Utilizing the ankle brachial index in clinical practice

The ankle brachial index is one of many tests that can be used to indirectly assess lower extremity peripheral blood flow. This article reviews ankle brachial index technique and presents some of its applications for clinicians and researchers based on a literature review. The ankle brachial index is relatively simple and inexpensive and can be performed in both clinical and home care settings. Reliability level is reported to be high, with an intraclass correlation coefficient range of 0.80 to 0.99. When used with other noninvasive vascular tests such as pulse volume recordings, lower extremity segmental systolic limb pressures, and transcutaneous oximetry mapping, the ankle brachial index is a valuable screening tool to detect individuals at risk for wounds and other problems associated with poor peripheral arterial circulation.     

健康人群脉搏波传导速度与踝臂指数影响因素的研究

目的探讨健康人群脉搏波传导速度（pulse wave velocity，PWV）、踝臂指数的影响因素。方法用全自动动脉硬化测定仪测定PWV与踝臂指数855例，分为5个年龄组，了解年龄、血压、体质量指数等临床指标与PWV和踝臂指数的相关性。结果①男性PWV和踝臂指数比女性高（P〈0．01）；②PWV与踝臂指数随年龄增加而逐渐增加（P〈0．01）：③多元线性相关表明：年龄、收缩压、平均动脉压、舒张压、脉压、体质量指数、心率与PWV相关（P〈0．01）；年龄、体质量指数、脉压、平均动脉压、收缩压、舒张压，与踝臂指数相关（P〈0．01），心率与踝臂指数相关无统计学意义。结论①男性PWV和踝臂指数高于女性，随年龄增加而增加：②年龄、脉压、平均动脉压、收缩压、舒张压和体质量指数与PWV和踝臂指数呈正相关。     

踝臂血压指数与血小板活化的关系

目的探讨无创踝臂血压指数(ankle/brachial index,ABI)与血小板活化之间的关系。方法选择2008年某单位年龄≥40岁且60岁无症状中年体检人群共426例为研究对象。应用动脉硬化早期测定仪检测其ABI值,其中ABI0.9为异常组,0.9≤ABI≤1.3为正常对照组,利用流式细胞术检测两组外周血小板膜糖蛋白CD62p、CD63的表达水平。结果异常组CD62p、CD63表达水平显著高于正常组,差异有统计学意义(16.86±3.20vs.6.65±3.25,P0.05;6.82±1.74vs.1.90±0.67,P0.05)。结论 ABI0.9时血小板活化程度显著增高,在初筛动脉功能异常、心脑血管病情评估及长期随访监测中具有实用价值。     

新疆成年人踝臂指数异常发生率及其相关因素分析

目的 通过测量踝臂指数(ABI)评价新疆成年人汉族、维吾尔族、哈萨克族ABI异常情况及相关危险因素。方法 采用整群随机抽样法,在新疆7个市及地区、26个社区及村抽取年龄在35岁以上样本,男女均衡。统计不同民族组、不同年龄组、不同性别组人群的ABI异常的发生率及相关的危险因素。结果 分析新疆不同民族成年人群14 618名,其ABI异常发生率为5.30％;其中汉族为3.56％,维吾尔族为7.05％,哈萨克族为5.79％。男性为3.74％,女性为6.65％。女性高于男性(x2 =58.79,P=0.00)。预测ABI异常的独立危险因素有性别、民族、收缩压、体质指数。结论 新疆ABI异常的发生率较高,且存在民族差异和性别差异。     

Raised ankle/brachial pressure index in insulin-treated diabetic patients

The ankle/brachial blood pressure index (A/B PI) is important in the vascular laboratory assessment of peripheral vascular disease. However it is falsely elevated in diabetes, hence underestimating the true severity of disease. We have therefore examined the influence of diabetes on the A/B PI in 2092 patients, 538 with diabetes, all referred for evaluation of peripheral vascular disease. The prevalence of a raised A/B PI (greater than or equal to 1.5) in insulin-treated patients (18.3%) was much higher (p less than 0.001) than that in both non-insulin-treated diabetic patients (4.5%) and patients with no diabetes (2.8%). Insulin-treated patients with a duration of diabetes of greater than 30 years had a higher prevalence of raised A/B PI than those with a duration of less than or equal to 9 years. No significant age effects were seen.     

