| Objective: With the increase in the morbidity of lower extremity arteriosclerotic occlusive disease, the detection methods of lower extremity arterial disease merge one after another. This paper aimed to investigate the diagnostic value of ankle-brachial index(ABI) and brachial-ankle pulse wave velocity(Ba PWV) for bilateral lower extremity arteriosclerotic occlusive disease with the bilateral lower extremity arterial ultrasonography as the gold standard. Hyperglycemia is an independent risk factor for ischemic stroke. The incidence of ischemic stroke in patients with diabetes is significantly higher than that of controls. This study examined the predictive value of the ankle-brachial index(ABI) and brachial-ankle pulse wave velocity(Ba PWV) in the incidence of ischemic stroke among patients with type 2 diabetes.Methods:(1) Healthy population or patients with cerebrovascular diseases that consulted in the outpatient or were hospitalized in The First Hospital of Jilin Universityfrom May, 2015 to October, 2015 were selected successively. All the enrolled patients received bilateral lower extremity arterial ultrasonography, ABI and Ba PWV examination, respectively. Calculated the normal reference ranges of ABI and Ba PWV by mean±1.96-fold standard deviation on the basis of the data collected from the enrolled patients with normal bilateral lower extremity arterial ultrasonography results. The patients were divided into 5 groups in accordance with the results of bilateral lower extremity arterial ultrasonography, namely, the normal group, the plaque group, the mild stenosis group, the moderate stenosis group, and the severe stenosis and occlusion group. The ABI values and Ba PWV values among the 5 groups were compared, respectively. Meanwhile, assumed that ABI=0.8, ABI=0.9, ABI=1.0 and ABI=1.1 were the cut-off points, respectively, and determined the best cut-off points for distinguishing normal and stenosis in lower extremity artery through drawing and analyzing the receiver operating characteristic curve(ROC curve), and calculated sensitivity, specificity, misdiagnosis rate and missed diagnosis rate.(2)Patients with type-2 diabetes were consecutively selected for brain magnetic resonance imaging(MRI) to determine whether lesion(s) indicative of cerebral infarction(including previous and newly onset cerebral lesions) were present. The patients were then divided into a diabetes-only group and diabetes with ischemic stroke group. The basic clinical characteristics of the patients, the ABI, and Ba PWV were collected. Multivariate regression analyses were conducted to identify clinical characteristics associated with the incidence of ischemic stroke among patients with diabetes.Results:(1)Altogether 173 people were enrolled in this research(346 legs), among which 86 people had normal bilateral lower extremity arterial ultrasonography results(51 male and 35 female); and the normal reference range of ABI calculated through mean±1.96-fold standard deviation was 1.02-1.31, while that of Ba PWV was 1078-1876cm/s. The number of legs enrolled was divided into the normal group(176), the plaque group(108), the mild stenosis group(7), the moderate stenosis group(14), and the severe stenosis and occlusion group(41) according to the bilateral lower extremity arterial ultrasonography results. There was remarkable difference in Ba PWV value(P<0.001) when compared among the 5 groups. It could be discovered through further comparison among groups that there were statistically significant differences when comparing the normal group with the plaque group, the mild stenosis and moderate stenosis group(all P<0.05); and the P=0.933 when comparing the normal group with the severe stenosis combined with occlusion group. As a result, it could be figured out that Ba PWV value could be applied in evaluating vascular elasticity before moderate stenosis, however, it had no diagnostic value for severe stenosis and occlusive vessels. It was also found that the Ba PWV values in the normal, plaque, mild stenosis, and moderate stenosis groups were all greater than 1000cm/s, while some of the Ba PWV values in the severe stenosis and occlusion group were smaller than 1000cm/s(9/41,21.95%), consequently, it could be concluded that when vascular stenosis in the lower extremity artery induced hemodynamic changes, Ba PWV < 1000cm/s could be treated as the auxiliary diagnostic reference index for diagnosing lower extremity arterial stenosis. There were significant differences when comparing the ABI values among the 5 groups(P<0.001). Assumed that ABI=0.8,ABI=0.9, ABI=1.0 and ABI=1.1 were the best cut-off points, respectively, and the best cut-off points for distinguishing the bilateral lower extremity arteries between the normal and the plaque groups, the plaque and the mild stenosis groups, and the mild and the moderate stenosis groups were all ABI=1.1, while the cut-off point between the moderate stenosis and the severe stenosis and occlusion groups was 1.0, indicating that ABI value showed no diagnostic values for distinguishing bilateral lower extremity arteries between the normal and the plaque groups, the plaque and the mild stenosis groups, and the mild and the moderate stenosis groups; but it had high diagnostic value for distinguishing moderate stenosis and the severe stenosis and occlusion. ABI=1.0 was selected at this time to be the cut-off points for diagnosing moderate stenosis and severe stenosis and occlusion, with the sensitivity of 70.7%, the specificity of 94.4%, misdiagnosis rate of 22.0%, and the missed diagnosis rate of 20.0%.(2)For this study, 117 patients were recruited to participate; 55 patients were categorized into the diabetes-only group(33 males, 22 females) and 62 patients were categorized into the diabetes with ischemic stroke group(44 males, 18 females). The ABI for the two groups of patients were 1.09 ± 0.15 and 1.01 ± 0.24 respectively, which was found to be statistically different(P = 0.013). Ba PWV for the two groups of patients were 1646.04 ± 271.95 and 1771.89 ± 300.06 respectively, indicating that the difference in the value of Ba PWV between the groups was statistically significant(P = 0.023). However, there was no statistically significant difference in the ABI’s positive rate(P> 0.05). The logistic regression analyses showed that the ABI and Ba PWV were significantly associated with the incidence of ischemic stroke among patients with type 2 diabetes. We also found that the ABI for the diabetes with ischemic stroke group was significantly lower than that of the diabetes-only group. The Ba PWV for the diabetes with ischemic stroke group was significantly higher than that of the diabetes-only group.Conclusions:Ba PWV could serve as the indicator for evaluating the bilateral lower extremity arterial elasticity, and Ba PWV < 1000cm/s could be treated as the auxiliary diagnostic reference index for diagnosing lower extremity arterial stenosis; ABI could serve as the diagnostic tool for bilateral lower extremity arterial stenosis; and ABI and Ba PWV were the independent predictive factors for ischemic stroke events in patients with type 2 diabetes, respectively.ABI and Ba PWV are independent predictors for ischemic stroke events among patients with type 2 diabetes mellitus. |
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