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目的:评价已发生心血管事件或有多重动脉粥样硬化(AS)危险因素的人群中踝臂指数(ABI)与肾功能不全的相关性。方法:连续入选2010-07-01-2011-02-28期间武汉市16家二级和三级医院的肾内科、心内科、内分泌科和神经内科收治的2 143例已发生心血管事件或有多重AS危险因素的患者,测定ABI值,并以Cockcroft-Gault公式计算肌酐清除率,肾功能不全定义为校正的肌酐清除率<60ml.min-1.1.73m-2;下肢动脉疾病(PAD)定义为ABI≤0.9。结果:821例(38.3%)有肾功能不全,630例(29.4%)有PAD。肌酐清除率与ABI呈正相关(r=0.29,P<0.01)。肾功能受损的独立危险因素包括:ABI异常(OR=1.22,95%CI,1.09～1.37,P<0.001)、年龄(OR=1.11,95%CI,1.10～1.14,P<0.001)、BMI(OR=0.83,95%CI,0.79～0.85,P<0.001)和高血压病史(OR=1.90,95%CI,1.40～2.60,P<0.001)。按AS累及血管床范围进行分组,肾功能不全发生率随着受AS累及的血管床范围的增加而增加(P<0.001)。经校正年龄、性别、高血压病史、糖尿病史、肥胖等因素后,受AS累及的血管床每增加一处,发生肾功能不全的可能增加1.54倍(OR=1.54,95%CI,1.22～1.94,P<0.001)。结论:心血管疾病高危人群中PAD和肾功能不全发病率高。肌酐清除率与ABI呈正相关。ABI异常是发生肾功能不全独立的危险因素。肾功能不全发生率随着AS累及血管床范围的增加而升高。
PURPOSE: To evaluate the association of ankle-brachial index (ABI) with renal insufficiency in a population of people who have had a cardiovascular event or risk of multiple atherosclerosis (AS). Methods: A total of 2 143 cases of cardiovascular events were enrolled in Department of Nephrology, Cardiology, Endocrinology and Neurology from 16 secondary and tertiary hospitals in Wuhan during 2010-07-01-2011-02-28. ABI values were measured in patients with multiple AS risk factors and creatinine clearance was calculated using the Cockcroft-Gault formula. Renal insufficiency was defined as corrected creatinine clearance <60 ml.min-1.1.73 m -2; definition of lower extremity arterial disease (PAD) ABI ≤ 0.9. Results: 821 (38.3%) had renal insufficiency and 630 (29.4%) had PAD. Creatinine clearance was positively correlated with ABI (r = 0.29, P <0.01). The independent risk factors of impaired renal function included ABI (OR = 1.22, 95% CI, 1.09-1.37, P <0.001), age (OR = 0.83, 95% CI, 0.79-0.85, P <0.001) and history of hypertension (OR = 1.90, 95% CI, 1.40-2.60, P <0.001). The incidence of renal insufficiency increased with the extent of vascular beds affected by AS (P <0.001), grouped by the extent of AS involvement in the vascular bed. After adjusting for factors such as age, gender, history of hypertension, history of diabetes, and obesity, renal dysfunction may increase by 1.54 times (OR = 1.54, 95% CI, 1.22-1.94) for every additional vascular bed affected by AS , P <0.001). Conclusions: The incidence of PAD and renal insufficiency in high-risk cardiovascular disease patients is high. Creatinine clearance was positively correlated with ABI. ABI abnormalities are independent risk factors for developing renal insufficiency. The incidence of renal insufficiency increased with the extent of AS involvement in the vascular bed.