臂踝脉搏波传导速度和踝臂指数对下肢动脉粥样硬化的诊断价值

目的研究应用臂踝脉搏波传导速度(brachial-ankle pulse wave velocity,BaPWV)和踝臂指数(ankle-branchial index,ABI)对下肢动脉粥样硬化的诊断价值。方法连续选取2015年5月~2015年10月就诊于吉林大学白求恩第一医院门诊或住院的健康或脑血管病患者173例,分别对入组患者行双下肢动脉彩超、BaPWV和ABI检查,根据双下肢动脉彩超正常的入组者所收集数据采用均数加减1.96倍标准差分别计算出BaPWV和ABI的正常参考值范围;根据双下肢动脉彩超结果分为:正常组、斑块组、轻度狭窄组、中度狭窄组、重度狭窄+闭塞组5组,并分别比较5组间BaPWV值和ABI值;同时假设分别以ABI=0.8、ABI=0.9、ABI=1.0、ABI=1.1为分界点,通过绘制、分析受试者操作特征曲线(ROC curve)明确区分下肢动脉正常与狭窄之间的最佳分界点,并计算其灵敏度、特异性、误诊率及漏诊率。结果 BaPWV的正常参考值范围是1078~1876 cm/s,ABI的正常参考值范围是1.02~1.31;5组间BaPWV值比较(P0.001),具有显著差异,进一步进行组间比较得出,BaPWV值可应用于中度狭窄病变以前的血管弹性评估,对重度狭窄及闭塞血管无诊断作用;5组间ABI值比较(P0.001),有显著差异,结合ROC曲线下面积得出,ABI值对于区分双下肢动脉正常与斑块、斑块与轻度狭窄、轻度狭窄与中度狭窄病变之间没有诊断价值,但对于区分中度狭窄与重度狭窄+闭塞之间有较高的诊断意义。结论 BaPWV可以作为评估下肢动脉血管弹性的指标,ABI可以作为下肢动脉狭窄的诊断工具。

the diagnostic value of BaPWV and ABI to lower extremity atherosclerosis

Objective This paper aimed to investigate the diagnostic value of ankle-brachial index ( ABI) and bra-chial-ankle pulse wave velocity (BaPWV) for lower extremity arteriosclerotic disease with the lower extremity arterial ultra-sonography as the gold standard .Methods Healthy population or patients with cerebrovascular diseases that consulted in the outpatient or were hospitalized in The First Hospital of Jilin University from May ,2015 to October,2015 were selected successively .All the enrolled patients received bilateral lower extremity arterial ultrasonography ,ABI and BaPWV examina-tion,respectively.Calculated the normal reference ranges of ABI and BaPWV by mean ±1.96-fold standard deviation on the basis of the data collected from the enrolled patients with normal bilateral lower extremity arterial ultrasonography re -sults.The patients were divided into 5 groups in accordance with the results of bilateral lower extremity arterial ultrasonog-raphy,namely,the normal group,the plaque group,the mild stenosis group,the moderate stenosis group,and the severe ste-nosis and occlusion group .The ABI values and BaPWV values among the 5 groups were compared , respectively .Mean-while,assumed that ABI=0.8,ABI=0.9,ABI=1.0 and ABI=1.1 were the cut-off points,respectively,and determined the best cut-off points for distinguishing normal and stenosis in lower extremity artery through drawing and analyzing the re -ceiver operating characteristic curve (ROC curve),and calculated sensitivity,specificity,misdiagnosis rate and missed diag-nosis rate.Results The normal reference range of BaPWV calculated through mean ±1.96-fold standard deviation was 1078-1876cm/s,while that of ABI was 1.02-1.31.There was remarkable difference in BaPWV value (P<0.001) when compared among the 5 groups .It could be figured out that BaPWV value could be applied in evaluating vascular elasticity before moderate stenosis ,however ,it had no diagnostic value for severe stenosis and occlusive vessels .There were signifi-cant differences when comparing the ABI values among the 5 groups (P<0.001).According to ROC curve indicating that ABI value showed no diagnostic values for distinguishing bilateral lower extremity arteries between the normal and the plaque groups ,the plaque and the mild stenosis groups ,and the mild and the moderate stenosis groups;but it had high diag-nostic value for distinguishing moderate stenosis and the severe stenosis and occlusion .Conclusions BaPWV could serve as the indicator for evaluating the bilateral lower extremity arterial elasticity ,and ABI could serve as the diagnostic tool for bilateral lower extremity arterial stenosis .