职业性体力劳动强度与外周动脉疾病的相关分析

目的 探讨职业性体力劳动强度与外周动脉疾病患病的关系.方法 选取我国9个地区的16 446名35岁以上居民作为研究对象,进行踝臂指数测量(踝臂指数≤0.9诊断为外周动脉疾病),并收集相关危险因素资料.采用logistic回归模型分析职业性体力劳动强度与外周动脉疾病的关系.结果 单因素分析显示,随着职业性体力劳动强度的增加,外周动脉疾病的患病风险呈下降趋势(趋势检验P<0.05).在调整了性别(仅对总体人群)、年龄、吸烟、高血压病、高总胆固醇血症、超重或肥胖、糖尿病以及心脑血管疾病(包括冠心病和卒中)病史之后,与无工作者比较,极轻、轻、中及重度职业性体力劳动强度的工作者患外周动脉疾病的OR值分别为1.02(95%CI:0.80～1.31),0.91(95%CI:0.72～1.15),0.92(95%CI:0.70～1.19),0.90(95%CI:0.72～1.12)(趋势检验P<0.05).结论 职业性体力劳动强度与外周动脉疾病患病风险间存在一定的剂量反应关系,增加体力活动可能对预防外周动脉疾病有重要意义.     

重视外周动脉疾病的临床诊治

<正>1概述动脉粥样硬化性疾病,是我国居民死亡和致残的主要原因之一。动脉粥样硬化是全身系统性的血管疾病,主要发生在冠状动脉和脑动脉,是最常见和最严重的动脉粥样硬化病变,同时,还累及上肢或下肢等外周动脉。近年来,上肢或下肢动脉病变引起的外周动脉疾病发病率逐年上升,成为危害程度高的重要动脉粥样硬化病变类型。我国是世界人口最多的国家,目前我国年龄>60岁的老年人占总人口的13%,随着人口老龄化的不断发展,预计到2030     

外周动脉疾病与卒中

外周动脉疾病(PAD)是一种全身性动脉粥样硬化性疾病,踝臂指数(ABI)是诊断PAD的指标,也是缺血性卒中的独立预测因素.越来越多的证据表明,PAD与卒中具有许多共同危险因素,二者呈高度相关性.文章对PAD与卒中相关性研究做了综述.     

中国自然人群下肢外周动脉疾病患病率及相关危险因素

目的 调查中国自然人群下肢外周动脉疾病(peripheral arterial disease,PAD)患病率及相关危险因素,为开展下肢动脉粥样硬化的预防提供科学依据.方法 采用分层整群随机抽样的方法,选取北京、上海、长沙、广东、内蒙古和新疆地区的社区自然人群作为研究对象,由培训过的医师对调查对象进行踝臂指数(ankle brachial index,ABI)测量和资料收集.任一侧肢体ABI≤0.9诊断为PAD.结果 在21 152例受试者中,PAD患病率3.08%,标化患病率3.04%;男性PAD患病率2.52%,标化患病率1.84%;女性PAD患病率3.66%,标化患病率4.31%,男性PAD患病率低于女性(P相似文献   

老年人外周血管疾病

<正>当前,慢性非传染性疾病已成为老年人致死、致残的主要原因,其中脑卒中、冠心病等因动脉粥样硬化所致的心脑血管病已引起了临床医师及患者的高度重视。动脉粥样硬化性疾病是一个连续发展的全身性疾病,即使在进行了相关危险因素及心血管病史的校正后,外周动脉疾病(PAD)患者发生心血管事件与全因死亡率是无PAD患者的1.6².0倍。PAD已被认为是冠心病的等危症;同样,深静脉血栓(DVT)在老年患者尤其是长期卧床者中发生率高,由其导     

