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下肢周围动脉疾病的筛查

Author
Rodney A Hayward, MD
Section Editor
Robert H Fletcher, MD, MSc
Deputy Editor
Lee Park, MD, MPH
Translators
尹杰, 主治医师

引言

下肢周围动脉疾病(peripheral artery disease, PAD)是影响行走的常见原因，同时是下肢创伤和截肢的首要原因。该病也与身体其他部位的动脉硬化相关。因此PAD患者发生心脑血管事件及相关死亡的风险显著增加。

有大量证据表明，大部分PAD的病例通过常规的临床实践未被发现[1,2]。因此，如何通过常规筛查发现PAD已备受关注[3-6]。然而，一项对周围动脉疾病筛查临床指南的系统评价显示，发表自主要机构的8个筛查指南的推荐存在分歧[7]。在缺乏随机试验评估对无症状患者的筛查结果的情况下，有关筛查目的、筛查的适当性以及最佳的筛查方案等关键问题尚有待解决。

本专题将总结筛查PAD的有关原则和推荐，并着重讨论踝/肱指数(ankle-brachial index, ABI)作为筛查试验的应用。下肢PAD的临床特点和PAD的无创性诊断检查将单独讨论。 (参见“下肢外周动脉疾病的临床特征与诊断”和“动脉疾病的无创性诊断”)

PAD的患病率

55岁以上的成年人中大约有20%患有PAD，不过对PAD患病率的评估差别很大[8]。2000年至2010年收集的资料表明，在全世界范围内，高收入国家中45-49岁人群的预计患病率为5.3%，而85-89岁人群为18.5%[9]。美国一项于1999-2004年进行的大型研究表明，大约710万社区居住的美国人被诊断为PAD[10]。2010年全球约有2.02亿人患有PAD[9]。据报道，在过去的10年中PAD的发病率有显著增长(中低收入国家增长28.7%，高收入国家增长13%)。

文献报道未诊断的PAD非常普遍。在一项纳入近7000例接受初级保健的、70岁或以上或50-69岁有动脉粥样硬化风险因素(吸烟史或糖尿病史)的患者的研究中，通过踝/肱指数(ABI)筛查或者早先的记录确定29%的患者有PAD，而这些患者有超过一半在之前未被诊断[1]。与在临床中的人群相反，健康人群中无症状PAD的患病率显著较低。一项纳入1017例60-69岁(平均66岁)成人患者(排除重大慢性疾病患者，但纳入吸烟者和糖尿病患者)的研究表明，通过ABI筛查(ABI＜0.90)发现的PAD患病率2%，而目前正在吸烟的人群中为6.6%[11]。PAD在糖尿病患者中并未显著更普遍。

                   

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-25.
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