踝臂指数与缺血性卒中的临床研究进展

踝臂指数（ankle-brachial index,ABI）即踝部动脉收缩压与上臂动脉收缩压之比.ABI最初用于诊断下肢外周动脉疾病,并与心脑血管疾病事件发生具有良好的相关性.在预测缺血性卒中的发病风险中,如何确定早期评估脑血管疾病风险性的客观量化指标,成为近年来研究的热点.     

踝臂指数及心踝血管指数对冠状动脉病变的诊断价值

目的评价踝臂指数(ankle brachial index,ABI)与心踝血管指数(cardio-ankle vascular index,CAVI)对冠状动脉病变的诊断价值。方法选择2012年6月至2012年11月在重庆医科大学附属第一医院心血管内科住院,因拟诊为冠状动脉粥样硬化性心脏病(冠心病)而行冠状动脉造影的127例患者,根据冠状动脉造影结果,88例冠状动脉狭窄患者列入冠状动脉病变组(D组):根据狭窄程度,将患者分为轻度病变亚组(A组,31例),中重度病变亚组(B组,57例);依累及血管支数,分为单支病变亚组(22例),双支病变亚组(26例),三支病变亚组(40例)。对照组为39例冠状动脉造影阴性患者。入选患者接受ABI及CAVI检测,比较分析各组间ABI及CAVI。结果对照组、A组、B组3组比较,ABI依次降低,且对照组、A组、B组两两比较差异有统计学意义(P<0.05)。CAVI在对照组、A组、B组3组数值依次增高,但两两比较差异无统计学意义(P>0.05);但D组与对照组比较CAVI明显升高,且差异有统计学意义(P<0.05)。对照组、单支病变组、双支病变组、三支病变组4组ABI值依次降低,对照组与各病变组ABI值差异有统计学意义(P<0.05),但各病变组之间两两比较差异无统计学意义(P>0.05)。在各组中随病变范围增大,CAVI数值并未依次增高,且各病变组两两比较差异无统计学意义(P>0.05)。结论 ABI值能很好地反映病变狭窄程度,ABI数值越低,冠状动脉狭窄程度越重,但无法反映病变范围;CAVI既不能反映冠心病的病变程度,也无法反映病变范围。     

低踝臂指数与死亡风险的荟萃分析

目的 用荟萃分析方法系统性评价低踝臂指数对死亡的风险性.方法 收集近12年来国内外相关队列研究文献,通过χ2统计量结合I2统计量进行异质性检验,用倒方差法固定效应模型分析低踝臂指数对死亡的风险,得到合并效应指标风险比(hazard ratio,HR)及其95%可信区间.结果 经严格筛选,最终纳入文献8篇,总样本量30 029人,经异质性检验,χ2=5.46,I2=0.0%,P=0.604,合并HR为1.69(95%CI:1.55～1.84).结论 低踝臂指数可增加死亡风险,应引起足够的重视.

Abstract：

Objective To evaluate the association between low ankle brachial index and risk of death. Methods Related cohort studies in the past 12 years were collected. Heterogeneity was analyzed with χ2 and I2. Pooled hazard ratio (HR) as the effect indicator and 95% confidence interval (CI) were used to estimate the association of low ankle brachial index and risk of death by fixed effect model ( inverse variance method). Results A total of 8 studies were included with sum sample size of 30 029. In heterogeneity analysis, χ2 was 5.46, I2 was 0. 0%, and P was 0. 604. Meta-analysis resulted in pooled HR of 1.69 (95%CI:1.55 - 1.84). Conclusion Low ankle brachial index is associated with increased risk of death.     

