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目的:探讨抬高双下肢45°踝肱指数(ankle/brachial index,ABI)筛查糖尿病周围血管病变及其程度的敏感性和特异性。方法:纳入我科143例住院糖尿病患者,均行平躺体位、双下肢抬高45°ABI检查和双下肢血管彩超。分别根据ABI和血管彩超结果将下肢血管病变分为4级,1级:ABI 在0.9-1.3或血管未见异常或仅有斑块,2级:ABI在 0.6-0.9或有血管狭窄,程度<50%,3级:ABI在0.4-0.6或血管狭窄程度介于50-75%,4级:ABI <0.4或血管狭窄程度 >75%。比较两种体位所测ABI之间的差异;以血管彩超为标准,比较平躺体位和双下肢抬高45°ABI与之的一致率、低估率和高估率的差异。结果:平躺体位ABI和双下肢抬高45°ABI比较有明显统计学差异(P<0.05);与血管彩超结果比较,抬高45°ABI和血管彩超一致性明显高于平躺体位ABI(P<0.05),但高估了血管病变程度(P<0.05),尤其是对1级血管病变的评估(87%),平躺体位ABI则低估血管病变程度(P<0.05),尤其4级血管病变(51.2%)。结论:双下肢抬高45°ABI可明显提高筛查糖尿病患者周围血管病变及其程度的敏感性,但同时可能降低其特异性。
Objective: To investigate the sensitivity and specificity of elevating the ankle / brachial index (ABI) at 45 ° in both lower extremities for the screening of peripheral vascular lesions in diabetic patients. Methods: We included 143 hospitalized patients with diabetes mellitus in our department. All patients underwent lying position with double lower extremity elevation 45 ° ABI examination and double lower extremity vascular ultrasound. According to the results of ABI and vascular ultrasound, the lower extremity vascular lesions were divided into 4 grades, grade 1: ABI 0.9-1.3 or no abnormal blood vessels or only plaque, grade 2: ABI 0.6-0.9 or vascular stenosis, degree of < 50%, grade 3: ABI 0.4-0.6 or vessel stenosis 50-75%, grade 4 ABI 0.4 or vessel stenosis 75%. The differences between ABI measured by two kinds of postures were compared. According to the color Doppler ultrasound, the differences of the coincidence rate, the underestimation rate and the overestimation rate of lying position and double lower extremity elevation 45 ° ABI were compared. Results: There was a significant difference (P <0.05) between ABI of lying position and elevation of 45 ° of lower extremity (P <0.05). Compared with the results of vascular ultrasonography, the consistency of elevated 45 ° ABI and vascular color Doppler was significantly higher than that of lying position ABI (P < 0.05), but over-estimated the degree of vascular lesion (P <0.05), especially the grade 1 vascular lesion (87%) and the lying position ABI underestimated the degree of vascular lesion (P <0.05) (51.2%). CONCLUSIONS: Elevated 45 ° ABI in both lower extremities significantly increases the sensitivity of screening for peripheral vascular lesions and their extent in diabetic patients, but may also reduce their specificity.