Diagnostic Value Of Ankle-Brachial Index And Toe-Brachial Index In Arterial Disease Of Lower Extremity

The lower extremity arterial disease (LEAD) is a common complication of diabetesmellitus (DM) and (or) hypertension (EH), and vascular stenosis and occlusion is oftenformed on the basis of vascular atherosclerosis. The early stages of LEAD often have noclinical symptoms, and late period shows the symptoms of lower limb ischemia, such asintermittent claudication, diabetic foot and vascular occlusion etc. severe cases needamputation treatment.Therefore, to save the limb, it is very important to diagnose andevaluate correctly the degree of vascular lesions at the early stage of the disease.Epidemiological survey shows that the incidence of lower limb arteriosclerosis obliterans isapproximately10%, and along with the increase of age the incidence rate shows an upwardtrend. Currently ankle-brachial index (ABI) and toe-brachial index (TBI) are used as aprimary screening for lower extremity vascular ischemic disease in the clinical diagnosis,ABI has been widely used in clinical and TBI is only the supplement of ABI. hs-CRP is themost sensitive indicators when reactive protein in acute phase, often as an importantinflammatory markers in clinical diagnosis, and hs-CRP is also a basis for the inflammationdiagnosis in clinical.This study analyzed the correlation of ABI and TBI in patients with thediabetes and (or) hypertension,and observed the influences of the age, obesity parametersand biochemical index to ABI and TBI, and further analysis the clinical values of thehs-CRP combined ABI and TBI detection for early indicators.The purpose of this study is toprovide the basis for early evaluation and diagnosis of lower extremity vascular disease inclinical.Subjects and Methods:1. Subjects402cases of patients with diabetes mellitus and (or) hypertension were collected fromJuly2010to March2011in hypertension endocrinology hospitalization of Da Ping. Male227cases, female175cases, aged from24to91years, mean age (62.04±12.54) years old. Exclusion criteria: type1diabetes mellitus, secondary diabetes mellitus, secondaryhypertension, severe liver function and renal damage and heart function of III class abovepersons were eliminated. There is an acute complication of diabetes, various acute andchronic infection, systemic autoimmune diseases and heart, liver, renal insufficiency,dialysis or kidney transplantation, malignant tumor and thyroid disease, nearly half of theyear, or history of trauma operation or taking immune modulators, and hs-CRP≥10.0mg/Lexcluded.2. Methods and IndexAll subjects were measured the height, weight, blood pressure,waist circumference(WC), hip circumference, calculate body mass index (BMI)，waist-to-hipratio（WHR）；Record the gender, the age, smoking history； All subjects were measured fasting totalcholesterol (TC), fasting triglycerides (TG), low-density lipoprotein cholesterol (LDL-c),high density lipoprotein cholesterol (HDL-c)，and fasting plasma glucose (FPG) byadopting venous blood. Part of the research subjects received the tests of glycosylatedhemoglobin (HbA1c), OGTT, insulin release experiment, high sensitive c-reactive protein(hs-CRP). All patients were detected ABI, and part of the patients were detected TBI.This research is divided into three chapters: The patients were divided into narrowgroup(ABI＜0.9), normal group (0.9≤ABI＜1.3), and calcification group (ABI≥1.3)according to the value of the ABI, and also into narrow group (TBI＜0.7) and normalgroup(TBI≥0.7) according to the value of the TBI, The correlation of ABI with TBI wasanalyzed, and the differences in age, obesity parameters, biochemical indicators and otherfactors were compared between the groups; The patients were divided into normal hs-CRPgroup (hs-CRP＜3mg/l) and high hs-CRP group(hs-CRP≥3mg/l) according to the value ofthe hs-CRP.Influence of hs-CRP on ABI and TBI was further analyzed.Results:1. Results in the second chapter1. ABI and TBI of combination group with diabetes and hypertension weresignificantly lower than those of diabetic group and hypertensive group. TBI of diabeticgroup was significantly lower than those of the hypertensive group.2. When ABI＜0.9, ABI and TBI were significant correlation (r=0.826, p＜0.01);3. When0.9≤ABI＜1.3, ABI and TBI were not high significant correlation (r=0.325, p＜0.01)4. When ABI≥1.3, ABI and TBI were not significant correlation (r=0.155, p＞0.05).5. The age and hs-CRP are independent risk factors for LEAD patients.2. Results in the third chapter1. The comparison related factors of three groups divided by the size of ABIvalues shows: the age and hs-CRP of the narrow group were significantly higher than theother two groups (p＜0.01), TC, LDL-c of the normal group were significantly higherthan the narrow group (p＜0.05, p＜0.01);2. The comparison related factors between the two groups divided by the size of TBIvalue shows:the age, systolic blood pressure, hs-CRP of the narrow group weresignificantly higher than the normal group (p＜0.01, p＜0.01, p＜0.05), and the TG of thenormal group were significantly higher than the narrow group (p＜0.05).3. The age, BMI, WC, FPG of the high hs-CRP group were significantly higher thanthe normal hs-CRP group (p＜0.05, p＜0.01, p＜0.01,p＜0.05),and the ABI and TBI of thehigh hs-CRP group were significantly lower than the normal hs-CRP group (p＜0.05).Conclusions:1. The age is the most important risk factor in the LEAD.2. It may also be a good indicator to detect TBI when ABI≥0.9.3. The value of hs-CRP as an independent factor to predict vascular lesions of thelower extremity is limited, the hs-CRP level in combination with ABI and TBImeasurements can improve early diagnosis of arterial lesions of lower extremity.