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目的研究具有动脉硬化危险因素的女性住院患者的踝臂指数(ankle-brachial index,ABI)与全因死亡和心血管疾病(CVD)死亡的关系。方法收集2004年7月至2005年1月上海和北京多中心连续内科住院患者中具有2个或2个以上动脉硬化危险因素的女性患者1744例,年龄35~95岁,进行基线特征调查并平均随访(11.8±0.4)个月。结果ABI≤0.90诊断外周动脉疾病(PAD)者492例,ABI为0.91~1.40者1252例为非PAD,PAD组的年龄、高血压史、收缩压、血脂紊乱史、甘油三酯、高密度脂蛋白胆固醇、糖尿病史、空腹血糖、吸烟史、全因病死率和CVD病死率均高于非PAD组,差异有显著性意义。全因病死率和CVD病死率分别在重度PAD组、轻度至中度PAD组、临界组和正常对照组中的差异有显著性意义(P<0.05)。采用Cox回归分析后,重度PAD组全因死亡的RR为4.429(95%CI:2.144~9.149),CVD死亡的RR为6.215(95%CI:1.831~21.099),轻至中度PAD组CVD死亡的RR为2.024(95%CI:1.117~3.664)。PAD组的存活率显著低于非PAD组(P<0.001)。结论低踝臂指数是具有多重动脉硬化危险因素的女性患者全因死亡和CVD死亡的独立危险因素,尤其是CVD死亡,ABI越低,CVD死亡危险性越高。
Objective To investigate the relationship between ankle-brachial index (ABI) and all-cause mortality and cardiovascular death (CVD) in female inpatients at risk of arteriosclerosis. Methods A total of 1744 female patients with atherosclerosis risk factors of 2 or more atherosclerotic inpatients from July 2004 to January 2005 in Shanghai and Beijing were enrolled. The age ranged from 35 to 95 years old. The baseline characteristics were collected and averaged Follow-up (11.8 ± 0.4) months. Results There were 492 patients with ABI ≤0.90 diagnosed with peripheral arterial disease (PAD), and 1252 patients with ABI ranging from 0.91 to 1.40 were non-PAD. The age, history of hypertension, systolic blood pressure, dyslipidemia, triglyceride, Protein cholesterol, history of diabetes, fasting blood glucose, smoking history, all-cause mortality and CVD mortality were higher than non-PAD group, the difference was significant. All-cause mortality and CVD mortality were significantly different between the severe PAD group, the mild to moderate PAD group, the critical group and the normal control group (P <0.05). After Cox regression analysis, the RR of all-cause death in patients with severe PAD was 4.429 (95% CI: 2.144-9.149) and the RR of CVD death was 6.215 (95% CI: 1.831-21.099). CVD was mild to moderate in the PAD group The RR was 2.024 (95% CI: 1.117 ~ 3.664). The survival rate of PAD group was significantly lower than that of non-PAD group (P <0.001). Conclusions Ankle brachial index is an independent risk factor of all-cause and CVD death in female patients with multiple arterial stiffness, especially CVD death. The lower the ABI, the higher the risk of CVD death.