Study On The Predictive Value Of Ankle-brachial Index And Toe-brachial Index On The Risk Of Cardiovascular And Cerebrovascular Events In Patients With Diabetic Foot

Diabetic Foot(DF)is a serious complication of diabetes.DF patients are often complicated with diabetic microvascular and macrovascular complications,which increase the risk of cardiovascular and cerebrovascular events in DF patients.Half of DF patients will die within five years.Most of them died of cardiovascular and cerebrovascular diseases.Therefore,it is of great significance to screen out a promising indicator to predict the risk of cardiovascular and cerebrovascular events in DF patients.This study aimed to evaluate the value of ankle-brachial index(ABI)and toe-brachial index(TBI)as predictors of the risk of cardiovascular and cerebrovascular events in DF patients,providing a simple and quick tool for clinical prediction of cardiovascular and cerebrovascular events in DF patients.The research methods of this paper include(1)A retrospective study was conducted,including a total of 197 DF patients hospitalized in the endocrinology department from February 2014 to September 2016.According to ABI,they were divided into ABI>0.9 group(Normal ABI,N-ABI group,n=138),0.6<ABI≤0.9 group(Low ABI,L-ABI group,n=36)and ABI≤0.6 group(Extremely low ABI,EL-ABI group,n=23)and according to TBI,they were divided into TBI≥0.7 group(Normal TBI,N-TBI group,n=107),0.5≤TBI < 0.7 group(Low TBI,L-TBI group,n=41)and TBI < 0.5 group(Extremely Low TBI,EL-TBI group,n=49).Patient information were collected,including gender,age,body mass index(BMI),duration time of diabetes,history of hypertension,hyperlipidemia,medical history,chronic renal insufficiency,smoking,levels of glycosylated hemoglobin(Hb A1c),creatinine,lipid,usage of asprin and stain.Patients were followed up for 36 months.(2)Multivariate Logistic regression analysis,Kaplan-Meier survival curve and Cox regression model were used to evaluate the value of ABI and TBI in predicting the risk of cardiovascular and cerebrovascular events in DF patients.The study outcomes include(1)The mean follow-up time of 197 patients was(33.47±7.86)months.27 patients(13.7%)developed cardiovascular and cerebrovascular events during follow up.(2)Age,duration time of diabetes and renal insufficiency were significant risk factors in ABI three groups.There was no statistically significant difference in risk factors between the L-ABI group and the N-ABI group(P >0.0167).The duration time of diabetes and chronic renal insufficiency were significant risk factors in the EL-ABI group compared with the N-ABI group.Age,duration time of diabetes,hypertension,hyperlipidemia and renal insufficiency were significant risk factors in TBI three groups.The age was significant risk factors in the L-TBI group compared with the N-TBI group.The age,duration time of diabetes and chronic renal insufficiency were significant risk factors in the EL-TBI group compared with the N-TBI group.(3)Multivariate Logistic regression analysis showed that chronic renal insufficiency,ABI≤0.6 and TBI < 0.7 were significant risk factors for cardiovascular and cerebrovascular events in DF patients,and the OR values were 4.711(95%CI: 1.312-16.914)、5.126(95%CI: 1.432-18.345)and 8.097(95%CI: 2.148-30.519)respectively.(4)The Kaplan-Meier survival analysis curve showed that the survival time of three groups in ABI group were compared,P=0.000(P<0.05).The L-ABI group compared with the N-ABI group,P=0.559(P>0.0167).The N-ABI group compared with the EL-ABI group,P=0.000(P<0.0167).The survivaltime of the three groups in the TBI group were compared,P=0.000(P<0.05).The L-TBI group compared with the N-TBI group,P=0.016(P<0.0167).The N-TBI group compared with the EL-TBI group,P=0.000(P<0.0167).(5)Cox regression analysis showed that the HR values of cardiovascular and cerebrovascular events in L-ABI group and EL-ABI group were 1.403(P>0.05)and 2.269(P<0.05)respectively.The HR values of cardiovascular and cerebrovascular events in L-TBI group and EL-TBI group were 4.749(P<0.05)and 10.495(P<0.05)respectively.The conclusion of this study is(1)ABI and TBI can be used as independent predictors of the risk of cardiovascular and cerebrovascular events in DF patients.(2)TBI is more sensitive than ABI to predict the risk of cardiovascular and cerebrovascular events in DF patients.(3)According to the results of ABI and TBI,the risk of cardiovascular and cerebrovascular events can be stratified.