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|本期目录/Table of Contents|

下肢动脉硬化性闭塞症的早期诊断(PDF)

《中国普外基础与临床杂志》[ISSN:1007-9424/CN:51-1505/R]

期数:
2010年07期
页码:
690-693
栏目:
专题
出版日期:
2010-07-22

文章信息/Info

Title:
 Diagnosis of Arteriosclerosis Obliterans of Lower Extremity in Early Stage
稿件编号:
201007014
作者:
陆京伯;  刘正军;  林智琪
南方医科大学南方医院血管外科（广州 510515）
Author(s):
LU Jing-bo;  LIU Zheng-jun;  LIN Zhi-qi.
 Department of Vascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
关键词:
粥样动脉硬化;  下肢动脉硬化性闭塞症;  早期诊断;  动脉功能检测;  踝肱指数
Keywords:
 ; Atherosclerosis;  Arteriosclerosis obliterans of lower extremity;  Early diagnosis;  Artery detection;  Ankle brachial index
分类号:
R654.4
DOI:
-
文献标识码:
A
摘要:
目的  探讨下肢动脉硬化性闭塞症（ASOLE）的早期诊断方法。
方法 复习国内、外相关文献，对现阶段临床上使用的各种检测手段进行比较。
结果 踝肱指数（ABI）及趾肱指数（TBI）测定可以发现无症状的ASOLE，是评估下肢动脉功能的优良指标; 脉搏波速度（PWV）测定适合大样本的筛查，但其测量值易受多方面因素影响，且其敏感性低于ABI; 动脉弹性指数（ASI）是直接检测动脉结构及功能生物学状态的指标, 与PWV有很好的相关性。流量介导的动脉扩张（FMD）是测量血管内皮细胞功能的指标; 脉搏波测量操作简便、无创、结果灵敏、可靠。彩色多普勒超声具有解剖学定位准确、能够判定管腔狭窄程度等优势; 多层CT血管成像（MSCTA）可精确判断ASOLE的病变部位和范围, 但其固有缺陷也限制了临床应用; 三维动态增强磁共振血管造影安全无创, 但尚须与其他影像学手段相结合以判断血管病变。微循环检测操作简便快捷、无创或微创、灵敏度高，可用于ASO筛查，但对测量环境的一致性要求较高。
结论  加强对高危人群的宣教和筛查及合理选择检测手段，可以提高ASOLE的早期诊断率，对于该疾患的有效防治具有重大临床意义。
Abstract:
Objective   To explore the methods of early diagnosis of arteriosclerosis obliterans of lower extremity (ASOLE). Methods   The related literatures on ASOLE detection means adopted clinically were reviewed, and their advantages and disadvantages were compared.
 Results   Asymptomatic ASOLE could be discovered by determination of ankle brachial index (ABI) and toe brachial index (TBI), which was a good index for arterial function assessment of lower extremity. Pulse wave velocity (PWV) was more vulnerable and less sensitive than ABI, and therefore more suitable for screening of a large sample. ASI was an index to assess arterial structure and function, and it had a good correlation with PWV. Flow-mediated dilation (FMD) was a measurement evaluating the function of endothelial cell; Pulse wave measurement was simple, sensitive, and its result was reliable. Color Doppler ultrasonography could localizate the lesion and determine the degree of stenosis at the same time. Multiple-slice CT angiography (MSCTA) was more accurate than color Doppler ultrasonography, but its inherent shortcomings, such as nephrotoxicity of contrast agent, was still need to be resolved. 3D-contrast enhancement magnetic resonance angiography (CEMRA) had little nephrotoxicity, but a combination of other imaging methods was necessary. Microcirculation detections required high consistency of the measurement environment, but they were simple, sensitive and noninvasive, and therefore could be used for screening of ASO.
Conclusion   Publicity and education of highrisk groups, and reasonable selection of all kinds of detection means, are helpful to improve the early diagnosis of ASOLE.

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备注/Memo

备注/Memo:
 【通讯作者】林智琪，E-mail: linky66@fimmu.com
【作者简介】陆京伯（1972年-），男，江苏省南通市人，博士，主治医师，主要研究方向为下肢动脉硬化闭塞症，Email: luckylu@fimmu.com。
更新日期/Last Update: 2010-07-27