慢性阻塞性肺疾病合并外周血管疾病危险因素分析

目的探讨慢性阻塞性肺疾病(简称慢阻肺)患者合并外周血管疾病的危险因素。方法回顾性分析2013年5月至2018年5月兰州大学第一医院慢阻肺并接受外周血管检查的805例患者资料,根据检查部位及结果分组。比较患者临床资料,对差异具有统计学意义的因素行多因素Logistic回归分析危险因素。结果 (1)慢阻肺行颈动脉超声检查患者231例,其中80.95%合并颈动脉粥样硬化(CAS),慢阻肺CAS组合并高血压以及年龄、白细胞计数、中性粒细胞比例、纤维蛋白原(FIB)高于慢阻肺无CAS组,总胆固醇及高密度脂蛋白低于慢阻肺无CAS组。Logistic回归分析示合并高血压及高龄、高白细胞是慢阻肺患者合并CAS的危险因素。(2)慢阻肺行下肢动脉超声检查患者86例,其中72.09%合并下肢动脉疾病(PAD),慢阻肺PAD组合并高血压、高脂血症以及年龄高于慢阻肺无PAD组。Logistic回归分析示合并高脂血症是慢阻肺患者合并PAD的危险因素。(3)慢阻肺行下肢静脉超声检查患者419例,其中11.93%合并下肢深静脉血栓(DVT),慢阻肺DVT组白细胞计数、中性粒细胞比例、D-二聚体高于慢阻肺无DVT组。Logistic回归分析示高中性粒细胞比例是慢阻肺患者合并DVT的危险因素。(4)慢阻肺行计算机断层肺动脉造影(CTPA)检查患者69例,其中34.78%合并肺栓塞(PE),慢阻肺PE组合并DVT比例以及D-二聚体水平高于慢阻肺无PE组。Logistic回归分析示合并DVT是慢阻肺患者合并PE的危险因素。结论慢阻肺患者外周血管疾病高发,合并高血压、高脂血症、高龄、高白细胞、高中性粒细胞比例是慢阻肺患者合并外周血管疾病的危险因素。     

老年外周动脉疾病的诊治

<正>动脉粥样硬化性疾病严重威胁老年人的健康,以动脉粥样硬化为主要病因的外周动脉疾病(PAD)也越来越多地受到临床医师的重视。PAD广义上指除冠状动脉和颅内动脉以外的其他动脉疾病,包括颈动脉、四肢动脉和内脏动脉,其特点是动脉系统不能将富氧血液送达外周组织。狭义PAD则指临床上最常见的下肢动脉粥样硬化性狭窄/闭塞病变,我们着重讨论后者。PAD患病率随年龄增长而增高。流行病学调查显示,60岁以上人群PAD患病率约18%,跛行患者7%。我国目前约有3000万PAD患者。虽大多数     

上海市程桥社区高血压患者空腹血糖受损患病率的调查及相关因素分析

目的 探讨上海市程桥社区35岁以上原发性高血压患者空腹血糖受损患病率及影响因素.方法 选取上海市程桥社区35岁以上居民所有已患原发性高血压患者2 596例,其中男1 390例,女1 206例,年龄35～89岁,平均52.5±12.6岁,进行病史调查,测量血压、体重、身高、腰围、臀围、空腹血糖及血脂等指标,并进行统计学分析.结果 在2 596例高血压受试者中空腹血糖<5.6 mmol/L为1 561例,空腹血糖介于5.6～6.9 mmol/L为817例,空腹血糖>6.9 mmol/L为218例.高血压患者中血糖总异常率达39.9%,其中空腹血糖受损的忠病率为31.5%.高血压患者中血糖正常组与空腹血糖受损组的性别构成比、收缩压、体质指数、腰臀比、血糖、总胆固醇及甘油三酯水平差异有统计学意义(P<0.05).多因素Logistic回归显示,性别(β=0.068,P<0.001)、糖尿病家族史(β=0.468,P<0.05)、总胆固醇(β=0.248,P<0.001)及低密度脂蛋白胆固醇(β=-0.06,P<0.001)与空腹血糖受损有相关性.结论 上海市程桥社区35岁以上高血压患者空腹血糖受损患病率高于健康人群,且可能与性别、糖尿病家族史及血脂代谢异常有关.     

浙江省舟山渔区外周动脉病患病率调查

目的调查我国渔区自然人群中的外周动脉病患病情况. 方法 2004年夏季（休渔期）在舟山渔区10个渔业自然村用整群抽样的方法抽取≥35岁的渔民及其家属2668人进行1次横断面调查.全部受检对象采用便携式多普勒血流仪（8MHz）进行测量,以踝臂血压指数（AAI）＜0.9定为外周动脉病.并作空腹血糖及口服葡萄糖耐量试验检测正常糖耐量、糖耐量异常及糖尿病患者. 结果外周动脉病总患病率为2.1%,在糖耐量正常、糖耐量异常及糖尿病者分别为2.1%、2.9%及6.3%,其患病率随年龄增长而增加,＜50岁者仅2例. 结论在舟山渔区人群中外周动脉病的总患病率较低.     

老年腹膜透析患者外周动脉疾病及其危险因素分析

目的探讨老年腹膜透析患者外周动脉疾病(PAD)的发病率和危险因素。方法选择62例老年腹膜透析患者,分为PAD组19例,非PAD组43例。收集其临床、生化等资料,进行分析比较,采用多因素logistic分析PAD的危险因素。结果 PAD的总发病率为30.6%。与非PAD组比较,PAD组患者年龄偏大,透析龄明显延长,空腹血糖、糖化血红蛋白、C反应蛋白明显升高,舒张压、踝臂指数、白蛋白、残余肾总尿素清除率(Kt/V)比值明显降低(P<0.05,P<0.01)。多因素logistic分析显示,年龄(OR=1.150,P=0.043)、血清白蛋白水平(OR=1.485,P=0.040)、残余肾Kt/V比值(OR=1.725,P=0.016)为PAD的危险因素。结论老年腹膜透析患者PAD患病率较高,年龄、血清白蛋白水平、残余肾Kt/V比值为PAD的独立危险因素。     

Impact of ramipril in patients with evidence of clinical or subclinical peripheral arterial disease.

