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多重危险因素的临床病人和一般人群的ABI水平同济大学医学院余金明WhatisPAD?•PADisanatherothromboticdisorderaffectingtheperipheralarteriesa

nditisassociatedwithahighriskofMI,strokeandvasculardeath•ThemajorriskfactorsforPADare:–smoking–diabetes–age>55years(

men)or>65years(women)–hyperlipidemia–hypertension–historyofcardiovasculardiseaseMajormanifestationsoftherothromb

osisCerebrovasculardiseaseCoronaryarterydiseaseRenalarterystenosisVisceralarterialdiseasePeripheralarterialdisease–Intermittentclaudication–Critica

llimbischemiaPatientswithPADareathighriskofMIandstrokeIncreasedriskofMI*Increasedriskofstroke*PADPost-MIPost-stroke4greaterrisk(includesonlyfata

lMIandotherCHDdeath)5-7greaterrisk(includesdeath)2-3greaterrisk(includesanginaandsuddendeath†)2-3greaterrisk(includesTIA)3-4greaterrisk(includesT

IA)9greaterrisk一、多重危险因素临床病人ABI水平•1、一般情况–参与医院：上海7家、北京23家，共计30家–共收集6449例病例–其中男性3454例，女性2995人–年龄67.10±11

.762、ABI值的确定•ABI=•MeasureankleandbrachialsystolicpressureswithDoppler•Usehighestarmandeachanklepressures臂收缩压踝收缩压3、ABI诊断PAD的标准*•ABI–

>0.90Normal–0.41–0.90Mild-to-moderateperipheralarterialdisease–0.00–0.40Severeperipheralarterialdisease•*HiattWR.NEnglJMed2001;344:1608-1

621.4、按病种分类的PAD流行率和ABI水平•1）单病种：仅患有除PAD以外的一种疾病图1单病种不同疾病PAD患病率（%）17.921.216.015.90510152025CHDonlySTROKEonlyDMonlyHBPonly患病率（%）图2单

病种不同疾病ABI水平1.031.021.031.051.001.011.021.031.041.051.06CHDonlySTROKEonlyDMonlyHBPonlyABI均值•2）同时患有除PAD以外的两种不同的疾病图3双病种不同疾病PAD患病率

（%）26.537.525.934.325.830.20510152025303540CHD+HBPCHD+DMCHD+STROKESTROKE+HBPSTROKE+DMHBP+DM患病率（%）图4双病

种不同疾病ABI水平1.001.000.920.990.970.990.880.900.920.940.960.981.001.02CHD+HBPCHD+DMCHD+STROKESTROKE+HBPSTROKE+DMHBP+DMABI均值•3）同时

患有除PAD以外的两种以上的疾病图5多病种不同疾病PAD患病率（%）31.340.653.841.453.50102030405060CHD+HBP+DMCHD+HBP+STROKECHD+DM+STROKESTROKE+HBP+DMCHD+STROKE+HBP+DM患病率（%

）图6多病种不同疾病ABI水平0.960.890.840.900.810.700.750.800.850.900.951.00CHD+HBP+DMCHD+HBP+STROKECHD+DM+STROKESTROKE+HBP+DMCHD+STROKE+HBP+DMA

BI均值•4）患有的疾病数不同PAD患病率及ABI水平图7四种疾病不同组合PAD的患病率（%）16.326.538.653.501020304050601种疾病2种疾病3种疾病4种疾病患病率（%）图8四种疾病不同组合的ABI水平1.040.990.910.81

0.700.750.800.850.900.951.001.051.101种疾病2种疾病3种疾病4种疾病ABI均值•5）不考虑并发其他疾病时，单病种PAD患病率和ABI水平图9不考虑疾病交叉的各疾病PAD的患病率（%）32.634.426.531.525.8

0510152025303540CHDSTROKEHBPDMLipidDisorder患病率（%）图10不考虑疾病交叉的各疾病不同组合的ABI水平0.950.940.990.960.990.900.920.940.960.981.00CHDST

ROKEHBPDMLipidDisorderABI均值5、PAD总患病率•6449例研究对象中，ABI异常1595例•PAD总患病率为24.7%•PAD病人ABI均值为0.682±0.205，•非PAD病人ABI均值

为1.098±0.1236、危险因素分析RelationshipofABIbetweenage,smokingandBMIPADNon-PADtvaluePvalueAge(years)72.15±9.9165.44±11.85-20.4070.000Smoking(pack-ye

ar)13.51±21.5411.19±20.10-3.9170.000BodyMassIndex23.84±3.7824.38±3.675.0670.000RelationshipofABIbetweengender

anddiseasehistoryPADABI0.9Non-PADABI≥0.9Prevalence(%)2Pvaluegendermale811246323.56.2410.011female785221026.2CHDhistoryye

s1005245829.087.350.000no586239319.7hyperlipidemiayes1173337525.89.0220.003historyno423147822.3hypertensiony

es1449411726.036.0450.000historyno14773616.6diabetesyes777171331.290.7990.000historyno819314020.7Ischemicstrokeyes710138733.9140.7000.000his

toryno880346420.3BaselineCharacteristicsofPatientsRiskfactors*ABI≥0.9(N=3927)ABI<0.9(N=1336)Total(N=5263)

PValueABI1.09±0.100.86±0.191.03±0.16<.0001SBP(mmHg)138±22.27143±24.59139±22.95<.0001DBP(mmHg)80.9±12.2680.3±12.9880.7±12

.450.1618PP(mmHg)57.5±17.3562.3±19.7658.7±18.11<.0001TC(mmol/L)4.56±1.074.60±1.084.57±1.070.2302TG(mm

ol/L)1.58±0.871.61±0.901.59±0.880.2816HDL(mmol/L)1.19±0.351.16±0.341.18±0.350.0288LDL(mmol/L)2.70±0.812.72±0.832.71±0.820.65