踝臂指数与缺血性脑卒中患者颅内动脉狭窄的相关性

目的 探讨缺血性脑卒中患者踝臂指数（ABI）与颅内动脉狭窄程度、数量、部位以及不同类型缺血性脑卒中的关系.方法 选择82例行全脑血管造影（DSA）的缺血性脑卒中患者,所有患者在造影前均进行ABI测量和常规生化检查.按血管狭窄程度及病变血管数量对患者进行分组,并进行中国缺血性脑卒中亚型（CISS）分型,比较颅内动脉狭窄程度、病变数量、部位以及不同类型脑卒中与ABI的关系.运用SPSS 13.5统计学软件进行统计学分析.结果 （1）颅内动脉狭窄组的ABI值（1.00±0.23）较无狭窄组（1.07±0.33）显著降低（t=1.990,P〈0.05）.3支及以1：病变组与无狭窄组、1支病变组和2支病变组ABI值有显著差异（t=1.684,t=2.441,P〈0.05）,但无狭窄组（ABI为1.07±0.33）、1支病变组（ABI为1.04±0.11）、2支病变组（ABI为1.02±0.35）之间比较没有显著性差异（t=1.684,t=1.688,t=1.711,P〉0.05）.（2）前后循环均狭窄组（0.89±0.08）的患者与无狭窄组（1.07±0.33）、颈内动脉狭窄组（1.02±0.17）、椎基底动脉狭窄组（1.04±0.15）比较ABI水平有显著性降低（t=1.725,t=2.0,t=2.12,P〈0.05）.（3）AB1≤0.9时预测重度颅内动脉狭窄的敏感度、特异度、准确度分别为85.4%、92.5%和69.7%.（4）大动脉粥样硬化（LAA）组ABI异常率显著高于穿支动脉疾病（PAD）组（P〈0.01）,LAA组ABI值（0.89±0.17）显著降低（t=2.639,P〈0.01）.结论 缺血性脑卒中患者ABI与颅内动脉狭窄严重程度、病变支数、病变部位相关,重度颅内动脉狭窄、3支以上病变以及前后循环系统均狭窄的缺血性脑卒中患者ABI值明显降低.ABI对重度颅内动脉狭窄有较高的预测价值.ABI与LAA有关,与PAD无关.     

臂踝指数检测对锁骨下动脉重度狭窄的诊断价值

目的探讨臂踝指数检测对锁骨下动脉重度狭窄的诊断价值。方法选择经数字减影血管造影和(或)CT血管成像证实的锁骨下动脉重度狭窄老年患者48例(狭窄组),另选择无锁骨下动脉病变患者50例(对照组)。采用无创伤全自动外周动脉检测仪测量臂踝指数、两侧肱动脉收缩压差、脉搏波上行时间和脉搏波形。结果狭窄组患侧肢体的臂踝指数明显低于健侧肢体和对照组;狭窄组患侧肢体的脉搏波上行时间较健侧肢体和对照组明显延迟,差异有统计学意义。狭窄组两侧肱动脉收缩压差与对照组比较差异有统计学意义(P<0.01)。狭窄组患侧肢体的脉搏波形呈低钝波40倒(83%),呈低平波8例(17%)。结论检测臂踝指数等参数有助于快速筛查和诊断锁骨下动脉重度狭窄,为临床寻找后循环缺血的原因和更深入研究缺血性脑血管病的发病机制提供重要依据。     