AIMS: The aim of this study was to assess the prognostic importance of peripheral arterial disease (PAD) as evaluated by ankle blood pressure index (ABI), and the impact of ramipril on the prevention of major cardiovascular events in PAD patients included in the Heart Outcomes Prevention Evaluation (HOPE) study. METHODS AND RESULTS: Patients were randomized to treatment with ramipril or placebo and followed for 4.5 years. Ankle brachial blood pressure index was measured, mainly by digital palpation of the foot pulse, at baseline in 8986 patients. The ABI was subnormal (< or =0.9) in 3099 patients and normal in 5887 patients. A low ABI was a strong predictor of morbidity and mortality during the follow-up even in patients with no clinical symptoms of PAD (n=6769). This was so for the primary outcome of the study; ABI>0.9:13.1%, 0.6-0.9: 18.2% and <0.6: 18.0% (P<0.0001) and for mortality from all causes: in those with a normal ABI it was 8.5%, in those with ABI >0.6-0.9, 12.4% and 14.2% in those with an ABI lower than 0.6 (P<0.0001). Ramipril reduced the risk of clinical outcomes in those with a clinical history of PAD as well as in the patients with subclinical PAD. CONCLUSIONS: The ABI even if measured simply by palpation of the foot arteries is a strong predictor for future cardiovascular events and for all-cause mortality. Ramipril prevented major cardiovascular events in patients with clinical as well as subclinical PAD.     

无症状下肢动脉病变老人的踝臂指数的检测及下肢动脉病变相关因素的分析

目的：检测无症状下肢动脉病变（LEAD）老人的踝臂指数（ABI）,分析LEAD的相关因素。方法：随机选择206例老年患者,以ABI≤0.9作为LEAD的诊断标准,所有对象被分为无症状下肢动脉病变组（LEAD组,48例）和无下肢动脉病变组（无LEAD对照组,158例）,比较两组心血管病危险因素的分布,分析与LEAD相关的因素。结果：LEAD组的年龄、动脉收缩压（SBP）、脉压（PP）、脂蛋白（a）[Lp（a）]、血尿酸（UA）、C反应蛋白（CRP）、糖化血红蛋白（HbA1c）,以及臂踝脉搏波传导速度（baPWV）均明显高于无LEAD对照组（P〈0.05,或P〈0.01）;而舒张压（DBP）显著低于无LEAD对照组（P〈0.05）。Pearson相关分析显示,ABI与年龄（r=-0.347,P=0.025）,PP（r=-0.246,P=0.034）,Lp（a）（r=-0.321,P=0.002）,UA（r=-0.215,P=0.046）,CRP（r=-0.335,P=0.031）,HbA1c（r=-0.272,P=0.017）,baPWV（r=-0.278,P=0.017）均呈负相关。Logistic多元回归提示,年龄、SBP、PP以及Lp（a）与LEAD独立相关。结论：年龄、收缩压、脉压以及脂蛋白（a）是LEAD独立危险因素,其积极矫正有助于无症状下肢动脉病变的防治,减少心、脑血管事件的发生。     

上海淞南地区外周动脉病变的流行状况及其危险因素

目的:探讨上海市淞南地区外周动脉病变(PAD)的流行现状及其危险因素。方法:选取上海市淞南地区3 881名社区居民进行调查。采用调查问卷收集受检者的既往病史和生活方式等信息。对受检者进行身高、体重、腰围、血压、踝肱指数(ABI)等检测以及75 g无水葡萄糖口服耐量试验(OGTT)。受检者任意一侧肢体的ABI>1.4或0.05)。多元Logistic回归分析显示,年龄、吸烟、糖尿病、蛋白尿、心脑血管疾病史与PAD的患病风险显著相关。结论:上海市淞南地区自然人群的PAD患病率为3.4%。年龄、吸烟、糖尿病、蛋白尿、心脑血管疾病史是PAD患病的危险因素。     

