.15～14.44);相关分析显示,ABI与年龄(r＝-0.273,P=0.025)、PP(r＝-0.230,P=0.034)、Lp(a)(r＝-0.361,P=0.002)、UA(r＝-0.210,P=0.046)、CRP(r＝-0.311,P=0.030)、HbA1c(r＝-0.272,P=0.017)、baPWV(r＝-0.291,P=0.018)均呈负相关.Logistic回归分析提示,年龄、SBP、PP及Lp(a)是PAD的独立危险因素.结论 ABI可评估老年高血压患者下肢动脉病变的严重程度,并预测其心脑血管疾病的发生风险.%Objective To investigate whether the ankle-brachial index ( ABI ) can assess peripheral arterial disease ( PAD ) in elderly hypertensive patients and predict the risk of cardio-cerebral vascular diseases. Methods The data of 285 elderly hypertensive patients was retrospectively reviewed and analyzed. They were diagnosed as hypertension with PAD ( n = 55 ) or without PAD ( none-PAD, n = 230 ) according to ABI criteria. Brachial-ankle pulse wave velocity ( baPWV ) and various cardiovascular risk factors were compared between the two groups. Results The prevalence of PAD in elderly hypertensive patients was 19. 3% . Compared with patients without PAD, the levels of systolic blood pressure ( SBP ), pulse pressure ( PP ), low density lipoprotein-cholesterol ( LDL-C ), lipoprotein (a)[Lp(a)], uric acid ( UA ), C-reactive protein ( CRP ), HbAl c and baPWV increased significantly ( P <0.05, or P <0.0l)in the PAD group. The risk of suffering from coronary heart disease and cerebral infarction were increased of 3. 17 ( 95% CI 1. 29 ~7. 76 ) and 5. 57 ( 95% CI 2. 15 ~ 14. 44 ) times in the PAD group respectively. There was a negative correlation between ABI and age( r = -0.273, P =0.025 ), PP( r = -0.230, P =0.034), Lp( a)( r = -0.361, P =0.002), UA( r = -0.210, P =0.046), CRP( r = -0.311, P = 0.030), HbAlc( r = -0.272, P =0.017 ) and baPWV( r = -0.291, P =0.018). Multivariate Logistic regression analysis indicated that age, SBP, PP and Lp ( a ) were independent risk factors for ABI. Conclusion ABI can assess the severity of peripheral arterial disease in elderly hypertensive patients and effectively predict the risk of cardio-cerebral vascular diseases.
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