踝臂指数与心脑血管病危险因素关系的研究

目的探讨心脑血管病高危患者踝臂指数（ABI）异常的检出率与心脑血管疾病危险因素及临床心脑血管事件的关系。方法选取我院288例心脑血管病高危住院患者,年龄30-93（64±13）岁,男性165例,女性123例;分为ABI正常组（ABI 0．9～1．3）193例和ABI异常组（1．3〈ABI〈0．9）95例,进行ABI、身高、体重指数、腰围、臀围、血压、心率测量,病史采集及血液生化检查;比较两组间与心脑血管病各危险因素及临床心脑血管病事件发生情况的差异。结果288例患者中ABI异常95例,检出率为32．98％。影响ABI的主要危险因素为年龄（P=0．001）、性别（P=0．013）、血糖（P〈0．01）、血脂（P=0．003）、血压（P〈0．01）、吸烟（P=0．002）等。异常组心、脑血管病事件的检出率分别为26．32％和37．89％,明显高于ABI正常组的10．36％和20．21％,经Logistic回归分析处理,OR值分别是4．09、2．11,P〈0．05,差异有统计学意义。结论心脑血管病高危患者中ABI异常检出率高;ABI与心脑血管病各危险因素具有良好的相关性;ABI是心脑血管事件的预测因子之一。     

Relation of levels of hemostatic factors and inflammatory markers to the ankle brachial index

Associations between hemostatic and inflammatory markers relative to the ankle brachial index (ABI), an indicator of the presence and severity of peripheral arterial disease (PAD), are not fully understood. We studied relations among selected hemostatic factors, inflammatory markers, and the ankle brachial index (ABI) in patients with and without peripheral arterial disease (PAD). Participants were 370 men and women with ABI <0.90 and 231 patients with ABI 0.90 to 1.50 identified from noninvasive vascular laboratories and general medicine practice. Blood factors were D-dimer, prothrombin 1.2, tissue plasminogen activator (t-PA) antigen, plasminogen activator inhibitor-1 (PAI-1), and inflammatory markers (high-sensitivity C-reactive protein [CRP], fibrinogen, and serum amyloid A [SAA]). Among patients without a history of cardiac or cerebrovascular disease, the ABI was significantly inversely associated with log D-dimer (p <0.001), log prothrombin 1.2 (p = 0.001), log CRP (p <0.001), and log fibrinogen (p = 0.005) in unadjusted analyses. In multivariable regression analyses adjusting for all blood factors as well as potential confounders, D-dimer was associated independently with ABI in participants with a history of cardiac or cerebrovascular disease (p = 0.003) and in participants without a history of cardiac or cerebrovascular disease (p = 0.017). In these analyses, CRP was associated independently with ABI among participants with a history of cardiac or cerebrovascular disease (p = 0.026). CRP was not associated independently with ABI in participants without a history of cardiac or cerebrovascular disease. We conclude that D-dimer levels may be more sensitive than other blood markers for measuring the extent of atherosclerosis in lower extremity arteries.     

Symptoms of chronic arterial insufficiency correlate with absolute ankle pressure better than with ankle: brachial index

BACKGROUND: Doppler-based measurement of the ankle: brachial index (ABI) has long been regarded as the standard by which to objectively quantify the degree of lower extremity arterial occlusive disease, but this method fails to account for the contribution of systemic blood pressure to actual limb perfusion. We hypothesized that the absolute blood pressure would be a better predictor of the severity of symptoms of chronic occlusive disease than the ABI. Experimental design: retrospective comparative study. Setting: university inpatient/outpatient vascular laboratory. Patients: 1396 evaluable patients out of 2436 total consecutive patients referred with suspected lower extremity arterial occlusive disease. Measures: comparison of absolute ankle and digital pressures and ABI according to severity of symptoms of chronic lower extremity ischemia using three-way analysis of variance (ANOVA), likelihood ratios, and receiver operator characteristic (ROC) curves. RESULTS: The symptoms of tissue ulcer/gangrene, rest pain, and gangrene were characterized by differences in absolute pressures in the great toe (47 +/- 42 mmHg vs 55 +/- 40 mmHg vs 62 +/- 33 mmHg [mean +/- SD], F = 19.05, p < 0.001) and ankle (92 +/- 53 mmHg vs 98 +/- 44 mmHg vs 106 +/- 37 mmHg, F = 12.91, p < 0.001), but not by the ABI (0.71 +/- 0.33 vs 0.68 +/- 0.34 vs 0.71 +/- 0.28, F = 1.24, p > 0.05). ROC curves confirmed absolute digital pressure (area under curve [AUC] = 0.628) and absolute ankle pressure (AUC = 0.607) to be superior to ABI (AUC = 0.572). CONCLUSIONS: The severity of symptoms for peripheral vascular disease correlate better with absolute pressure measurement than with ABI.     