社区居民婚姻状况与外周血管疾病的关系

目的 探讨社区居民婚姻状况与外周血管疾病(PAD)之间的关系.方法 2007年5月至8月,通过多阶段分层整群随机抽样方法调查北京市社区居民10 054名.运用广义线性混合模型,以社区站作为群组随机因素,分析不同婚姻状况下不同性别和年龄人群PAD的患病风险.结果 调整PAD危险因素(年龄、地区、血脂、血糖、血压、肥胖、吸烟、饮酒和体育活动)的影响之后,在45岁以下人群中,未婚男性与已婚男性比较PAD患病的OR值为1.56(0.39 ～6.35),未婚女性与已婚女性比较PAD患病的OR值为0.75(0.22 ～2.57);在45岁及以上人群中,未婚男性与已婚男性比较PAD患病的OR值为1.61 (0.77 ～3.35),未婚女性与已婚女性比较PAD患病的OR值为1.78( 1.23 ～2.58).45岁及以上未婚女性的年龄、腰围、收缩压、空腹血糖、总胆固醇、低密度脂蛋白胆固醇和吸烟比例均高于已婚者(P均＜0.01).结论 45岁及以上女性的婚姻状况与罹患PAD有关.女性雌激素的变化和PAD危险因素的分布可能是造成这种现象的原因.     

Using ankle-brachial index to detect peripheral arterial disease: prevalence and associated risk factors in a random population sample

Background and aimThe ankle-brachial index (ABI) is being used increasingly to diagnose peripheral arterial disease (PAD) that predicts cardiovascular morbidity and mortality. The aim of this study is to determine the prevalence of PAD and associated risk factors in a Spanish random population sample of age ≥40.Methods and resultsPAD is defined as an ABI < 0.9 in either leg. 784 participants of age ≥40 were randomly selected in a Spanish province. 55.4% of them were female. The prevalence of PAD in this sample was 10.5% (95% confidence interval (CI) 8.4–12.8); 9.7% in females and 11.4% in males. In logistic regression analyses, adjusted for age and gender, smoking per 10 pack-years (odds ratio (OR) 1.40, 95% CI 1.23–1.58), hypertension (OR 1.85, 95% CI 1.05–3.28), hypercholesterolemia (OR 1.76, 95% CI 1.04–2.98), and diabetes (OR 1.80, 95% CI 1.04–3.11) were positively associated with prevalent PAD. More than 91% of persons with PAD had one or more cardiovascular disease risk factors.ConclusionsWe conclude that in our study hypertension, hypercholesterolemia, diabetes mellitus and smoking are associated with PAD. The majority of individuals with PAD had at least one important cardiovascular risk factor advanced enough to be considered eligible for an aggressive treatment.     

Inflammatory, haemostatic, and rheological markers for incident peripheral arterial disease: Edinburgh Artery Study.

AIMS: Recently, markers of inflammation, haemostasis, and blood rheology have received much attention as risk factors for coronary heart disease and stroke. However, their role in peripheral arterial disease (PAD) is not well established and some of them, including the pro-inflammatory cytokine interleukin-6 (IL-6), have not been examined before in prospective epidemiological studies. METHODS AND RESULTS: In the Edinburgh Artery Study, we studied the development of PAD in the general population and evaluated 17 potential blood markers as predictors of incident PAD. At baseline (1987), 1519 men and women free of PAD aged 55-74 were recruited. After 17 years, 208 subjects had developed symptomatic PAD. In analysis adjusted for cardiovascular risk factors and baseline cardiovascular disease (CVD), only C-reactive protein, fibrinogen, lipoprotein (a), and haematocrit [hazard ratio (95% CI) corresponding to an increase equal to the inter-tertile range 1.30 (1.08, 1.56), 1.16 (1.05, 1.17), 1.22 (1.04, 1.44), 1.22 (1.08, 1.38)] were significantly (P < 0.01) associated with PAD. However, these markers provided very little prognostic information for incident PAD to that obtained by cardiovascular risk factors and the ankle brachial index. Other markers including IL-6, intracellular adhesion molecule 1, d-dimer, tissue plasminogen activator antigen, and plasma and blood viscosities showed weak associations, which were considerably attenuated when CVD risk factors were accounted for. CONCLUSIONS: Our prospective data showed that several inflammatory, haemostatic, and rheological markers are associated with incident PAD; however, their clinical utility is likely to be limited. Future research is necessary to validate the importance of these biomarkers explicitly on PAD and to address the causality of the reported associations.     

2型糖尿病合并外周血管病变相关危险因素探讨

目的探讨2型糖尿病（T2DM）患者发生外周血管病变（PVD）的危险因素。方法选取180例T2型DM患者,其中合并PVD80例,无PVD100例,检测相关临床指标。结果T2DM合并PVD组糖尿病病程、血清肌酐、总胆固醇、高密度脂蛋白胆固醇、高血压、脑梗死史、高敏C反应蛋白（hsC-RP）和白细胞介素6（IL-6）水平显著高于无PVD组。多因素回归分析显示hsC-RP和糖尿病病程与T2DM并发PVD正相关。结论hsC-RP是促使T2DM并发PVD的独立危险因素。