踝肱指数(ABI)诊断外周动脉疾病的敏感度达95%

Ankle test for PAD has 95% sensitivity

踝肱指数(ABI)诊断外周动脉疾病的敏感度达95%

Author: Helen Saul

作者：Helen Saul

A FIVE-MINUTE TEST carried out by nurses in general practice could identify patients at high risk of death, Curt Diehm from Karlsbad-Langensteinbach hospital in Germany told a Hot Line Session yesterday. The test picks up asymptomatic peripheral arterial disease (PAD) which, according to a new epidemiological study, is as dangerous as symptomatic PAD.

德国Karlsbad-Langensteinbach医院的 Curt Diehm教授在昨天的电话会议上说，全科医疗护士进行五分钟的检查就能发现高危死亡患者。一项流行病学研究显示，该检查可以检出与有症状周围动脉疾病（PAD）同样危险的无症状PAD。

The test – the Ankle Brachial Index (ABI) – compares blood pressure in the arms with those in the legs. “Today, ABI is the most effective, accurate and practical method for PAD detection. It is quick, easy, non-invasive and cost effective,” Diehm said. “We have to implement ABI in general practice to identify higher risk patients.”

该检查——踝肱指数（ABI）——将臂部和腿部的血压进行比较。“目前，ABI是最有效、最准确和最可行的PAD检出方法。它快速、简便、无创，且经济有效。” Diehm 说，“在全科医疗中我们必须检测ABI，以发现高危患者。”

The German epidemiological trial on ABI (getABI) was initiated in 2001 to test the accuracy of ABI and to quantify the risks associated with asymptomatic PAD. It included 6880 unselected patients, aged 65 and over, in 344 German primary care offices.

德国ABI流行病学试验 （getABI）于2001年发起，目的是检验ABI的准确性，并量化为症状PAD的危险因素。研究包括6880名非选择性患者，年龄65岁及以上，均来自德国344个初级保健诊所。

The study found that an ABI score of 0.9 or lower (tibial anterior or posterior BP/brachial artery BP) identified PAD with a sensitivity of 95% and specificity of 50%. This is better than mammography for breast cancer, or the PSA test for prostate cancer, Diehm said.

研究发现，ABI小于等于0.9（胫前或胫后动脉BP/肱动脉BP）识别PAD的敏感度为95%，特异度为50%。Diehm说，这比乳房造影用于乳腺癌或PSA用于前列腺癌的效果还要好。

Of the total study cohort, 20.8% had a pathological ABI test, but the majority had no clinical signs or complaints. This asymptomatic PAD was as dangerous as symptomatic PAD: the groups did not differ significantly in terms of cardiovascular risk. PAD itself was a strong and independent predictor of mortality: at five years, all cause mortality was 24% in patients with symptomatic PAD and 19% among those with no signs or symptoms.

在总体研究人群中， ABI检测异常者占20.8%，但大多数没有临床症状和体征。这种无症状的PAD与有症状的PAD具有相同的危险性：两者的心血管风险没有显著差异。PAD本身就是很强的独立的死亡预测因素：PAD的五年全因死亡率在有症状患者中为24%，在无症状或体征的患者中为19%。

Existing AHA/ACC guidelines and the TASC II Document on PAD state that antithrombotic treatments should only be used in symptomatic patients. Diehm: “We have to change these very quickly now because we know that if you have the disease, whether symptomatic or asymptomatic, you die almost 10 years earlier. Therefore you need optimal secondary prevention.”

目前关于PAD的 AHA/ACC指南和 TASC II均指出，抗血栓治疗仅用于有症状的患者。 Diehm说：“我们必须尽快改变这些观点，因为我们知道，如果你患病，不管有没有症状，都会提前10年死亡。所以，你必须进行最佳的二级预防。”

The patients were under-treated, Diehm said. Antiplatelet therapy was given to only 56% of patients and statins to 23%. Beta-blockers are the optimal therapy for those with underlying coronary artery disease, but were given to only 25%. He said betablockers are not contraindicated, as many still believe.

Diehm说，目前患者没有得到充分治疗，仅有56%的患者接受了抗血小板治疗，23%的患者接受了他汀类药物治疗。β受体阻滞剂是合并冠心病患者的最佳治疗，但也只有25%的患者接受治疗。他说，β受体阻滞剂并不是PAD的禁忌，而很多人仍这样认为。

Discussant Don Poldermans from the Netherlands, stressed that only a few patients with PAD have no other disease and they require further investigation: “Most of the affected organs are asymptomatic. Screen for aortic aneurysms, screen for carotid disease, screen for coronary artery disease,” he urged.

荷兰Don Poldermans强调，仅少数PAD患者没有其他合并症，需要对他们进行进一步研究：“多数器官受累是无症状的，要对主动脉瘤、颈动脉疾病和冠状动脉进行筛查。”

Poldermans also stressed the need for PAD patients to be treated: “We all know these patients will benefit from medical therapy, butwe just don’t do it and that’s the point.”

Poldermans也强调PAD患者治疗的必要性：“我们都知道，这些患者将从治疗中获益，但我们却没有这样做，这是个问题。”