The toe-brachial index in the diagnosis of peripheral arterial disease
The toe-brachial index in the diagnosis of peripheral arterial disease
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DOI：
10.1016/j.jvs.2013.03.044
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发表时间：
2013-07-01
影响因子：
4.3
通讯作者：
Petersen, Lars J.
中科院分区：
文献类型：
--
作者：
Hoyer, Christian;Sandermann, Jes;Petersen, Lars J.
背景：外周动脉疾病(PAD)可以通过节段性血压测量和计算踝臂指数(ABI)或趾臂指数(TBI)进行无创性诊断。众所周知，ABI对于血管僵硬的患者是不可靠的，并且无法检测到动脉硬化发展的早期阶段。脚趾血管不太容易受到血管僵硬的影响，这使TBI变得有用。然而，指南、临床设置和实验研究中使用的诊断界限有很大不同。这篇综述提供了支持TBI临床应用的证据的概述。方法：文献综述确定了关于使用TBI的指南建议、正常人群、与血管造影结果的相关性以及预后影响的研究。结果：在正常人群中进行了8项研究，其中只有一项研究使用了影像技术来排除动脉狭窄。在四肢预热的研究中，根据加权平均值，参考值0.71被估计为正常的下限。另有7项研究显示了脑外伤与血管造影结果的相关性。TBI诊断血管狭窄的敏感性为90%~100%，特异性为65%~100%。很少有研究探讨脑外伤作为心血管死亡率和发病率的预后标记物的价值，也没有得出确切的结论。然而，研究表明，脑外伤与肾脏疾病、糖尿病和微血管疾病等并存疾病之间存在相关性。结论：与脑外伤的明确定义和循证界限相比，病理性脑损伤的诊断标准仍然不明确。尽管PAD诊断的几个指南和综述建议使用TBI
Background: Peripheral arterial disease (PAD) can be diagnosed noninvasively by segmental blood pressure measurement and calculating an ankle-brachial index (ABI) or toe-brachial index (TBI). The ABI is known to be unreliable in patients with vascular stiffness and fails to detect the early phase of arteriosclerotic development. The toe vessels are less susceptible to vessel stiffness, which makes the TBI useful. However, the diagnostic limits used in guidelines, clinical settings, and experimental studies vary substantially. This review provides an overview of the evidence supporting the clinical use of the TBI.Methods: A review of the literature identified studies reporting the use of the TBI regarding guideline recommendations, normal populations, correlations to angiographic findings, and prognostic implications.Results: Eight studies conducted in a normal population were identified, of which only one study used imaging techniques to rule out arterial stenosis. A reference value of 0.71 was estimated as the lowest limit of normal based on the weighted average in studies with preheating of the limbs. A further seven studies showed correlations of the TBI with angiographic findings. The TBI had a sensitivity of 90% to 100% and a specificity of 65% to 100% for the detection of vessel stenosis. Few studies investigated the value of the TBI as a prognostic marker for cardiovascular mortality and morbidity, and no firm conclusions could be made. Studies have, however, shown correlation between the TBI and comorbidities such as kidney disease, diabetes, and microvasculature disease.Conclusions: In contrast to the well-defined and evidence-based limits of the ABI, the diagnostic criteria for a pathologic TBI remain ambiguous. Although several guidelines and reviews of PAD diagnostics recommend a TBI