Lower extremity manifestations of peripheral artery disease: the pathophysiologic and functional implications of leg ischemia.
Lower extremity manifestations of peripheral artery disease: the pathophysiologic and functional implications of leg ischemia.
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DOI：
10.1161/circresaha.114.303517
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发表时间：
2015-04-24
影响因子：
20.1
通讯作者：
McDermott MM
中科院分区：
文献类型：
--
作者：
McDermott MM
下肢外周动脉疾病(PAD)经常被低估，部分原因是PAD患者表现出各种各样的腿部症状，部分原因是无症状PAD的发生率很高。在初级保健医疗实践中，30%到60%的PAD患者报告没有劳累腿部症状，大约45%到50%的患者报告劳累腿部症状与典型的间歇性跛行不一致。PAD的功能损害和功能衰退的发生率和程度也可能被低估。功能损害和功能衰退在PAD中很常见，即使在那些没有症状的人中也是如此。腿部缺血还与小腿骨骼肌的病理生理变化有关，包括小腿肌肉面积缩小、小腿肌肉脂肪含量增加、腿部力量受损和代谢功能受损。重度PAD患者的腓神经传导速度比轻度PAD患者或无PAD患者差。PAD患者肢体肌肉和周围神经缺血相关的病理生理改变程度与功能损害程度相关。需要新的干预措施来改善大量PAD患者的功能表现和防止活动能力丧失，包括那些没有症状或有腿部劳累症状而不是跛行的患者。
Lower extremity peripheral artery disease (PAD) is frequently under-diagnosed, in part because of the wide variety of leg symptoms manifested by patients with PAD and in part because of the high prevalence of asymptomatic PAD. In primary care medical practices, 30% to 60% of PAD patients report no exertional leg symptoms and approximately 45–50% report exertional leg symptoms that are not consistent with classic intermittent claudication. The prevalence and extent of functional impairment and functional decline in PAD may also be underappreciated. Functional impairment and functional decline is common in PAD, even among those who are asymptomatic. Lower extremity ischemia is also associated with pathophysiologic changes in calf skeletal muscle including smaller calf muscle area, increased calf muscle fat content, impaired leg strength, and impaired metabolic function. People with severe PAD have poorer peroneal nerve conduction velocity compared to people with mild PAD or no PAD. The degree of ischemia-related pathophysiologic changes in lower extremity muscles and peripheral nerves of people with PAD are associated with the degree of functional impairment. New interventions are needed to improve functional performance and prevent mobility loss in the large number of PAD patients, including in those who are asymptomatic or who have exertional leg symptoms other than claudication.