踝肱指数诊断终末期肾病患者下肢外周动脉闭塞性疾病的价值

目的　评价踝肱指数(ABI)在终末期肾病(ESRD)患者下肢外周动脉闭塞性疾病(PAOD)诊断中的敏感性和特异性。方法　选择73例ESRD患者,其中血液透析组4 2例,非透析组31例,采用HDI5 0 0 0超声仪和5～10MHz的超声探头依次探测患者双侧髂动脉、股动脉、胫后动脉、腓动脉和足背动脉的内膜、内径、收缩期峰速、舒张末期流速、搏动指数和阻力指数以及测定双侧肱动脉(造瘘者仅测非造瘘侧)、胫后动脉和足背动脉收缩压,计算ABI。根据多普勒超声检测结果诊断患者下肢是否为PAOD ,以此为标准判断ABI诊断下肢PAOD的敏感性和特异性。结果　多普勒超声检测显示,5 0 .6 8% (37/ 73)ESRD患者下肢PAOD ,其中血液透析组5 0 % (2 1/ 4 2 ) ,非透析组5 1.6 1% (16 / 31)。以ABI≤0 .9为诊断下肢PAOD标准,其敏感性和特异性分别达81.0 8%和97.2 2 % ,Kappa指数0 .78。结论　ESRD患者下肢PAOD非常常见,多数患者无临床症状,ABI是筛选ESRD患者下肢无症状PAOD的可靠方法。

Diagnostic value of ankle- brachial index for lower- extremity peripheral arterial occlusive disease among patients with end stage renal disease

Objective Ankle-brachial Index (ABI) is noninvasive and simple to measure. An ABI less than 0.90 is 95% sensitive and 99% specific for peripheral arterial occlusive disease (PAOD) in general population. The purpose of this study is to evaluate the sensitivity and specificity of ABI for lower-extremity PAOD in patients with end stage renal disease(ESRD). Methods Seventy-three ESRD patients including 31 non-dialysis patients and 42 on hemodialysis were enrolled in this study. With ultrasound machine HDI5000 and 5 to 10MHz scaners, all their double iliac arteries, femoral arteries, posterior tibial arteries, fibular arteries and dorsalis pedis arteries were measured to determine whether a lower-extremity PAOD existed or not. The items included tunica intima, lumen diameter, peak systolic velocity, end diastolic velocity, pulsitive index and resistent index. In addition, ABIs were calculated on the basis of the systolic pressures at posterior tibial arteries, dorsalis pedis arteries and brachial arteries(non-fistula). Based on the results with doppler ultrasonography, the sensitivity and specificity of ABI for lower-extremity PAOD were analysed. Results The doppler ultrasound examination showed lower-extremity PAODs were found in 50.68%(37/73) ESRD patients, including 51.61%(16/31) non-dialysis patients and 50%(21/42) on hemodialysis. If An ABI0.90 or less was defined as PAOD, the sensitivity and specificity of ABI for lower-extremity PAOD in ESRD patients were 81.08% and 97.22% respectively, and Kappa value was 0.78. Conclusions Lower-extremity PAOD is common in ESRD patients and most of which are asymptomatic. ABI is a reliable screening tool for asymptomatic lower-extremity PAOD in this population.