Association of low ankle brachial index with high mortality in primary care.

AIMS: We aimed to assess the increased risk of death and severe vascular events in elderly individuals with subclinical or manifest peripheral arterial disease (PAD), evidenced by low ankle brachial index (ABI < 0.9) in primary care. METHODS AND RESULTS: In this monitored prospective observational study, 6880 representative unselected patients aged >or=65 years were followed up over 3 years by 344 primary care physicians. Main outcome measures were mortality or a combined endpoint of mortality and severe vascular events. In total, 20 127 patient-years were observed. In the group of PAD patients (n=1230), 134 patients died; in the group without PAD (n=5591), 237 patients died [multivariate hazard ratio (HR) 2.0; 95% confidence interval 1.6-2.5, P<0.001]. Compared with an ABI>or=1.1, the risk of death increased linearly in the lower ABI categories: ABI 0.7-0.89, HR 1.7 (1.2-2.4, P<0.001); ABI<0.5, HR 3.6 (2.4-5.4, P<0.001). CONCLUSION: Patients with a low ABI (PAD), who can be readily identified in a primary care setting, have a substantially increased risk of death and severe vascular events. Patients with an ABI between 1.1 and 0.9 should be considered and followed up as borderline PAD cases. Particular attention should be paid to patients with PAD and previous vascular events, as their risk is markedly increased.     

老年H型高血压患者踝臂指数变化的临床意义

目的探讨老年H型高血压患者踝臂指数(ABI)的异常情况及临床意义。方法选择127例患者,根据血浆高同型半胱氨酸和诊室血压水平分为H型高血压组(HH组)65例、非H型高血压组(NHH组)32例和正常血压组(NT组)30例。测定ABI、高敏C反应蛋白(hs-CRP)、髓过氧化物酶(MPO)水平和血管内皮功能。结果与NT组比较,HH组和NHH组ABI明显降低(P<0.05,P<0.01);与NHH组比较,HH组ABI明显降低(P<0.05)。与NT组比较,HH组MPO、hs-CRP明显升高,内皮依赖性舒张功能(FMD)明显降低(P<0.05,P<0.01);与NHH组比较,HH组FMD明显降低(P<0.05)。相关分析显示,HH组ABI与hs-CRP和MPO呈负相关(r=-0.739、r=-0.723,P<0.01),与FMD呈正相关(r=0.927,P<0.01)。结论 ABI降低与炎性反应及血管内皮功能受损密切相关,对评估老年H型高血压患者动脉功能损害及识别高危患者有重要的临床意义。     

老年隐蔽性高血压患者踝臂指数变化的临床意义

目的探讨老年隐蔽性高血压患者踝臂指数(ABI)的异常情况及临床意义。方法根据动态血压和诊室血压将研究对象分为隐蔽性高血压(MH)组32例、原发性高血压(EH)组45例和正常血压(NT)组40例。测定踝臂指数(ABI)、高敏C反应蛋白(hs-CRP)和髓过氧化物酶(MPO)水平、血管内皮功能。结果与NT组比较,MH组、EH组ABI值显著性降低(P<0.05),hsCRP、MPO水平显著性增高(P<0.05),肱动脉内皮依赖性舒张功能有显著性减低(P<0.05)。老年MH患者ABI与hsCRP、MPO水平呈负相关(r=-0.723、-0.719,P均<0.01),与血管内皮功能障碍呈正相关(r=0.917,P<0.01)。结论 ABI降低与斑块不稳定、炎性反应及血管内皮功能受损密切相关,对提高老年MH患者高血压的诊出率,评价其动脉结构、功能的损害程度、判断预后、指导合理治疗有重要的临床意义。