92BUN(µmol/L)6.34±4.857.25±4.756.57±4.84<.0001CRE(µmol/L)92.20±69.26106.28±80.9395.77±72.65<.0001UA(mmol/L)316.35±112.06339.35

±125.01322.19±115.91<.0001BG(mmol/L)6.22±2.616.52±2.756.30±2.650.0004RiskfactorsassociatedwithPADatmultiplelogisticregressionanalysisriskfactors*O

R95%CIPvaluewomen1.641.39-1.930.001age1.061.05-1.060.001BMI0.960.94-0.980.001CHD1.671.42-1.950.001Stroke1.781.55-2.0

40.001Diabetes1.761.53-2.020.001Smoking1.521.29-1.790.001TC1.111.04-1.190.0017HDL-C0.770.62-0.950.016Creatinine1.0021.001-1.0030.0013BUN1.

0080.992-1.0240.3294Uricacid1.0011.001-1.0020.001二、一般人群的ABI水平•1、一般情况•研究对象来源：四川省盐边县•抽样方法：按城镇乡村分层，再进行随机整群抽

样•研究对象共1277人，其中男性471人，女性806人，年龄：为8岁以上人群。•2、ABI水平及PAD患病率（ABI≤0.9）表1不同性别、年龄的ABI水平性别男女合计年龄（岁）例数均数±标准差例数均数±标准差例数均数±标准差＜1580.97±

0.12140.96±0.13220.96±0.1215～351.02±0.12611.02±0.10961.02±0.1125～1111.05±0.122291.03±0.103401.04±0.1135～1111.08±0.131991.03

±0.113101.05±0.1245～891.06±0.111451.04±0.122341.05±0.1255～671.06±0.12971.04±0.101641.05±0.11≥65501.06±0.1

4611.00±0.111111.03±0.12合计4711.06±0.128061.03±0.1112771.04±0.121.不同性别比较：P<0.00012.不同年龄组：男P=0.114女P=0.030合计P=0.007表2不同

性别、年龄的PAD患病率（%）性别男女合计年龄（岁）例数PAD（%）例数PAD（%）例数PAD（%）＜15837.501435.712236.3615～3511.43619.849610.4225～1119.912

2910.9234010.5935～1119.0119910.5531010.0045～896.7414511.032349.4055～6710.45976.191647.93≥655012.006116.3911114.41合计4719.9880611.0412

7710.651.不同性别比较：P=0.5522.不同年龄组：男P=0.222女P=0.1113、参考值范围的确定•由于ABI均值在不同年龄组及不同性别间均无差异，参考值确定只计算整个人群的结果•由于ABI低为异常，故参考值范围确定时取

单侧下限•分三步纯化研究对象：–剔除有明确冠心病、高血压、高血脂、糖尿病、中风等病史的人104例–剔除血脂、血糖检测异常：167例–剔除血压异常：253例ABI参考值范围N90%范围95%范围99%范围

病史纯化后1173>0.892>0.851>0.770血脂血糖检测异常纯化后1006>0.893>0.851>0.772血压检测值异学纯化后753>0.893>0.851>0.771•以ABI＜0.85为PAD–原资料PAD患病率男：4.2%；女5.2%；合计5.0%•患病

率明显低于以ABI＜0.90的标准–分别为：9.98%、11.04%、10.65%–高估患病率5%左右PAD病人非PAD病人0.850.90三、大学生踝臂指数参考值•1、研究对象–入选标准：采用随机整群抽样的

方法，以宿舍为单位，选取上海市某高校在校大学为研究对象，共收集2021例研究对象资料。–排除标准：符合以上入选的研究对象，若患有心脑血管疾病、高血压、高脂血症、糖尿病、慢性肾脏疾病等，将被排除在研究对象之外，共29例。•2、一般情况–研究对象来自某综合性大学32

个不同的院（系）–符合研究要求的研究设计要的对象1992例–年龄21.921.78岁–其中男性1224例，年龄22.161.82岁，女性748例，年龄21.541.64岁–男性平均年龄高于女性（P<0.001）–汉族1927例，回族18例，其

他民族76例。–96例研究对象（4.8%）吸烟，不吸烟为95.2%。x±SD95%CIMedian正态性检验skewnessPKurtosisP左ABI1.0480.0911.044~1.0521.

0470.350<0.010.757<0.01右ABI1.0510.0941.047~1.0551.0490.349<0.010.737<0.01ABI1.0260.0891.022~1.0301.0190.272<0.010.616<0.01ABI值的分布ObservedValue1.

41.31.21.11.0.9.8.743210-1-2-3-4不同性别ABI差异成组t检验男女tP左ABI1.0380.0901.0660.0916.910<0.01右ABI1.0380.0921.0730.0938.23

7<0.01ABI1.0150.0881.0430.0886.63<0.01正态分布法确定的参考值范围双侧单侧(下限)90%95%99%90%95%99%左ABI0.899~1.1970.870~1.2260.810~1.2860.9310.

8990.836右ABI0.897~1.2050.867~1.2350.808~1.2940.9310.8970.832ABI0.880~1.1720.852~1.2000.796~1.2560.9120.8800.819百分位数法确定的参

考值范围双侧单侧(下限)90%95%99%90%95%99%左ABI0.909~1.2040.876~1.2450.823~1.3280.9710.9090.846右ABI0.909~1.2110.875~1.2710.

815~1.3410.9310.9090.833ABI0.883~1.1820.850~1.2150.803~1.3000.9130.8830.818若以0.85为临界值•ABI0.85为PAD患者•则多中心临床研究•Totalprevalence=19.5%•(0.9为切点时为

24.7%)