Circulation:微血管疾病、外周动脉疾病与截肢

2019-07-08 xing.T MedSci原创

由此可见,独立于传统危险因素,微血管疾病的存在增加了截肢的风险,并协同增加了外周动脉疾病患者的风险。需要进一步研究以了解发生这种情况的机制。

与外周动脉疾病相关的不良肢体事件的机制仍未完全明确。近日,心血管领域权威杂志Circulation上发表了一篇研究文章,研究人员在一大群退伍军人中调查了微血管疾病是否与截肢有关,并确定在任何位置诊断的微血管疾病是否会增加单独截肢和与外周动脉疾病一致的风险。 

参与者为2003年4月1日至2014年12月31日的退伍军人老龄化队列研究的受试者。研究人员排除了既往已知下肢截肢的参与者,并使用时间更新的Cox比例风险回归分析了微血管疾病(视网膜病变、神经病变和肾病)和外周动脉疾病状态对调整人口统计学指标和心血管危险因素后发生截肢事件风险的影响。 

在基线时既往没有截肢证据的125674名退伍军人中,9.3年的中位随访期间截肢事件发生率为1.16/1000人每年,共截断1185例。在时间更新的多变量调整分析中,与没有外周动脉疾病或微血管疾病的患者相比,仅有微血管疾病与截肢风险增加3.7倍[95%CI=3.0-4.6]相关;单一周围动脉疾病使截肢风险​​增加13.9倍[11.3-17.1];并且外周动脉疾病和微血管疾病的组合与截肢风险增加22.7倍[18.3-28.1]相关。 

由此可见,独立于传统危险因素,微血管疾病的存在增加了截肢的风险,并协同增加了外周动脉疾病患者的风险。需要进一步研究以了解发生这种情况的机制。 

原始出处:

Joshua A. Beckman,et al.Microvascular Disease, Peripheral Artery Disease and Amputation. Circulation. 2019.https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.040672

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