摘要
目的 评估运动平板试验（Bruce方案）对下肢动脉粥样硬化早期病变的临床诊断价值.方法 2008年3～9月解放军总医院心血管内科门诊患者,随机选取173例周围动脉疾病高危患者,采取运动平板试验结合踝臂指数（ABI）检测,并于同1周内完成下肢动脉超声检查,以下肢动脉超声结果为诊断标准,分析运动平板试验诊断下肢动脉粥样硬化早期病变的敏感性、特异性、阳性似然比及阴性似然比,并采用ROC曲线评价其临床诊断价值.结果 随着下肢动脉粥样硬化病变程度的加重,运动后ABI下降幅度（R值）逐渐增大;分别以下肢动脉存在动脉粥样硬化Ⅳ级（斑块病变面积〉20 mm^2）、Ⅲ级（存在动脉粥样硬化斑块）及Ⅱ级（存在动脉粥样硬化病变）为阳性诊断标准,R值的ROC曲线下面积分别为0.80（95% CI：0.72～0.88）、0.78（95% CI：0.71～0.85）及0.60（95% CI：0.44～0.76）.以下肢动脉粥样硬化大斑块病变为阳性诊断,R值为0.80时,其敏感性54.0%,特异性96.7%,阳性似然比为16.4,阴性似然比为0.58;R值为0.85时,其敏感性70.0%,特异性91.9%,阳性似然比为8.64,阴性似然比为0.33.结论 运动平板试验结合ABI检查是检测下肢动脉粥样硬化早期病变较为准确的客观工具.R值为0.85作为运动平板诊断下肢动脉粥样硬化大斑块病变（面积〉20 mm^2）的阈值为宜.
Objective To assess the value of exercise treadmill testing （bruce protocol） in diagnosing early atherosclerotic lesions of the lower limb. Methods Between March and September 2008, 173 outpatients with high risks of peripheral arterial disease （PAD） were enrolled randomly from the cardiology clinic of Chinese PLA General Hospital. The patients were subjected to exercise treadmill testing （Bruce protocol） and ankle-brachial index （ABI） determination, as well as lower limb artery ultrasonography within one week. Using ultrasonic findings as diagnostic criteria, the diagnostic sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of exercise treadmill testing for early atherosclerotic lesions of the lower limb were analyzed, and the diagnostic value of exercise treadmill testing was assessed using the ROC curve. Results After exercise, ABI decrement （R value） increased in subjects with high risks for PAD with atherosclerotic lesions of the lower limb aggravating. Using the presence of large atherosclerotic plaques （area 〉 20 mm^2 ）, atherosclerotic plaques and atherosclerotic lesions in lower limb arteries as positive diagnostic criteria, the area under curve of ROC was 0. 80 （95% CI： 0.72-0.88）, 0.78 （95% CI： 0.71-0.85） and 0. 60 （95% CI： 0.44-0.76）, respectively. Using the presence of large atherosclerotic plaques in lower extremities as positive diagnosis, R value was 0.80, with a sensitivity of 54. 0%, a specificity of 96. 7%, a LR＋ of 16. 4, and a LR- of 0. 58, meanwhile, R value was 0. 85, with a sensitivity of 70.0%, a specificity of 91.9%, a LR ＋ of 8.64, and a LR- of 0.33. Conclusions Exercise treadmill testing （Bruce protocol） in combination with ABI determination is a safe, accurate, objective tool for detecting early atherosclerotic lesions of the lower limb. Immediately after exercise, 0.85 is the cut-off R value appropriate for diagnosing large atherosclerotic plaques of the lower limb （area 〉 20 mm^2）.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2010年第7期532-535,共4页
Chinese Journal of Geriatrics
